Concussion

This session included presentations on: What is concussion and how do you recognise it at community and age-group levels?; Advances in side-line assessment in the elite game; The role of the general practitioner in diagnosis and managing recovery; How to assess cases where recovery is prolonged or concussions are repeated; How to manage cases where recovery is prolonged – vestibular physio and OT; and A single-sport model for concussion risk management.

Sport-related concussion has a detailed theoretical definition (2017 Concussion in Sport Group) that may result in a wide range of presentations (signs and symptoms). Although it is usually short-lived and resolves spontaneously, signs and symptoms can evolve over minutes to hours in some cases. This can make recognition of concussion difficult. However, the introduction of the World Rugby Head Injury Assessment (HIA) process has greatly improved the recognition of concussion in elite adult rugby. The SCAT5 (Sport concussion assessment tool, 5th edition) should be used to support the clinical assessment at the time of the incident and later. The rule of thumb is always “If in doubt sit them out”. As with other injuries, pitchside assessment is challenging and, hence, diagnosis may often need to confirmed retrospectively by a GP. The GP potentially can play further roles involving recovery advice and review as well as referring complex concussions. A minority of patients develop prolonged symptoms, often involving migraine, vestibular and psychological factors. Accurate assessment and personalised management of the individual is key. Management of multiple concussions requires specialist input and an MDT is useful. Rugby is leading the way with concussion management including awareness and education of players, clear management guidelines for professional and community/age-group level, as well as research on every stage (measurement, recognition, management, long-term health study, prevention).