Jon Patricios

Risk factors for sports concussion: an evidence-based systematic review

Concussion is a common sports injury with approximately 1.6–3.8 million sport-related concussions reported in the USA annually. Identifying risk factors may help in preventing these injuries. This systematic review aims to identify such risk factors. Three electronic databases; ScienceDirect, PubMed and SpringerLink, were searched using the keywords ‘RISK FACTORS’ or ‘PREDISPOSITION’ in conjunction with ‘SPORT’ and ‘CONCUSSION’. Based on the inclusion and exclusion criteria, 13 628 identified titles were independently analysed by two of the authors to a final list of 86 articles. Only articles with a level of evidence of I, II and III were included according to robust study design and data analysis. The level of certainty for each risk factor was determined. A high level of certainty for increased risk of a subsequent concussion in athletes sustaining more than one previous concussion was reported in 10 of 13 studies. Further, a high level of certainty was assigned to match play with all 29 studies reporting an increased concussion risk during matches. All other risk factors were evaluated as having a low level of certainty. Although several risk factors were identified from the appraised studies, prospective cohort studies, larger sample sizes, consistent and robust measures of risk should be employed in future research.

The Sport Concussion Assessment Tool 5th Edition (SCAT5): Background and rationale

This paper presents the Sport Concussion Assessment Tool 5th Edition (SCAT5), which is the most recent revision of a sport concussion evaluation tool for use by healthcare professionals in the acute evaluation of suspected concussion. The revision of the SCAT3 (first published in 2013) culminated in the SCAT5. The revision was based on a systematic review and synthesis of current research, public input and expert panel review as part of the 5th International Consensus Conference on Concussion in Sport held in Berlin in 2016. The SCAT5 is intended for use in those who are 13 years of age or older. The Child SCAT5 is a tool for those aged 5–12 years, which is discussed elsewhere.

What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review

Background Sideline detection is the first and most significant step in recognising a potential concussion and removing an athlete from harm. This systematic review aims to evaluate the critical elements aiding sideline recognition of potential concussions including screening tools, technologies and integrated assessment protocols. Data sources Bibliographic databases, grey literature repositories and relevant websites were searched from 1 January 2000 to 30 September 2016. A total of 3562 articles were identified. Study selection Original research studies evaluating a sideline tool, technology or protocol for sports-related concussion were eligible, of which 27 studies were included. Data extraction A standardised form was used to record information. The QUADAS-2 and Newcastle-Ottawa tools were used to rate risk of bias. Strength of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation Working Group system. Data synthesis Studies assessing symptoms, the King-Devick test and multimodal assessments reported high sensitivity and specificity. Evaluations of balance and cognitive tests described lower sensitivity but higher specificity. However, these studies were at high risk of bias and the overall strength of evidence examining sideline screening tools was very low. A strong body of evidence demonstrated that head impact sensors did not provide useful sideline concussion information. Low-strength evidence suggested a multimodal, multitime-based concussion evaluation process incorporating video review was important in the recognition of significant head impact events and delayed onset concussion. Conclusion In the absence of definitive evidence confirming the diagnostic accuracy of sideline screening tests, consensus-derived multimodal assessment tools, such as the Sports Concussion Assessment Tool, are recommended. Sideline video review may improve recognition and removal from play of athletes who have sustained significant head impact events. Current evidence does not support the use of impact sensor systems for real-time concussion identification.

International consensus statement on injury surveillance in cricket: a 2016 update

Cricket was the first sport to publish recommended methods for injury surveillance in 2005. Since then, there have been changes to the nature of both cricket and injury surveillance. Researchers representing the major cricket playing nations met to propose changes to the previous recommendations, with an agreed voting block of 14. It was decided that 10 of 14 votes (70%) were required to add a new definition element and 11 of 14 (80%) were required to amend a previous definition. In addition to the previously agreed ‘Match time-loss’ injury, definitions of ‘General time-loss’, ‘Medical presentation’, ‘Player-reported’ and ‘Imaging-abnormality’ injuries are now provided. Further, new injury incidence units of match injuries per 1000 player days, and annual injuries per 100 players per year are recommended. There was a shift towards recommending a greater number of possible definitions, due to differing contexts and foci of cricket research (eg, professional vs amateur; injury surveillance systems vs specific injury category studies). It is recommended that researchers use and report as many of the definitions as possible to assist both comparisons between studies within cricket and with those from other sports.

The Concussion Recognition Tool 5th Edition (CRT5): Background and rationale

The Concussion Recognition Tool 5 (CRT5) is the most recent revision of the Pocket Sport Concussion Assessment Tool 2 that was initially introduced by the Concussion in Sport Group in 2005. The CRT5 is designed to assist non-medically trained individuals to recognise the signs and symptoms of possible sport-related concussion and provides guidance for removing an athlete from play/sport and to seek medical attention. This paper presents the development of the CRT5 and highlights the differences between the CRT5 and prior versions of the instrument.

5th International Conference on Concussion in Sport (Berlin)

Sport-related concussion (SRC) has received much media coverage over the past 5 years. In the face of misinformation about this injury in the minds of parents, coaches and athletes, it is critical that all involved stakeholders receive scientifically sound and up-to-date information regarding SRC and its potential consequences. One of the most significant developments in SRC over the past two decades has been the establishment of the Concussion In Sport Group (CISG). This group has organised the key consensus meetings in this field and has published assessment tools that have …

The sports concussion note: should SCAT become SCOAT?

