Champlain Primary Care Digest

Home » Brain Injury » Concussion Update 2017

Concussion Update 2017

In October 2016, world leaders in the field of sport-related concussion (SRC), of which a large proportion are Canadian, met in Berlin to develop the latest statement on our current knowledge of the science of SRC. As a quick review, an SRC is a traumatic brain injury induced by biomechanical force transmitted to head causing functional disturbance. It does not require a direct blow to the head. Some of the new developments and highlights from the statement include:

Office evaluation

–        Assessment of mental status, cognitive functioning, sleep/wake disturbance, ocular function, vestibular function, gait, and balance is recommended

–        Insufficient evidence for investigations such as EEG or MRI

–        A new Sports Concussion Assessment Tool Version 5 (SCAT) was developed

Management

–        A brief period (24–48 hours) of cognitive and physical rest is appropriate for most patients

–        Subsymptom threshold activities and submaximal exercise are encouraged (as long as symptoms are not exacerbated)

–        Cervical spine rehab is recommended for neck pain/headaches

–        Vestibular rehab is recommended for dizziness

–        Return-to-play and return-to-school/work protocols can advance in parallel

–        Children and adolescents should not return to sport until they have successfully returned to school

–        Physiological dysfunction may be delayed relative to clinical recovery, suggesting that using a ‘buffer zone’ of a graduated return to activity/return to play progression before full return to contact risk may be appropriate

Prognosis

–        Preinjury mental health problems and prior concussions appear to be risk factors for persistent symptoms.

–        Greater acute and subacute symptoms are a consistent predictor of worse clinical outcome.

–        The teenage years might be a particularly vulnerable time for having persistent symptoms—with greater risk for girls than boys.

Prevention

–        Strongest evidence exists for disallowing body checking in youth ice hockey

–        Strong recommendations to mandate helmet use in skiing/snowboarding

–        Mixed evidence for mouthguard but there may be an overall protective effect

The top 5 key messages from the 5th International Consensus Statement on Concussion in Sport
See: 5-key-messages-from-Berlin_ENG.pdf

Reference

  1. McCrory P, Meeuwisse W, Dvořák J, et al. Consensus statement on concussion in sport—the 5thinternational conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 2017;51:838-847.

 

  1. Shields, MD, CCFP, Sport and Exercise Medicine Fellow, University of Ottawa

Advisor: Taryn Taylor, MD, CCFP (SEM), Dip Sport Med

 


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

w

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this: