You don’t have to be a healthcare provider who cares for athletes with concussions, however, to know that the topic of concussions has become a very prominent, and sometimes very controversial topic in our sports- crazy (some might say obsessed) culture. In recent years, you only have to turn on the TV to 60 Minutes or ESPN, or see the front cover of Sports Illustrated or your favorite newspaper to read or hear about a story having to do with sports related concussions.
The 4th International Consensus Statement on Concussion in Sport was just published last month. This statement was written by a group of international experts in sports-related concussions at a meeting held specifically for this purpose in Zurich in November 2012, and is an update from the 3rd Statement written in 2008 (with many of the same authors and also in Zurich).
Why Zurich? The world governing body of soccer (football), FIFA, is headquartered there, and hosted the quadrennial meeting. The first statement was published in 2001 and the second in 2004, known respectively as the Vienna and the Prague concussion statements.
For us sports medicine docs who follow the clinical challenge of concussions closely, we have been eagerly awaiting the publication of this updated statement on concussions, authored by well -regarded experts in this area. While this most recent expert opinion statement does not offer any new definitive treatment or diagnostic test to be used in concussion management—no magic wand or silver bullet is contained within the pages—but it does support what we think we know so far about sports related concussions. Here are a few of the important things for all of us—athletes, coaches, families, healthcare providers—to be on the same page regarding concussions:
- Diagnosing a concussion may be subtle and challenging even for those with experience in the field, and symptoms can vary widely.
- We no longer grade concussions into mild, moderate or severe, or into simple versus complex; there is no such thing as a “mild” concussion, and we treat each concussion as a serious injury.
- No return to play the same day the concussion occurs.
- The person should not return to play while still experiencing any concussion-related symptoms.
- Once symptom-free, the person should gradually return to play in a step-wise progressive fashion, assessing for recurrence of concussion- related signs or symptoms
- Physical and cognitive rest are the current cornerstones of concussion management.
- The optimal evaluation and management of concussions is still evolving.
The 4th International Consensus Statement on Concussion in Sport is not going to have a profound impact on our clinical practice, largely because we are already following many of its recommendations. I do think, however, it is a very important document and useful addition to the medical literature. I would strongly recommend that every healthcare professional involved with athletes and/or sports in some fashion read and review this statement; at the very least it can serve as a clinical touchstone for healthcare professionals who evaluate and manage sports related concussion.
At its best, the statement serves as a thorough and thoughtful practical review of the professional literature on concussions, and a consensus of expert opinion on the known research thus far. The authors are careful to note that this statement is not to be used as a standard of care, nor is it intended as such (and I wholeheartedly agree). The statement is available on the web to athletes, coaches, parents, healthcare professionals, and any interested party: http://bjsm.bmj.com/content/47/5/250.full.
In my next blog posting, I will review and report on another expert consensus statement on the subject of concussion that is due to be published this month by the American Academy of Neurology.
-Gene Hong, M.D.
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