2017 Concussion in Sport Group Consensus Statement

The concussion in Sport Group (CISG) consensus statement is designed for physicians and health care professionals who are involved in athlete care and applies to all athletes from recreational to elite. The document is intended to help guide clinical practice and reflects the current research and expert consensus. The following is a few excerpts from the review that we see as clinically relevant. 

The definition: The definition of sport related concussion has been modified as follows:

Sport related concussion (SRC) is a traumatic brain injury induced by biomechanical forces. Several common features that may be utilised in clinically defining the nature of a concussive head injury include:

• SRC may be caused by either direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
• SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptom evolve over a number of minutes to hours.
• SRC may result in neuropathiological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
• SCR results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course.  However, in some cases symptoms may be prolonged. 

Signs and Symptoms: The 2017 CISG has not modified the diagnosis of acute SRC and diagnosis involves the assessment of:

• Symptoms: somatic, cognitive, and /or emotional  lability)
• Physical Signs
• Balance impairment
• Behavioural changes
• Cognitive impairment
• Sleep/wake disturbances

If symptoms or signs in any one or more of the clinical domains are present SRC should be suspected and the appropriate management strategies instituted.

Re-evaluate: the key features of follow up examination should encompass:

• A medical assessment including a comprehensive history and detailed neurological exam including a thorough assessment of mental status, cognitive functioning, sleep/wake disturbances/ocular function/ vestibular function , gait and  balance
• Determination of the clinical status of the patient, including whether there has been improvement or deterioration since the time of injury.
• Determination of the need for emergent neuroimaging to exclude a more severe brain injury

Rest: (less than previously recommended)

Rest is recommended in the acute phase (24-48 hours) and patients are encouraged to become gradually and progressively more active while staying below their cognitive and physical symptom exacerbation thresholds. However, activity should not bring on or worsen symptoms. The exact amount and duration of rest requires further study.

Refer:

Persistent symptoms

The CISG consensus is that the term persistent symptoms’ should be used to reflect the failure of normal clinical recovery.  Symptoms beyond the expected time frame of 10-14 days in adults and greater than 4 weeks in children.

In persistent symptoms treatment should be individualized and target specific medical, physical and psychosocial factors identified on assessment.  Ongoing rest until symptom resolution is not recommended.

Return to activity:  The consensus statement continues to recommend a graduated and stepwise rehabilitation strategy for return to sport.

Return to School:  Children and adolescents should return to school before they return to sport.  However, early symptom- limited activity is deemed appropriate.

For the complete 2017 Consensus Statement on Concussion in Sport, please refer to: McCrory P, et al Br J Sports Med 2017;0:1-10