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

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

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.