Concussion Guidelines Research Articles

Utilisation of New Zealand Rugby's concussion management pathway: A mixed methods investigation.

Concerns around concussion highlight the need for strategies to improve the implementation and translation of concussion guidelines in community sports. This study assessed players' utilisation and compliance with New Zealand Rugby's Concussion Management Pathway (CMP). This pragmatic, mixed methods study comprised of concussion injury surveillance and mapping of players' healthcare touchpoints through the CMP. Semi-structured interviews were conducted to understand stakeholders' experiences. Over the season, 27 different healthcare pathways were identified with 28% of players progressing through all phases of the CMP (ideal pathway). Of the 206 suspected concussions reported over the season, 70% were logged in the CMP phone App, and 89% of these had an associated valid baseline concussion assessment. Prior to returning to contact training, 64% of players obtained a medical clearance. One theme, 'belief in the value of pathway' was identified as a facilitator across all CMP components. Themes such as 'concussion knowledge and the nature of concussion'; 'communication between stakeholders and sufficient information on the process'; and 'strong relationships and clarity around responsibilities' were identified as facilitators across several pathway components. Other facilitators included 'ease and timing of general practitioner access'; 'the phone App as facilitator to logging'; and 'spotting for concussion as a team'. Additionally, the findings signify baseline testing as a potential pre-cursor to overall CMP compliance. Strategies that support the facilitators identified in this study may further enhance compliance.

Return to Play Guidelines in Pediatric Concussion: A Systematic Review of Current Literature.

Pediatric concussions, particularly in youth sports, are a significant public health concern, with up to 18% of children experiencing one by age 17. Return-to-play (RTP) guidelines aim to protect athletes from the adverse effects of repeated injuries, but these protocols vary widely based on factors such as age, sport, and geography. This review synthesizes current literature on RTP guidelines for pediatric concussions to provide evidence-based recommendations. A systematic search of PubMed was conducted using Medical Subject Headings (MeSH) terms "return to play," "pediatric concussion," and "mild traumatic brain injury." Studies published between January 2000 and December 2023 were included if they focused on RTP protocols for children aged 5 to 17. After screening 60 articles, 45 were selected for review. Study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. RTP protocols showed significant variability influenced by age, gender, and sport type. Common themes included initial rest followed by a gradual return to activity. Female athletes generally required longer recovery periods. Multidisciplinary care and early therapeutic interventions, such as vestibular therapy, were associated with better outcomes and faster recovery. There is a need for standardized, evidence-based RTP guidelines to address inconsistencies in concussion management. Future research should focus on creating universally applicable protocols, with attention to gender, sport-specific factors, and early intervention to improve recovery outcomes for young athletes.

Knowledge, attitude, and behaviour around concussion at the FIFA Women's World Cup 2023: part 1 - medical staff.

The objective of this observational cross-sectional study was to assess the knowledge, attitudes and behaviours of medical staff participating in the FIFA Women's World Cup 2023 regarding the assessment and management of concussion in football. Medical staff from 32 teams qualified for the FIFA Women's World Cup 2023 were invited to answer an online survey. Results were analysed descriptively. 47 participants completed the survey. Concussion knowledge: 98% were aware of concussion protocol(s). Most concussive signs or symptoms were recognised, though only 36% of participants (n = 17) correctly reported potential symptom onset time. Knowledge on assessment and return to play elements varied. Attitude: 77% (n = 36) reported being very confident or confident in recognizing a suspected concussion. When assessing a suspected concussion on the pitch, 55% (n = 26) reported to have felt pressured by the player sometimes, very often or always, and 47% (n = 22) by the coaching staff. Behaviour: Among doctors, 70% reported their national team performs baseline concussion assessments. Reported use of on-field assessment elements suggested in concussion guidelines varied between 5% and 95%. In conclusion, most medical staff participating in the FIFA Women's World Cup 2023 were generally knowledgeable about concussion, reported on-pitch and return to play attitudes and behaviours aligning with evidence-based standards for safeguarding players' health. However, gaps were observed in all three domains, compared to guidelines. Expanding education to players and coaching staff is suggested to facilitate the delivery of evidence-based best practice.

An Assessment of Existing Sport-Related Concussion Guidelines in Ireland: The Need for a United Approach.

