Concussion is a common problem in many sports and recreational pursuits, especially those involving body contact, collisions or high speeds. In general practice, concussive brain injuries may present acutely following head trauma. More commonly, patients present some time after their head injury, either with ongoing symptoms or for medical clearance to allow them to return to play. Clinical management involves confirming the diagnosis, differentiating concussion from structural head injury, estimating the severity of injury and determining when the patient can return safely to competition.
Concussive injuries are common in many sports and
recreational activities, especially those involving body
contact, collisions or high speed. Over the past 8 years,
international experts met on three occasions to address key
issues in the understanding and management of concussion
in sport; most recently in Zurich in November 2008. The
consensus statement produced from this meeting provides
an outline of up-to-date knowledge and best practice
management guidelines on concussion in sport.
The aim of this article is to provide an overview of the key
concepts from the Zurich consensus statement, including an
understanding of concussion and an outline of potential risks
and recommended management as applicable to the general
Concussion is thought to reflect a functional injury to the
brain. Clinical features are typically short lived and resolve
spontaneously, with the majority of affected individuals
recovering within 10–14 days. However, complications can
occur including prolonged symptoms or cognitive deficit,
depression, and cumulative deterioration in brain function.
The potential for adverse outcomes and the absence of
direct measures of recovery following a concussive injury,
make decisions regarding return to play a challenge. Clinical
management includes confirming the diagnosis, differentiating
concussion from structural head injury, estimating the severity
of injury, and determining when the patient can return safely to
competition. Players should return to play in a graded fashion
after clinical features have resolved and cognitive function has
returned to ‘normal’ on neuropsychological testing.
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