Sports concussion research and clinical guidelines have evolved rapidly. The most recent concussion consensus statement and guidelines (Zurich, 2008) provided clinicians with the Sports Concussion Assessment Tool version 2 (SCAT2) as a clinical template for the assessment of acute concussion. For the subsequent serial examinations required for the complete assessment of the concussed athlete, SCAT2 may be inadequate. This paper describes the experience and suggestions of South African sports physicians in evolving a more comprehensive clinical evaluation tool and record of patient care, the Sports Concussion Office Assessment Tool.

Inflammatory and apoptotic signalling pathways and concussion severity: a genetic association study

ABSTRACT The objective was to investigate the relationship between IL-1B rs16944, IL-6 rs1800795, and CASP8 rs3834129 genetic polymorphisms and concussion severity. Rugby players from high school, senior amateur, and professional teams completed a concussion severity questionnaire and donated a DNA sample. Participants (n = 163) were split into symptom severity groups around the median number and duration of symptoms. The frequency of participants with high symptom counts (more than five symptoms) increased across the IL-1B (C/C: 35%; C/T: 51%; T/T: 56%; P = 0.047) and the IL-6 (C/C: 31%; C/G: 44%; G/G: 58%; P = 0.027) genotypes. The C–C inferred interleukin allele construct frequency, created from combining the IL-1B and IL-6 genotype data, was lower in participants reporting a high symptom count (18%), compared to those with a low symptom count (fewer than six symptoms, 36%, P = 0.002). Similarly, the C–C inferred interleukin allele construct frequency was lower in those reporting prolonged symptom duration (more than one week, 16%), as opposed to short symptom duration (less than one week, 34%, P = 0.015). This study provides evidence of novel inflammatory pathway genetic associations with concussion severity, which supports the hypothesis implicating neuroinflammation in the development of concussion symptoms.

Toxic tau: The TAU gene polymorphisms associate with concussion history in rugby union players

OBJECTIVES Concussion is a brain injury that occurs when biomechanical forces are transmitted to the head region resulting in neurological deficits. The accumulation of tau protein in autopsies of athletes with multiple concussions implicates tau in concussion-associated neurodegeneration. The TAU rs2435211 (C>T) and rs2435200 (G>A) polymorphisms are involved in pathological tau expression and neurodegenerative disease risk. The aims of this study were to investigate the associations of TAU (rs2435211, rs2435200) polymorphisms with concussion history and sustaining multiple concussions in rugby. DESIGN In total, 140 non-concussed controls and 163 previously concussed participants (all cases group, N=163; clinically diagnosed, N=140; multiple concussed, N=87) were recruited from high school (N=135, junior), club and professional rugby teams (N=166, senior). METHODS Participants were genotyped for TAU rs2435211 and rs2435200 polymorphisms. RESULTS In seniors, the rs2435200 AA genotype was significantly over-represented in the control group compared to the multiple concussed subgroup (P=0.033, control: 25%, N=16, multiple concussed: 11%, N=6; OR: 0.34, 95% CI 0.12-0.96). While the AG genotype was significantly under-represented in the control compared to multiple concussed (P=0.024, control: 45%, N=29, multiple concussed: 63%, N=36; OR: 2.34, 95% CI 1.11-4.95). The inferred TAU (rs2435211 C>T-rs2435200 G>A) T-G haplotype was significantly under-represented in the control (19%, N=12) compared to the all cases group (30%, N=28, P=0.031). CONCLUSIONS The TAU-associated neurodegenerative pathway was implicated as a potential pathophysiological mechanism underlying concussion in seniors. In future, the identification of TAU polymorphisms associated with concussion risk may assist clinical management and reduce risk of severe complications.

Concussion in sport: best from Berlin, direction from Dublin and gems from gridiron

Sports-related concussion (SRC) is one of the most important medical issues in contact and collision sports around the world. The NFL Head, Neck and Spine Committee’s Concussion Diagnosis and Management Protocols, published in this edition of the BJSM , represent a comprehensive approach to concussion management in professional sport.1 The protocols highlight how much the approach to SRC has evolved, particularly since the first International Conference on Concussion in Sport held in Vienna in November 2001.2 This evolution has been driven largely by concerns (both medical and public) regarding potential short-term and long-term adverse outcomes following SRC, and have been underpinned by evolving concepts from five international consensus meetings, and an explosion of research on SRC over the past decade. The fifth International Conference on Concussion in Sport was held in Berlin in October 2016. The meeting involved more than 18 months of active planning, 10 scientific committee members, 23 additional expert panellists and 420 participants representing 24 countries.3 The output included 12 comprehensive systematic reviews (which collectively screened nearly 60 000 articles), 202 additional conference scientific abstracts, a consensus paper4 and revised standardised concussion recognition and assessment tools (SCAT5, ChildSCAT5 and CRT5). The output from the Berlin meeting provides a blueprint of 11 key principles of concussion management (the 11 ‘R’s’).4 Translation and implementation of these principles …