In 2014, an Irish parliament white paper called for greater addressing of sport-related concussions (SRCs) in Ireland, requesting the adoption of the Concussion in Sport Group's (CISGs) guidelines and greater consistency in SRC return to play (RTP) management. Ten years later, it is unclear how these requests have been addressed. Recently, the United Kingdom's government centralised guidelines to one SRC document for all grassroots sports. This study aimed to investigate all publicly available SRC guidance in Irish sports and national governing bodies (NGBs) to determine if centralised guidelines are warranted. Sport Ireland and the Irish Federation of Sports were searched for all recognised NGBs and sports in Ireland. Websites were searched for any information pertaining to SRCs and data were extracted and collated in Microsoft Excel. In total, 15 of 83 sports and/or NGBs included SRC guidance, nine of which provided RTP protocols. Various iterations of the CISGs guidance and tools were implemented. Several sports with a documented SRC risk had no guidelines present. The findings indicate disjointed and outdated guidance across Irish sport. Additionally, there are sports with a documented concussion risk that have no SRC guidance available. This study provides support for centralised guidelines to be adopted in Irish grassroots sports.

Managing concussion in the real world: Stakeholder perspectives of New Zealand Rugby's concussion management pathway

The potential adverse consequences associated with poor concussion management highlights the need to improve the translation of concussion guidelines into consistent use in real-world sport settings. To facilitate this process, New Zealand Rugby developed a community concussion management pathway to support concussion recognition, diagnosis, and management. This study adopted a pragmatic, descriptive qualitative approach to explore key stakeholders’ perceptions of the concussion management pathway, with the aim to inform policy and practice. Interviews were conducted with 123 participants, including players, parents, coaches, healthcare professionals, and school and provincial union representatives. The framework method was used to analyze data. Themes were organized according to the principles of realist process evaluation that considers contextual factors and mechanisms influencing a program's operation to produce specific outcomes. Contextual factors influencing the concussion management pathway's implementation included governing bodies’ support, existing local resources, general concussion attitudes, or concussion severity. The optimal functioning of the concussion management pathway ( mechanism) was influenced by (i) pathway resources, (ii) roles and relationships, (iii) buy-in and support towards the concussion management pathway, and (iv) diligence and communication. Outcomes identified included (i) hitting the target (optimally managed and enhanced awareness) or (ii) missing the mark (dissatisfaction or management gaps). Overall, participants found the concussion management pathway valuable. However, the acceptability of certain policy-related aspects and the underlying attitudes associated with these perceptions, are some areas requiring further investigation and support. Tailoring programs according to end-users’ perceptions is crucial in developing context-sensitive interventions appropriate for a specific setting. These findings may act as a foundation for investigations of concussion management in other settings.

Concussion assessment and management — What do community-level cricket participants know?

ObjectivesTo explore Australian cricket participants' knowledge of concussion assessment and management, and awareness of current concussion guidelines. DesignCross-sectional survey. MethodsNovel and validated surveys were disseminated online, among over 16 year Australian cricket players and officials at the end of the 2018/19 cricket season. Data were collected on knowledge and awareness of concussion and analysed using descriptive statistics and crosstabulations. Further comparisons were made for the players between injured and non-injured, and helmet wearers and non-helmet wearers using Fisher's exact statistical test. ResultsBoth players (n = 224, 93 %) and officials (n = 36, 100 %) demonstrated strong knowledge of the importance of immediately evaluating suspected concussions. In comparison with players without helmets (n = 11), those using helmets (n = 135) considered replacing their helmets after a concussion to be vital to concussion assessment (p = 0.02). Overall, 80–97 % of players and 81–97 % of officials understood the importance of many factors regarding concussion management. When concussion management knowledge was compared by injury status, injured players (n = 17, 94 %) believed someone with a concussion should be hospitalised immediately, in contrast to non-injured players (n = 154, 69 %) (p = 0.04). Players (63 %) were less aware of concussion guidelines than officials (81 %). ConclusionsOverall, the knowledge of concussion assessment and management was satisfactory. However, there were discrepancies among players on some aspects of awareness of concussion guidelines. Increasing players' familiarity and experience in using the concussion guidelines is warranted. Targeted campaigns are needed to further improve concussion recognition and treatment at community-level cricket, so all participants play a role in making cricket a safe sport.

