Concussion – If In Doubt, Sit Them Out

What is concussion?

Concussion is a temporary neurological impairment as a result of impact either directly to the head, or as a transmitted impulsive force to the head, commonly occurring in recreational and competitive sports. Symptoms often develop and change over time, they are highly varied between patients. Common symptoms include headache, drowsiness, balance disturbance, and impaired cognitive function. Most concussions result in only functional disturbance with no observable structural change, a small percentage result in microscopic structural changes, consistent with mild traumatic brain injury.

How can concussion be diagnosed?

Unfortunately, there is no specific diagnostic test for concussion currently. Concussion should be suspected after any head impact sustained as a part of sport or recreation. Immediate signs requiring removal from sport include loss of consciousness, disorientation, balance disturbance, and amnesia. If there is a suspicion of concussion the person should be removed from that environment and either further assessed by a qualified practitioner or prevented from returning to the field of play. In assessing patients with suspected concussions health professionals utilise all elements to the injury; from mechanism of impact, symptom development, to concussion assessment tools such as the SCAT6 to make a diagnosis of concussion.

How do we treat concussion?

Early management relies on removal from the field of play, and a subsequent period of 24-48 hours of mental and physical rest, it is also recommended to avoid certain aggravating factors such as artificial light (e.g. mobile phones, television), loud noises, and alcohol. Once reviewed by a health professional, and the symptoms have resolved, there is a guided, graduated return back into cognitive activities, followed by non-contact training return, until a final clearance by a health professional before returning to any contact activity. The duration of return is guided by symptoms, rather than specific timeframes, and in children under the age of 18, the return is more conservative.

How can we prevent concussion?

There is currently mixed evidence in the use of protective gear in sport to reduce the risk of concussion, the use of soft-shell headgear can reduce the risk in adolescent soccer, but there is no evidence in other sports. The use of mouthguards has reduced the frequency of concussion in ice hockey, but not rugby or other contact sports. Protective gear still plays a role in preventing other injuries such as dental trauma, lacerations, and fractures. Beyond prevention the best management to reduce acute and possible long-term effects is to treat all concussions appropriately with no premature return to sport.

References: AIS: Concussion and Brain Health Position Statement 2024

Pro Medical SA,  Dr Michael Haynes, General Practitioner

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