Return to Sports Following Sports-Related Concussion in Collision Sports: An Expert Consensus Statement Using the Modified Delphi Technique

Abstract

The purpose of this study was to perform a Delphi consensus for return to sports (RTS) following sports related concussion (SRC). Open-ended questions in rounds 1 and 2 were answered. The results of the first two rounds were used to develop a Likert style questionnaire for round 3. If agreement at round 3 was <80% for an item, if panel members were outside consensus or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%. Individualized graduated RTS protocols should be used. A normal clinical, ocular and balance examination with no more headaches and asymptomatic exertional test allows RTS. Earlier RTS can be considered if athletes are symptom free. SCAT5 and VOMS are recognized as useful tools to assist in decision making. Ultimately RTS is a clinical decision. Baseline assessments should be performed at both collegiate and professional level and a combination of neurocognitive and clinical tests should be used. A specific number of recurrent concussions for season - or career ending decisions could not be determined but will affect decision making for RTS. Consensus was achieved for 10 of the 25 RTS criteria: early RTS can be considered earlier than 48-72 hours if athletes are completely symptom-free with no headaches, a normal clinical, ocular and balance examination. A graduated RTS should be utilized but should be individualized. Only two of the nine assessment tools were considered to be useful: SCAT5 and VOMS. RTS is mainly a clinical decision. Only 31% of the baseline assessment items achieved consensus: baseline assessments should be performed at collegiate and professional levels using a combination of neurocognitive and clinical tests. The panel disagreed on the number of recurrent concussions that should be season- or career ending.