Consensus Statement on Concussion in Sport - The 3 rd International Conference on Concussion in Sport Held in Zurich, November 2008

Postconcussive impairment differences across a multifaceted concussion assessment protocol

OBJECTIVE

To examine the proportion of athletes with concussion and with impairment disagreements across various clinical concussion assessment measures.

DESIGN

Quasi-experimental repeated measures design.

SETTING

Clinical research laboratory.

PARTICIPANTS

A sample of 100 collegiate-aged athletes participated in the study (mean [SD] age, 18.5 ± 1.1 years; mean [SD] height, 180.6 ± 9.9 cm; mean [SD] weight, 84.1 ± 20.6 kg). METHODS OR INTERVENTIONS: Participants completed preseason baseline and postconcussive injury assessments on a clinical assessment battery, including a 17-item graded symptom checklist, a computerized neurocognitive assessment, and a balance performance assessment.

MAIN OUTCOME MEASUREMENTS

Symptom severity total score, 8 cognitive domain scores from the Automated Neuropsychological Assessment Metrics, and the composite balance score obtained from the Sensory Organization Test served as outcome measures for the study. McNemar tests of paired proportions were then used to analyze impairment disagreements (where one measure identified impairments not identified by the other) between the study outcome measures. The α level was set to .05 a priori.

RESULTS

We observed significant disagreements between symptom severity total scores, and all other measures used in the study in which symptom severity total scores identified more impairments than all other measures. In addition, we observed significant disagreements for half of the clinical measures used in the study, with disagreement proportions that ranged from 22%-52%.

CONCLUSIONS

Our study underscores the importance of using a multifaceted approach for management of concussion that includes assessment of symptom severity, cognitive function, and balance. Use of this multifaceted approach also can aid clinicians in understanding other comorbidities that may complicate the management of concussion.

Return-to-play decisions

Concussions occur as a result of forces directed to the head or neck, or from impulsive forces transmitted from the body to the head. They result in the rapid onset and spontaneous recovery of short-lived impairment of neurologic function. Concussions represent a functional, rather than structural, disturbance, and do not result in abnormalities on standard structural imaging. This article discusses a comprehensive approach to return to play in sports concussion, including managing athletes returning after prolonged postconcussion syndrome, multiple concussions, and intracranial hematomas and craniotomy.

The current status of postconcussion syndrome

PURPOSE OF REVIEW

Concussion produces a brief disruption in mental status and is associated with a variety of physical and cognitive symptoms which typically diminish during the first several days to weeks posttrauma. This review highlights problems in defining and measuring concussion, the mildest form of traumatic brain injury (TBI). Furthermore, the 'natural' course of recovery correlates of postconcussion syndrome (PCS) and guidelines for clinical management are discussed.

RECENT FINDINGS

Traditional measures of TBI severity (e.g. length of loss of consciousness or period of posttraumatic amnesia) do not correlate with persistent concussion symptoms. Abnormal eye movements, cerebrovascular disturbances, extra-axial injuries, alcohol intoxication at time of injury, and presence of an axis I disorder are associated with persistent symptoms. Early management of physical, cognitive, and emotional symptoms following concussion may reduce long-term morbidity. Techniques used to help concussed athletes return to play appear useful when evaluating and treating concussion in nonathletes.

SUMMARY

The study of concussion and PCS has increased significantly over the past 10 years, with recent research supporting an underlying biological cause for initial symptomatology. Persistent symptoms may be associated with both neurological and non-neurological variables. Early and serial monitoring and treatment of symptoms appears to result in substantial improvement in the vast majority of concussed patients.