Mild TBI in sport

Introduction

Concussion is a mild traumatic brain injury.

It causes short-lived neurological impairment and the symptoms may evolve over the hours or days following the injury.

Recognising concussion can be difficult. The symptoms and signs are variable, non-specific and may be subtle. Onlookers should suspect concussion when an injury results in a knock to the head or body that transmits a force to the head. A hard knock is not required, concussion can occur from relatively minor knocks.

Children and adolescents take longer to recover from concussion. They should be advised to wait a minimum of 14 days from when symptoms cease before returning to full contact/collision activities (after medical clearance).

Key points for Coaches, parents and athletes

1. Concussion is a type of brain injury that occurs from a knock to head or body.
2. Recognising concussion is critical to ensure appropriate management and prevention of further injury.
3. The Concussion Recognition Tool 5 (CRT5) is recommended to help recognise the signs and symptoms of concussion. This can be freely downloaded at bjsm.bmj.com/content/bjsports/early/2017/04/26/ bjsports-2017-097508CRT5.full.pdf
4. First aid principles apply in the management of the athlete with suspected concussion. This includes observing first aid principles for protection of the cervical spine.
5. Any athlete suspected of having concussion should be removed from sport and not allowed to return to sport that day. This athlete should be reviewed by a medical practitioner.
6. Features that suggest more serious injury and should prompt immediate emergency department referral include neck pain, increased confusion, agitation or irritability, repeated vomiting, seizure, weakness or tingling/ burning in the arms or legs, reduced level of consciousness, severe or increasing headache, or unusual behaviour.
7. When assessing a patient with suspected concussion, a medical practitioner will ask about details of the event as well as past medical history and then assess the patient including asking about symptoms, signs, testing memory function and concentration, balance and neurological function.
8. There is no single test that can determine whether someone has sustained a concussion, your doctor may not order blood tests or medical imaging unless they wish to exclude other more serious injuries.
9. Once a diagnosis of concussion has been confirmed the main treatment for concussion is rest. After 24 – 48 hours of rest, moderate intensity physical activity is allowed as long as such activity does not cause a significant and sustained deterioration in symptoms.
10. The activity phase should proceed as outlined below with a minimum of 24 hours spent at each level. The activity should only be upgraded if there has been no recurrence of symptoms during that time. If this occurs there should be a ‘step down’ to the previous level for at least 24 hours (after symptoms have resolved):
1. light aerobic activity (at an intensity that can easily be maintained whilst having a conversation), until symptom-free
2. basic sport-specific drills which are non-contact and with no head impact
3. more complex sport-specific drills without contact (may add resistance training)
4. full contact practice following medical review
5. normal competitive sporting activity.

1. Children and adolescents take longer to recover from concussion. They should be advised to wait a minimum of 14 days from when symptoms cease before returning to full contact/collision activities (after medical clearance).
2. The long-term consequences of concussion, and especially multiple concussions, are not yet clearly understood.
3. If in doubt, sit them out.