American Medical Society for Sports Medicine Position Statement on Concussion in Sport

Abstract

Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment, and management of SRC. In addition to a growing need for knowledgeable health care professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. The American Medical Society for Sports Medicine formed a writing group to review the existing literature on SRC, update its previous position statement, 1 and address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology, and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short- and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The American Medical Society for Sports Medicine is committed to best clinical practices, evidence-based research, and educational initiatives that positively impact the health and safety of athletes.

Concussion in Sports

“…The wider public health implications of improving sports safety and encouraging developmentally suitable participation among youth and adolescents are particularly important long-term benefits of research in SRC [38]. Sports medicine physicians are frequently involved in the care of patients with sports concussion and should specially be trained to provide care along the continuum of sports concussion from the site where acute injury occurred to the return-to-play (RTP) decision moment [4,39]. In fact, recently, in the USA, in certain sports disciplines such as football, sports medicine physicians and specialists of concussion are even present on the playground just to assess on-the-field diagnosis of athletes suspected to have experienced a concussion [40].…”

“…It has been stated that concussive head injury could be typically recognized by a rapid onset of spontaneously resolving neurological impairment accompanied, at the molecular level, by alterations of various cellular functions rather than by structural damages. [2,[4][5][6]. Athletes, particularly those who practice contact sports, are more prone than non-athletes to sustaining concussions.…”

Brain Connectivity and Behaviour in Post-Concussion Syndrome: A Scoping Review Protocol

“…Although most people who have experienced a concussion recover within weeks to months, in 10-15% of patients, symptoms including physical (e.g., headache, dizziness, fatigue), cognitive (e.g., memory issues, di culty concentrating) and emotional (e.g., anxiety, depression) may persist longer than 3 months, which is referred to as Post-Concussion Syndrome (PCS). [8][9][10] The 2016 Berlin Consensus Statement on Concussion in Sport de nes persistent post-concussive symptoms as having complaints longer than normal recovery time, which is estimated to be 10-14 days in adults and 4 weeks in children. 5 This is mostly accepted in literature related to contact sports.…”

Athletic Injuries

“…Concussions are defined as a traumatically induced transient disturbance of brain function resulting from either direct trauma or indirect forces to the face, head, or neck [4]. In the United States, over 1 million pediatric sports-related concussions occur yearly: 400,000 of these in high school athletes [5]. Symptom presentation can include a wide variety of complaints including headache, balance disturbances, retrograde amnesia, nausea, photophobia, phonophobia, visual tracking issues, slow cognition, mood changes, sleep disorders, concentration issues, confusion, dizziness, and possible loss of consciousness.…”

“…Symptom presentation can include a wide variety of complaints including headache, balance disturbances, retrograde amnesia, nausea, photophobia, phonophobia, visual tracking issues, slow cognition, mood changes, sleep disorders, concentration issues, confusion, dizziness, and possible loss of consciousness. Typically, symptoms begin immediately after the injury but can be delayed for up to 72 h. For adult patients, the majority of symptoms will resolve spontaneously within 14 days of injury; however, pediatric and adolescent patients may have prolonged symptoms lasting up to 4 weeks [5].…”