Sports related concussion - management in general practice

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 practice setting.

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.