A-39 A Comparison of Concussion Reporting between the Olympic and Paralympic Games

Abstract Purpose Research has established that the Paralympic Games have a higher injury rate than the Olympic Games, but less is known about how concussion rates may differ between these two populations. Concussions in Paralympic athletes are more difficult to accurately diagnose due to the lack of robust concussion guidelines specific to para athletes. This literature review sought to compare reporting of concussion symptoms and incidence between the Paralympic and Olympic Games since 2010. Data Selection: Searches of Google Scholar, PubMed, and ResearchGate were performed to identify Paralympic and Olympic injury and surveillance study data. Hand-searching citation lists yielded additional results. Articles were included if they reported head injury and/or concussion data. Results Fourteen articles were included that provided injury surveillance study data from 2010 to 2022. Data on head injury and concussion incidence and diagnosis were extracted and reviewed. Between 2010 and 2018, higher concussion rates were reported in Olympic athletes, possibly due to the lack of concussion-specific injury questions for Paralympic athletes. When concussion-specific injury questions for Paralympic athletes were implemented in 2018, data suggests that Paralympic athletes sustained more concussions than Olympic athletes. Additionally, the review suggested potential under-reporting of concussions in Paralympic athletes, despite symptoms, suggesting incidence may be higher than reported. Conclusions Higher concussion rates in the Paralympic Games and possible under-reporting of concussions highlights the need for improved identification and evaluation of concussions in Paralympic athletes. Establishing robust guidelines for the identification, evaluation, and management of concussions for para athletes is critical to increase their safety.

International perspectives on trends in paediatric sports-related concussion: knowledge, management, unanswered questions

PurposeIn the last 20 years, concussion has received increased attention in the media, with distinct recognition of sports-related concussion (SRC). Much of this attention has centred on the paediatric population, due to concerns over adolescent brain development and the high numbers of teenagers playing contact sport. This qualitative study explored (1) what experts in the field of concussion perceive regarding trends in paediatric concussion awareness and management, and (2) how responses to these questions differ by country (US vs. NZ) and by discipline (research vs. sports coaching vs. sports medicine).MethodsAfter the development of a semi-structured interview template, questions were coded for interviews of six (N = 6) experts in academia, medicine, and coaching: three in the United States (N = 3) and three in New Zealand (N = 3). Interviews were then transcribed and qualitatively analysed using a thematic narrative analysis. Emergent themes included concussion knowledge, management, and unanswered questions.ResultsFindings showed general commonalities on the importance of concussion education, the improvement of concussion awareness, compliance to concussion protocols, and the need to research long-term outcomes. Fewer commonalities were found regarding the level of concussion reporting, the impact of multiple concussions, whether paediatric and adult concussion should be treated similarly, and the utility of concussion tests.ConclusionsConcussion experts agree on many areas; however, divergent opinions were apparent. Further original research is required within the paediatric population to analyse the efficacy of current concussion guidelines.

Availability and content of concussion guidelines in Australian combat sports

ObjectivesTo examine the availability and content of publicly available concussion information published by peak amateur and professional combat sport governing bodies in Australia. DesignCross-sectional study; document analysis. MethodsPublicly available concussion information was retrieved from the websites of eleven peak Australian amateur and professional combat sport governing bodies. Data on type of source material, concussion definition, provision of medical services, concussion evaluation, and return-to-sport information were extracted. The quality of the information was assessed using a modified version of the Global Rating Scale. ResultsEight out of eleven combat sport governing bodies provided concussion information in source documents ranging from competition rules to position statements to specific policies. Five governing bodies provided information on post-contest concussion evaluation or testing, four of which mentioned the Sport Concussion Assessment Tool. Eight governing bodies provided information on return-to-sport, of which six stipulated mandatory minimum rest periods and four indicated that athletes should complete a graduated return-to-sport protocol. The provided concussion information was generally of low quality, with a median score of 3 out of 9 (range: 1–4). ConclusionsThere is substantial scope and an urgent need for improving concussion guidelines across peak combat sport governing bodies in Australia to improve the health and safety of their athletes.

