Global consensus on concussion in sport

An international panel of concussion experts has provided new guidelines on evaluating and treating concussions during sporting events and in clinical settings.

Dr. Willem Meeuwisse, a physician, researcher and leader of the University of Calgary Initiative with the Hotchkiss Brain Institute (HBI), Alberta Children's Hospital Research Institute (ACHRI) and the Faculties of Kinesiology and Medicine, co-chaired an expert panel and co-authored the document entitled "The on Concussion in Sport; the 4th International Conference on Concussion in Sport held in Zurich, November 2012." The paper is being co-published simultaneously today in the April 2013 issue of the , the Clinical Journal of and will appear in a number of other leading biomedical journals.

Fellow University of Calgary researchers Dr. Kathryn Schneider and Dr. Brian Benson were members of the 30-member panel of global concussion experts who answered a number of questions surrounding concussion evaluation, treatment, management and prevention.

The goal was to give physicians, athletic therapists and other an update, based on current research, on the best practices to evaluate and treat concussion during sporting events and in a clinical setting.

"Concussion is one of the most complex injuries to diagnose and treat, and our understanding of concussion is constantly evolving," explains Meeuwisse. "This document attempts to give a roadmap to what we believe will provide the best patient outcomes."

The wide-ranging document begins with a definition of concussion then outlines the consensus agreement on the best way to evaluate, diagnose and manage a possible concussion. The conference has confirmed that no athlete should be allowed to return to play after a concussion or suspected concussion, and goes on to outline an approach to help physicians determine when an athlete might be safe to return to sport.

Surprisingly, the document admits that some of the current treatment protocols – extended rest – are largely unproven and may not be ideal after the first week post-injury. The authors suggest that a gradual (symptom limited) return to school, social and physical activities is "a sensible approach" but that athletes should receive medical clearance from a physician before returning to competition.

A new "Sport Concussion Assessment Tool", 3rd Edition (SCAT3) is also published with the consensus statement to act as a guide in the evaluation of concussion. It is accompanied by a children's version for ages 5-12 , as well as a "Pocket Concussion Recognition Tool" for parents and coaches.

The document also outlines a number of interesting points that will likely generate a lot of discussion. For example, the group declined to make a strong connection between concussion and the development of chronic traumatic encephalopathy (CTE), saying that the group "agreed that a cause and effect relationship has not as yet been demonstrated between CTE and concussions or exposure to contact sports." CTE has been widely linked in the media as the cause of several high-profile athlete suicides, and many are pointing to repeated concussion as the cause of the disorder.

The authors of the consensus document also considered the latest research on helmets and mouth guards, saying that while mouth guards and helmets may protect the athlete from trauma injuries (fractured skull, dental injury, etc.) "There is no good clinical evidence that currently available protective equipment will prevent concussion."

Instead, the group suggested that rule changes aimed at preventing concussion in sport would be a better strategy. Interestingly the group noted that better protective gear often leads to the adoption of more dangerous playing techniques, which they point out "can result in a paradoxical increase in injury rates."

and Brain Injury is one of the four priorities of UCalgary Brain and , a campus-wide initiative that encompasses nine faculties with a strong interest in brain and mental health. Other focus areas include Child and Mental Health, Healthy Brain Aging, and Spinal Cord and Nerve Repair. The Brain and Mental Health initiative is one of six research themes outlined in the university's 2012 Strategic Research Plan, which provides a roadmap for the university's Eyes High strategic direction to become one of Canada's top five research-intensive universities by our 50th anniversary in 2016.

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