Clinical challenges in the diagnosis and assessment of sports-related concussion.

Abstract

With growing concerns about long-term complications and expert consensus that premature return to play may increase the risk of adverse outcomes, there has been an increased emphasis on accurate diagnosis and a conservative management approach to concussion in sport.1 The diagnosis and clinical assessment of concussion, however, remains challenging. In addition to the variability in clinical presentation and the absence of a reliable direct biomarker of injury and recovery,2 the evolution of concussion symptoms is unpredictable, complicating the clinical assessment. While some athletes demonstrate the symptoms and signs of concussion immediately following impact, in many the symptoms evolve over minutes, and in some, over days. This is particularly common in younger athletes. Thus, concussion assessment performed too early, or using a single diagnostic modality, frequently fails to accurately diagnose concussion. Consequently, a multimodal approach is currently recommended for the assessment of concussion to maximize the sensitivity of the clinical evaluation.1