Newswise — An updated consensus statement on assessment and management of concussions in athletes—featuring a "pocket guide" summarizing the immediate evaluation of sport-related head injuries—appears in the March/April 2005 Clinical Journal of Sport Medicine.
The statement summarizes the conclusions of an international panel of sport medicine experts meeting at the 2nd International Conference on Concussion in Sport, held in Prague, Czech Republic, in November, 2004. The symposium was organized by the International Ice Hockey Federation (IIHF) in conjunction with the Federation Internationale de Football (FIFA) and the International Olympic Committee (IOC) Medical Commission. The goal was to present consensus recommendations for use by physicians, trainers, coaches, and others involved in the care of athletes at every level. The new statement also appears in the current issues of The British Journal of Sports Medicine, The Physician and Sportsmedicine, and Neurosurgery.
The Prague Group highlights the importance of classifying concussions according to the quality and timing of recovery after the injury, rather than by previously used injury grading scales. The experts emphasize that the true severity of a concussion can only be determined in hindsight, after all symptoms have cleared and neurological and cognitive status have returned to normal.
Most sport-related concussions resolve completely within 7 to 10 days. Under the new guidelines, these are classified as "simple concussions" and can be managed by a primary care physician or an athletic trainer working under medical supervision. "Complex concussions" are those in which symptoms resolve more slowly or other problems develop, especially in athletes with a history of previous concussions. These injuries warrant evaluation and follow-up by a medical specialist experienced in concussion management.
The statement also includes the Sideline Concussion Assessment Tool, or "SCAT." The SCAT provides simplified information for non-health professionals, focusing on how to identify concussions, what steps to take, and the expected recovery. The opposite side of the SCAT provides a pocket guide to on-the-scene assessment for use by physicians, trainers, or other health professionals.
The Prague Group highlights the importance of preparticipation physical examinations. Preseason examination and testing helps target athletes with previous concussions—particularly important because of the risk of irreversible changes with repeated concussions. Preseason testing also provides baseline data for monitoring recovery should a concussion occur.
If formal testing is impractical, the assessment techniques described on the SCAT can be used as a simple cognitive test. The authors highlight the need for specific tests for cognitive assessment of children and young adolescents, as well as further studies addressing the effects of concussions in children.
The members of the Prague Group hope that their updated statement will serve as a basis for further progress in understanding of sport-related concussions, including their prevention, assessment, and management.
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