International study of video review of concussion in professional sports

Abstract

BackgroundVideo review has become an important tool in professional sporting codes to help sideline identification and management of players with a potential concussion.AimTo assess current practices related to video review of concussion in professional sports internationally, and compare protocols and diagnostic criteria used to identify and manage potential concussions.MethodsCurrent concussion management guidelines from professional national and international sporting codes were reviewed. Specific criteria and definitions of video signs associated with concussion were compared between codes. Rules and regulations adopted across the codes for processes around video review were also assessed.ResultsSix sports with specific diagnostic criteria and definitions for signs of concussion identified on video review participated in this study (Australian football, American football, world rugby, cricket, rugby league and ice hockey). Video signs common to all sports include lying motionless/loss of responsiveness and motor incoordination. The video signs considered by the majority of sports as most predictive of a diagnosis of concussion include motor incoordination, impact seizure, tonic posturing and lying motionless. Regulatory requirements, sideline availability of video, medical expertise of video reviewers and use of spotters differ across sports and geographical boundaries. By and large, these differences reflect a pragmatic approach from each sport, with limited underlying research and development of the video review process in some instances.ConclusionsThe use of video analysis in assisting medical staff with the diagnosis or identification of potential concussion is well established across different sports internationally. The diagnostic criteria used and the expertise of the video review personnel are not clearly established, and research efforts would benefit from a collaborative harmonisation across sporting codes.

Engaging Athletic Trainers in Concussion Detection: Overview of the National Football League ATC Spotter Program, 2011–2017

“…This is certainly an area of needed research as professional athletes will demand high rates of sensitivity and specificity for examinations that may preclude their game participation. The recent international effort led by Davis et al 15 is certainly a valuable empirical step in this direction.…”

International consensus definitions of video signs of concussion in professional sports

“…Senior medical advisers and chief medical officers from major international sporting codes, including the Australian Football League (AFL), Cricket Australia (CA), Major League Baseball (MLB), NFL, NHL, National Rugby League (NRL) and World Rugby (WR), participated in the previous study, 16 and were purposively sampled and invited to participate in this study.…”

“…In the previous study, 16 17 A brief questionnaire was developed and sent out to participants in the current study to assess which video signs were considered to be most useful in the identification of a possible concussion. Consensus was defined as >90% agreement by respondents.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15] In a previous study, the authors examined the use of video review in a number of national and international professional sports. 16 Signs that were found to be common to most international professional sports included lying motionless/loss of responsiveness and motor incoordination. The video signs considered by the majority of sports as most predictive of a diagnosis of SRC included motor incoordination, impact seizure, tonic posturing and lying motionless.…”

“…The video signs considered by the majority of sports as most predictive of a diagnosis of SRC included motor incoordination, impact seizure, tonic posturing and lying motionless. 16 There was no universal consensus however as to the definitions of each of the video signs or how they should be interpreted (ie, which video sign mandated permanent removal from play). Currently, there is minimal evidence on the positive and negative predictive value of the video signs of SRC to guide management decisions.…”