The ISEH in collaboration with the National Hospital for Neurology and Neurosurgery, RFU and FA, has established a multidisciplinary concussion service to address this public health need for both the elite population and recreational athletes with ongoing problems after concussion.
Concussion is currently a major medical issue in world sport. As player welfare rises in priority across professional sports, the scale of the problem has become more evident through the injury surveillance systems that have been put in place. Although media focus has highlighted concussion in the highest echelons of sports, concussion is not isolated to elite sport, or to sport for that matter, and primary healthcare professionals are likely to be required to recognise and manage concussion in a broad patient population.
What is a concussion and how do you recognise it?
A concussion is a traumatic brain injury that is caused by a direct blow to the head, face, neck or an indirect force such as a hit to the body. It typically results in the rapid onset of neurological dysfunction that resolves spontaneously but in some cases symptoms and signs can take several hours to evolve. Contrary to popular belief less than 10% of concussions involve a loss of consciousness and these can be so momentary that they can be missed altogether.
Acute management and return to activity
The initial management of concussion is focused on a period of relative physical and cognitive rest, meaning that the patient should try to limit activities that stimulate the mind such as excessive use of personal electronic devices, watching television or even driving. Once the symptoms have completely resolved the individual undergoes a programme of gradually increasing stimulation and activity before they are medically cleared to return to all activities.
80-90% of acute concussions have an uncomplicated recovery generally resolving in 7-10 days.
The issues
A minority of patients who suffer concussion have many symptoms that can last for several months and continue to significantly affect their quality of life. Such patients require careful assessment and expert management in order to recover but unfortunately many do not have access to services that can provide this. Additionally, evidence is emerging for a link between concussion (particularly multiple concussions) and long term neurological conditions, including early dementia, in professional athletes. Although a number of high profile cases of retired NFL players with the condition of chronic traumatic encephalopathy (CTE) have been reported, the scale of the problem and whether concussion (or another factor) is the cause is currently unknown.
Concussion clinic at the ISEH
How to be referred
MDT team
Elite sport concussion MDT clinic at the ISEH
The FA's concussion guidelines
The RFU's guide to concussion