Concussion

Prevalence

• Most common neurological illness in young people.
• Accounts for 5 - 15% of total injuries in most contact sports.

Symptoms and Signs

• Wide variety.
• Do not need loss of consciousness to be concussed.
• Amnesia, dizziness, blurred vision, nausea, headache, attentional deficits, loss of consciousness.

Severity

• Difficult to grade.
• Should monitor symptoms – any change is more significant than any individual symptom.

Management

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Immediate...

DR ABC

D – danger R – response
A – airways B – breathing C – circulation and cervical spine

Later...

• Full neurological examination.
• Regularly monitored.
• Home with a responsible adult, and a head injury card.
• No drinking, driving, drugs.

Investigations...

• Usually normal.

Return to Play

• Contentious.
• Traditionally 3 weeks off.
• More sensible to regularly assess the player.
• Decision should be symptom based...
  • Any symptoms – no play or training.
  • Symptom free – graduate return.
  • Any recurrence – further rest.

Post Concussion Issues

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• Second impact syndrome – probably does not exist.
• Post concussion syndrome.
• Concussive convulsions.
• Cumulative effects.

Prevention

• Helmets – no evidence reduces risk of concussion in football codes.
• Correctly fitted mouthguard.
• Technical factors (tackling technique).
• Neck muscle conditioning.
• Proper coaching.
• Rule changes (ban spear tackling / head high tackling).
• Padding goalposts.