3rd International Symposium on Concussion in Sport

Here is a summary of the developments of the 3rd symposium on concussion in sport. This was held in Zurich  and brought together the "big dawgs" in sports concussion. Since this is merely a summary, I ask that you all read the original document in its entirety as well as my summary found at Research Review Service.

Here's the summary:

The 3rd and most recent symposium was based on the need to address issues pertaining to acute simple concussion, return-to-play, complex concussion and long-term issues, pediatric concussion, and future directions.  Additionally, this statement examined and addressed the management issues discussed in the first and second symposia.

• Updated classification of concussion in sport: The use of the terms “simple” and “complex” to classify concussion were abandoned at this symposium.
• Sideline evaluation of acute concussion: While the need for a thorough, post-injury evaluation was established since the first consensus statement, it was agreed that an appropriate medical assessment be performed in all cases and that rule modifications may be necessary in some sports in order for this to occur. Such modifications would enable a proper assessment to be performed without disrupting the game in play (e.g.. rugby) or punishing the team involved (e.g.. soccer).
• Concussion management and same-day return to play: It was recognized that certain settings in adult athletics may have experienced personnel, such as neuropsychologists, and resources (neuroimaging) at their immediate disposal. In such situations, return to play may follow a more rapid process based in part on evidence collected from research in professional football. However, was the conservative treatment of younger athletes (<18 yoa) was strongly suggested.
• Modifying factors: Identified at this symposium were a range of specific modifiers with the potential to complicate cases and therefore, warrant advanced care and attention. Prolonged LOC (> 1 minute) was an example of such a modifier. Gender on the other hand, was reported inconclusive as a modifier; however, sex was accepted as a potential risk factor and/or influence of injury severity. Further, the presence of immediate motor signs and/or convulsions were reported to warrant no more than standard concussion management.
• Children and adolescents: Updating from the previous developments of the Vienna and Prague statements was the statement that the standard evaluation and management recommendations be applicable only to those aged 10 and older. All assessments performed on younger athletes must include age-appropriate symptom checklists. In addition, cognitive testing was recommended to be developmentally sensitive, especially in those presenting with learning disorders and/or ADHD. A more conservative RTP approach was also reiterated in this population.
• Elite athletes: All organized high-risk sports should incorporate these formal baseline neuropsychological screening assessments regardless of age or level of play.
• The sport concussion assessment tool 2 (SCAT2): The original SCAT card was revised and includes a “pocket” SCAT2.

The SCAT2 now boasts four pages of examination resources to aid in the concussion assessment protocol. Specifically, the previously integrated evaluation components have been expanded to its original sources and the SCAT2 now incorporates the Glasgow Coma Scale (GCS), the Modified Maddocks Questionnaire and the Standardized Assessment of Concussion (SAC) as separate entities within. Identified in this tool is its potential use for baseline testing.  The quantification of injury evaluation plays a significant role in the updated SCAT2 and permits the tabulation of an “overall” test score. Unfortunately, however, a definitive “cut-off” score has yet to be determined. Useful though is the ability to isolate and quantify the SAC score for use in the management of a particular concussive event.

A section devoted to balance testing (based on the modified Balance Error Scoring System) was also incorporated. This protocol utilized the double leg, single leg, and tandem stances. A finger-to-nose task was also included to isolate upper limb coordination. Finally, a detachable section on the final page permits the provision of advice to those sustaining a concussive injury.
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...well there you have it. Again, I advise you to read both the document in its entirety as well as my review posted on www.researchreviewservice.com