Concussion in Sport: Recommendations From the 6th International Conference on Concussion in Sport

A sports-related concussion is an impact to the head, neck, or body during sport or exercise that results in a temporary loss of normal brain function but does not demonstrate any abnormality on neuroimaging. The Concussion in Sport Group created the 6th International Conference on Concussion in Sport consensus statement to provide updated recommendations on concussion care for athletes at any level of sport.

In several sports, specific policies have reduced concussion risk. In American football, policies decreasing the frequency, duration, and intensity of contact and collisions in practice reduced concussions by 64%. In youth ice hockey, prohibiting bodychecking decreased concussion by 58% and requiring mouthguards reduced concussions by 28%. Participating in an on-field neuromuscular training warm-up program three times a week in rugby is associated with lower concussion rates.

Players who exhibit loss of consciousness, seizure, tonic posturing, ataxia, poor balance, confusion, behavioral changes, or amnesia should be removed immediately from the field of play. Players with these symptoms may have a concussion or other injury that warrants further assessment.

For evaluation, the Sport Concussion Assessment Tool (SCAT6) can be used for adolescents 13 years or older and adults. Children 8 to 12 years of age can be evaluated using the Child SCAT6. The assessments are more accurate when used within 72 hours of the incident, take at least 10 minutes to complete, and are preferably done in a quiet area. When a concussion is suspected or diagnosed, the athlete should be repeatedly reevaluated because symptoms and signs may evolve with time.

When assessing a sports-related concussion in the office, the Sport Concussion Office Assessment Tool (SCOAT6) is recommended for adolescents 13 years or older and adults, or the Child SCOAT6 for children 8 to 12 years of age. These tools can be used to identify specific deficits and to guide individual management. They may be used as the initial assessment or as a comparison to the SCAT6 or Child SCAT6 and be repeated to monitor recovery progress.

The SCOAT6 and Child SCOAT6 tools include history of concussions (including management and recovery time), mental health history, and preexisting headache disorders, because these can be exacerbated by concussion and may require additional evaluation and treatment. Both tools evaluate global symptoms, cognition, vestibulo-ocular disturbances, cervical or neurologic complications, autonomic dysfunction, balance, sleep, anxiety, depression, graded aerobic exercise test results, and possibly computerized cognitive test results. Specific recommended testing includes 10-word immediate recall, backward digit testing (repeating three number sets in reverse order), and orthostatic blood pressure and heart rate testing. Neurocognitive and computer-based tests may be helpful in discerning severe concussion but are not useful in isolation to dictate clinical decisions.