A Knowledge Translation Framework for Improving Concussion Education Among Medical Students and Physicians

Objective: The objective of this paper is to outline key principles required for a knowledge translation (KT) strategy on concussion education for medical trainees and physicians to promote knowledge retention and practice change. Design: Qualitative review of the literature on concussion education for medical trainees and physicians utilizing the Canadian Institute of Health Research (CIHR) Knowledge to Action (KTA) Cycle as a framework. Results: Medical education on concussion appears to be increasing, but many knowledge gaps persist. Although many concussion guidelines and standardized assessments have been developed, many physicians are either not aware of them, do not use them, or provide inaccurate or inconsistent discharge instructions. Focused, interactive concussion education sessions, education outreach by trained facilitators, and adoption of a spiral curriculum are preferred modalities. To facilitate concussion education, medical professionals must recognize the importance of concussion in their practice. Interventions should deliver high-yield information and be integrated into existing programs such as academic half days (AHD) and the Maintenance of Certification Program (MOC). Many KT tools and interventions have been developed, such as the Concussion Awareness Training Tool (CATT) for Medical Professionals, but evidence of their utilization and effectiveness is limited. Existing tools should be reviewed, updated, implemented, and evaluated for their effectiveness of improving both conceptual and instrumental knowledge. Conclusion: KT strategies for concussion medical education should utilize the CIHR KTA Cycle principles outlined in this review as a guide to design interventions that improve the concussion knowledge of medical trainees and physicians.

Misdiagnosis of Pediatric Concussions in the Emergency Department: A Retrospective Study.

We aimed to determine the rate and predictors of correctly diagnosed concussions in the pediatric emergency department and to describe the characteristics, presentation, and management of concussions in children presenting for minor head injury. We included 186 patients aged 5 to 18 years presenting within 24 hours of minor head injuries and met our diagnostic criteria for concussion. We compared patients correctly diagnosed with a concussion with those who were not. Our main outcome was the rate and predictors of misdiagnoses. Of the patients, 5.4% were correctly diagnosed. Amnesia was the only variable associated with correct diagnoses (40.0% vs 10.2%, P = 0.02). The most common mechanism of injury was fall (8.4%); the most frequent symptoms were nausea/vomiting (42.5%), and 48.4% had a brain computed tomography scan done. The high rate of concussion misdiagnosis puts into question the usability of current concussion guidelines, their accuracy, and barriers to translation into clinical practice.

A Scoping Review of Concussion Guidelines in Amateur Sports in the United Kingdom.

Objectives To investigate which United Kingdom (UK) amateur sporting organisations have published sports-related concussion (SRC) guidelines, their accessibility and the extent to which they follow the Berlin statement recommendations. This article is targeted at those involved with designing and implementing SRC guidelines in amateur sport. Design Scoping Review. Data Sources The SRC guidelines of 15 sporting organisations were accessed through public materials available from the official organisation website. Eligibility Criteria: To be included in this review, sports must enjoy broad participation by UK amateur athletes with a high risk of athletes sustaining an SRC. Results: 15 sporting organisations were included in this review with two, British Cycling and British Eventing, found not to have published SRC guidelines. There was found to be a large discrepancy between the extent to which the sport-specific guides followed the Berlin statement recommendations. Conclusions: The large discrepancy between the contents of the SRC guidelines may be putting the health of athletes at risk. We recommend the UK government publish standardised concussion guidelines based on the latest scientific research that must be used by all UK amateur sport groups.

Top cited articles in concussion: A bibliometric analysis of the state of the science

Objective Citation analyses identify the most-cited publications in a given field, which aids in understanding areas of the literature that are well-developed and those where additional research is required. Our objective was to perform a citation analysis in concussion to understand the state of the science from a bibliometric perspective. Design We performed a keyword search for articles related to concussion in Harzing's Publish or Perish, which scrapes Google Scholar for citation metrics. This approach was used to identify the 50 articles with the most lifetime citations as well as the 50 articles with the highest citation rate. Main outcome measures Citations and citation rates. Results Per our citation analysis, we found that concussion guidelines are among the most cited publications (comprising ≥20% of each citation cohort), yet there is a dearth of widely cited clinical trials to inform them; only one randomized trial (studying the effects of rest following concussion) was included in our citation analysis. The majority of study designs (≥40% of each citation cohort) were cross-sectional. Concussion recovery and secondary complications of concussion were common study topics, with ≥20% of publications in each citation cohort focused on these issues. The publications included in our analysis were authored by 596 authors from only 12 countries, suggesting a lack of global representation in concussion research. Conclusions Existing reviews and consensus statements have called for additional, high-quality research in concussion; our citation analysis quantifies this need. Further, although concussion is a global problem with its incidence and burden increasing in the developing world, our citation analysis demonstrates that the most-cited and discussed articles in concussion are published by authors from only 12 countries. Going forward, to address the global problem that is concussion, a more global research perspective is called for.

