Treatment of concussion:guidelines for Salt Lake City and beyond
On November 2 and 3, 2001, the first International Symposium on Concussion in Sport was held in Vienna, Austria. This symposium, organized by the Medical Commission of the International Olympic Committee (IOC), the International Ice Hockey Federation (IIHF), and the Federation Internationale de Football Association Medical Assessment and Research Centre (FIFA, F-MARC), was designed to provide recommendations addressing this important topic for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, football (soccer) and other sports.
At the conclusion of the symposium, a representative group of the faculty, now identified as the "Concussion in Sport (CIS) Group", were given a mandate by the organizing bodies to develop a document by the end of the 2001, describing the agreed position reached by the group and to move forward as a concussion working group toward the advancement of knowledge in this field.
The working members of the CIS Group include Karen Johnston (Chair), Mark Aubry, Robert Cantu, Jiri Dvorak, Toni Graf-Baumann, James Kelly, Mark Lovell, Paul McCrory, Willem Meeuwisse and Patrick Schamasch. The establishment of this group is an unprecedented step forward toward understanding and managing this injury.
The detailed document, scheduled to be published simultaneously in the British Journal of Sport Medicine and the Clinical Journal of Sport Medicine and Physician in February 2002, identifies seven main points including guidelines for identification, grading, testing, rehabilitation and return-to-play protocol for the health and safety of any athlete. The document has been developed for use by doctors, therapists, health professionals and coaches, with the intention of introducing these recommendations at the Olympic Winter Games 2002.
Chair and spokesperson for the CIS Group, Dr. Karen Johnston, commented on the work and progress made by this symposium: "This effort on the part of the endorsing organizations represents a significant achievement in the field of concussion and offers profound advancement in care for the concussed athlete."
The positive result of this first cooperative effort between the CIS Group and sport bodies, combined with the understanding that concussion research is a continuous and relentless work in progress, suggests it may be advisable to convene future meetings so that sport may maintain access to the latest medical guidance to deal with the serious problem of head injuries in competition.
Please see the following containing highlights from the document scheduled for publication in February 2002.
TREATMENT OF CONCUSSION:
GUIDELINES FOR SALT LAKE CITY AND BEYOND
The following are highlights of the seven main points from the paper developed by the CIS Group:
1. Concussion Protocol:
A comprehensive approach to concussion is developed through a concussion protocol. The concussion in sport protocol includes:
1. Clinical history
3. Neuropsychological testing
4. Imaging procedures
5. Research methods
6. Management and rehabilitation
9. Future directions
10. Medico legal considerations
2. Definition of Concussion:
The CISG has revised the definition of concussion that was written over 35 years ago
3. Concussion Grading Scales:
The Concussion in Sport (CIS) Group recognized the strengths and weaknesses of several existing concussion grading scales that attempt to characterize injury severity but no single system was endorsed.. It was the recommendation of the Group that combined measures of recovery (identified in the document) should be utilised to assess injury severity (and/or prognosis) and hence individually guide return to play decisions.
4. Neuropsychological Testing:
The consensus of the CIS Group was that neuropsychological testing is one of the cornerstones of concussion evaluation and contributes significantly to both understanding of the injury and management of the individual. Organized sport federations have access to and should attempt to employ such testing as appropriate. To maximize the clinical utility of such neuropsychological assessment, baseline testing is recommended.
Research is vital in contributing to the science of concussion and will potentially provide valuable information for such important issues as clinical management, return to play guidelines and long term outcome. Therefore research should be continued and encouraged by sporting organizations.
a. Acute Response
When a player shows ANY symptoms or signs of a concussion:
1. The player should not be allowed to return to play in the current game or practice.
2. The player should not be left alone; and regular monitoring for deterioration is essenti