PITCHSIDE MANAGEMENT CONCUSSION IN SPORT

Although concussion falls within the category of minor head injury the conse- quences can be serious, particularly if the diagnosis is missed and the player is subjected to further head trauma while still suffering from post-concussion symptoms.

Players with concussion and post-concussion problems do not only present themselves to doctors and physiotherapists attending sports events. They and other recreational sports players may turn up at GP surgeries and primary care out-of-hours centres following minor head injuries sustained during play be it competitive or just a friendly kick-around in the park.

concussion ● Headaches ● Dizziness ● Blurred vision ● Nausea Different forces to the brain will produce different clinical pictures. Studies have shown that linear acceleration/decelera- tion forces are commonly associated with loss of consciousness (LOC).

Common symptoms of D

DEFINITION

Concussion is best defined as a transient and reversible distur- bance of neurological function caused by an external force, which may or may not involve loss of consciousness.

Table 1 Initial on-field assessment Danger

R A

While rota-

tional forces are associated with partial or total memory loss after the physical injury (post-traumatic amnesia (PTA)) and loss of postural stability.

Loss of consciousness is not required to make a diagnosis of concussion. More than 90% of concussions do not involve loss of consciousness.

28 SportEX

B C

Response Airways

Breathing Circulation

Ensure that there are no immediate environmental dangers which may potentially injure the patient or treatment team. This may involve stopping play in a football match or marshalling cars on a racetrack

Is the patient conscious? Can he/she talk?

Ensure the patient has a clear unobstructed airway. Remove mouthguards or other dental obstructions

Ensure the patient is breathing adequately Ensure there is adequate circulation

Adapted from McCrory PR. Were you knocked out? A team physician’s approach to initial concussion management Med.&Sci in Sport & Exercise Vol 29(7) Supp.p207-212

Immediate assessment When called to an injured player the basic first aid principles should apply – the

mnemonic DR ABC is useful in the sports setting (see table 1). Once the athlete is stable other injuries should be sought,

TIP