Availability and content of concussion guidelines in Australian combat sports

Introduction: Sport-related concussion continues to receive frequent and widespread media coverage. Sport governing bodies are facing increased pressure to improve athlete safety, but they have responded in diverse ways, from taking little or no action to developing and implementing comprehensive guidelines for evaluating and managing sport-related concussion. Despite the relatively high risk of concussion in full-contact combat sports, the status quo of concussion guidelines among combat sport governing bodies in Australia is unknown.

Athletic Administrators' Reporting of Emergency Preparedness Regarding Policies and Procedures in Iowa Secondary Schools.

Secondary schools that offer school-sponsored athletic events should follow best-practice guidelines to provide policies that promote student health and safety. To assess emergency preparedness from the perspective of athletic administrators (AAs) in Iowa secondary schools. Cross-sectional study. Online survey. Ninety-eight AAs from Iowa completed the survey (age = 45.33 ± 10.22 years, years as an AA = 9.37 ± 8.14, years in current role = 7.72 ± 7.09). The 6-section survey contained with questions about access to athletic trainers (ATs), emergency action plans (EAPs), cardiopulmonary resuscitation (CPR), automated external defibrillators (AEDs), concussions, heat illness, and other general policies. Descriptive statistics (percentages and frequencies) were reported. Relative risk was calculated to compare schools with and those without access to ATs (P < .05). Most respondents (76.5%, n = 75/98) reported their school had access to a licensed AT. The majority had a written EAP (83.3%, n = 70/84), but fewer than half (39.2%, n = 31/79) reviewed it annually and fewer than 10% (n = 6/85) reported practicing it each year. All respondents (100%, N = 78/78) stated they had an AED on campus. All respondents (N = 77/77) indicated that they were familiar with the Iowa High School Athletic Association's (IHSAA's) concussion policy and had a concussion guideline in place. Many respondents (95.9%, n = 71/74) described being familiar with the IHSAA's heat illness policy, but more than half (62.1%, n = 41/66) noted they did not have a heat illness policy in place at their school. Most respondents indicated their school had access to ATs, followed the state-mandated concussion guidelines, and had an AED. Although participants reported having written EAPs in place, levels of annual EAP review and practice were low. These results suggest that schools would benefit from educational opportunities to improve safety policies.

A cross-sectional study reporting concussion exposure, assessment and management in Western Australian general practice

BackgroundGeneral Practitioners (GPs) may be called upon to assess patients who have sustained a concussion despite limited information being available at this assessment. Information relating to how concussion is actually being assessed and managed in General Practice is scarce. This study aimed to identify characteristics of current Western Australian (WA) GP exposure to patients with concussion, factors associated with GPs’ knowledge of concussion, confidence of GPs in diagnosing and managing patients with concussion, typical referral practices and familiarity of GPs with guidelines.MethodsIn this cross-sectional study, GPs in WA were recruited via the RACGP WA newsletter and shareGP and the consented GPs completed an electronic survey. Associations were performed using Chi-squared tests or Fisher’s Exact test.ResultsSixty-six GPs in WA responded to the survey (response rate = 1.7%). Demographics, usual practice, knowledge, confidence, identification of prolonged recovery as well as guideline and resource awareness of GPs who practised in regional and metropolitan areas were comparable (p > 0.05). Characteristics of GPs were similar between those who identified all symptoms of concussion and distractors correctly and those who did not (p > 0.05). However, 84% of the respondents who had never heard of concussion guidelines were less likely to answer all symptoms and distractors correctly (p = 0.039). Whilst 78% of the GPs who were confident in their diagnoses had heard of guidelines (p = 0.029), confidence in managing concussion was not significantly associated with GPs exposure to guidelines. It should be noted that none of the respondents correctly identified signs of concussion and excluded the distractors.ConclusionsKnowledge surrounding concussion guidelines, diagnosis and management varied across GPs in WA. Promotion of available concussion guidelines may assist GPs who lack confidence in making a diagnosis. The lack of association between GPs exposure to guidelines and confidence managing concussion highlights that concussion management may be an area where GPs could benefit from additional education and support.

