What is a concussion?
A concussion is an injury to the brain that results in temporary loss of normal brain function. It usually is caused by a blow to the head. In many cases, there are no external signs of head trauma. Many people assume that concussions involve a loss of consciousness, but that is not true. In many cases, a person with a concussion never loses consciousness.
The formal medical definition of concussion is: ‘a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma’. (American Association of Neurological Surgeons, AANS).
The key words here are ‘Brain Injury’ as in its simplest form, that is what a concussion is. A concussion could precipitate following a direct impact to the head i.e. blunt force trauma. Or it could occur due to rapid acceleration/deceleration forces. This insult to the brain can cause momentary interruption to cerebral activity.
A concussion is not the only medical condition which can result from a head injury, an intracranial haemorrhage is another possible complication. There are many different types of intracranial haemorrhage, all of which can lead to an increase in intracranial pressure, and eventually prove fatal.
Initial symptoms associated with a bleed within the cranium may involve lucid intervals, loss of consciousness and headache. All of which are also symptoms which may be present during a concussion. This, therefore, stresses the importance of a continual player assessment, following a head injury. With a concussion, it is usual for the symptoms to dissipate after a period of time, whereas with an intracranial haemorrhage the patient will more likely deteriorate.
Signs and Symptoms of a concussion
Symptoms which may occur after the incident may include:-
• Short-term memory loss
• Nausea and/or vomiting
• Dazed or vacant expression
• Visual disturbances
• Balance problems
• Inability to follow commands
• Seizures or fits
If the player is showing any of these signs and/or symptoms following a head injury they should be removed from play immediately and assessed further. The assessment should be carried out by a doctor using an appropriate tool such as the Sports Concussion Assessment Tool (SCAT3 and Child SCAT).
A concussion can be slow to develop, or the individual may suffer a delayed onset concussion. In this instance, the competitor may be relatively symptom-free to begin with, and then progress to display signs and symptoms of a concussion as time passes. It is therefore important to continually assess a player who has received a blow to the head. Following removal from play, the individual should be repeatedly assessed for signs of improvement or deterioration and acted on accordingly.
Baseline checks should be taken, recorded and then repeated every 5 minutes i.e. pulse, blood pressure, oxygen saturation, respiratory rate, GCS, short-term memory test (Maddocks questions) etc. It is always best to air on the side of caution, especially with younger athletes. If there are any signs of deterioration, transport to a hospital for further assessment is required.
When can a player return to play?
The only person who can medically clear a player to continue in their given sport, at this present time, is a doctor. Many clubs and sporting bodies have their own protocols for dealing with head injuries and concussion, but there is no clear answer as to whether a player should continue or not. Individuals who cover sport should be competent and have a level of knowledge which is relevant to the care which they are expected to supply. This is harder to enforce within the lower leagues and especially so at youth level.
Anyone who offers medical support for a sporting team or sports competitors should have appropriate training in the management of traumatic sports injuries. By having this training they can safely acknowledge their capabilities and seek further assistance as and when required. As always your clinical judgement is what guides you when assessing an injured player, and assessment tools such as SCAT3 and child SCAT help to assist your decisions. The graduated return to play guidelines may also help with assessment of a sports competitor following a concussion before allowing them to return to their sport.
Concussion issues continue in high profile sport!
It’s rare for a month of sport to go by lately without hearing some mention of a concussion. At the start of 2015, we had a brilliant 6 Nations tournament that was overshadowed in the first weekend by the George North concussion issue. This was just one of three concussions in two months for North, and he was rightfully rested from his club duties. George North says he is now through his concussion problems and has been cleared to resume full training.
Later in the same tournament, we saw England’s Mike Brown receive a nasty concussion after colliding with Andrea Masi. Brown was rested for the next game against Ireland but returned for the last two games against Scotland and France. After which he complained of “not feeling right”. Being a more severe concussion Brown was still experiencing symptoms 12 weeks post incident and missed the rest of the Harlequins season while he underwent further assessment.
A concussion is not just isolated to rugby. There have recently been a number of high profile head injuries within other sports. Most notably in April 2015, we saw Chelsea’s Oscar collide with Arsenal’s David Ospina. Early signs showed Oscar was dazed and displaying unnatural positioning of his arms known as fencing. Surprisingly though, he
returned to play, only to be substituted later in the game before eventually requiring hospitalization for further assessment. Despite Premier league protocols, Oscar was back on the substitution bench for Chelsea three days later.
On our Lubas Medical Sports Trauma Management courses, we provide information on recognising, treating and the appropriate management of concussion in sport. We also teach participants how to manage a number of other conditions and injuries that can occur in sport. We ensure that every course we provide is specific to your chosen profession and helps you to provide the gold standard of care to the athletes and individuals you cover.