Sport-related concussion practices of medical team staff in elite football in the United Kingdom, a pilot study

ABSTRACT Objectives To explore sport-related concussion (SRC) awareness, behaviours, and attitudes of medical team staff working in elite football in the United Kingdom. Including usage and awareness of the FA concussion guidelines, concussion education rates of players and coaching staff, and collection of baseline concussion assessments. Methods Cross-sectional questionnaire study distributed online by organisations including or representing medical staff working in elite football in the United Kingdom. Results 120 responses were gathered. High awareness rates of the FA guidelines were found (97%) with variable rates of player and coaching staff concussion education. Baseline concussion assessments were collected by 78%. Of those, 99% collected SCAT5 with low rates of other neuro-psychometric testing (17%). Confidence of pitch-side SRC recognition was high (93% feeling very confident or confident). Introduction of a ‘concussion’ substitute was seen as strongly positive for player welfare (85% strongly agreeing or agreeing). Conclusions Awareness of FA concussion guidelines, and collection of SCAT5 baseline testing was high. Player and coaching staff concussion education rates were low, as was the use of neuro-psychometric testing beyond the use of the SCAT5. There was strong support the introduction of a ‘concussion’ substitute being a positive thing for player welfare.

Frequent but limited assessment of potentially concussed players in Gaelic Football: an opportunity to learn from other sports.

Sport-related concussion (SRC) is a potential issue within Gaelic Football. Therefore, it is essential that concussion management guidelines are adhered to. The aim of this study is to determine if potential concussive events (PCEs) in the Gaelic Athletic Association (GAA) National Football League (NFL) are assessed in accordance with GAA concussion guidelines and compare this to other sports. A descriptive video analysis approach was undertaken to identify PCEs throughout two seasons of play. Subsequent assessment, return to play (RTP) decisions, and signs of concussion were evaluated. A total of 242 PCEs were identified over 111 matches. Most PCEs (87.2%, n = 211) were assessed by medical personnel. However, 187 (88.6%) of assessments were under 2 min in duration. Of the 242 PCEs, 189 (78.1%) returned to play after on-pitch assessment, and 12 (5.0%) were removed following a PCE. Sixty-one (25.2%) players sustaining a PCE demonstrated one or more signs of concussion, of which 9 (14.8%) were removed from play. In the GAA NFL, PCEs are often briefly assessed but rarely result in player removal. Introduction of video incident analysis and concussion substitutions, as in other sports, may reduce the long-term burden of SRC on Gaelic Football players.

Community-Engaged Approach to the Development and Implementation of a Student-Centered Return to Learn Care Plan After Concussion.

Current return to learn (RTL) after concussion guidelines lack specificity for individualized student care, limiting potential for adoption and implementation. We used a community-engaged research framework to develop and evaluate the implementation of a student-centered care plan that assists school personnel in facilitating RTL. We used best-practice RTL guidelines and input from administrators and medical experts to iteratively develop a flexible student-centered care plan. Thirteen schools participated. Coding completion of care plans indicated feasibility and fidelity; interviews with RTL coordinators indicated acceptability. The care plan includes educational materials, symptom checklists, and guidelines for classroom adjustments linked to student symptoms. Care plans were initiated for 24 (70.6%) of 34 students with concussions, indicating feasibility. Fidelity was high, with the following subsections completed: Action Checklist (90%), Symptom Evaluation (91%), Temporary Adjustment Recommendations (95%). Qualitative analysis of interviews suggested care plans were acceptable and facilitate consistent communication, prioritization of individual needs of students, and increased ability to delegate tasks to other school staff. Implementation of a student-centered, individually tailored care plan for RTL is feasible and acceptable in public high schools. Future research should examine how to expediently initiate student-centered concussion care plans after diagnosis to optimize recovery.

Commentary: Concussion Guidelines in National and International Professional and Elite Sports.

Commentary: Concussion Guidelines in National and International Professional and Elite Sports.