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Commentary
Concussion guidelines need to move from only expert content to also include implementation and dissemination strategies
  1. Caroline F Finch1,
  2. Paul McCrory2,
  3. Michael T Ewing3,
  4. S John Sullivan4
  1. 1Australian Centre for Research into Sports Injury and its Prevention (ACRISP), Monash Injury Research Institute (MIRI), Monash University, Clayton, Victoria, Australia
  2. 2The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia 
  3. 3Department of Marketing, Faculty of Business & Economics, Monash University, Caulfield, Victoria, Australia
  4. 4Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
  1. Correspondence to Prof. Caroline Finch, Australian Centre for Research into Sports Injury and its Prevention (ACRISP), Monash Injury Research Institute (MIRI), Building 70, Monash University Clayton Campus, Melbourne, Victoria 3800, Australia; caroline.finch{at}monash.edu.

https://doi.org/10.1136/bjsports-2012-091796

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    Sport-related head injuries place a significant burden on the health service delivery systems needed to treat and assess them; the sport delivery systems responsible for providing safe sporting opportunities; and personally on the individuals who sustain them. The number of head injury occurrences, the anecdotally high levels of public concern about the risk of head injury in sport and the fact that there is so much public misinformation about their assessment, management and prevention1–3 make the prevention of sport-related head injury a health priority. The most recent international consensus statement on the management of concussion in sport stated that there is a need to develop guidelines, education resources and other health promotion approaches for the prevention of head injury and its adverse outcomes across all sports with a risk of serious head injury.4 However, while there is evidence that some educational resources and guidelines have been developed, these have had varying success because they have not incorporated social marketing approaches.2 ,3 ,5

    The content of concussion prevention

    Three meetings have developed international consensus and furthered the evidence base about the understanding and management of concussion in sport.4 ,6 ,7 The 2001 meeting defined concussion and recommended that management strategies be based on individualised clinical and cognitive recovery assessment post-injury.7 The 2004 meeting produced a standardised concussion assessment tool (the SCAT) to help medical personnel diagnose, assess and manage concussions; the concept of a concussion ‘rehabilitation’ protocol was introduced to facilitate a step-wise graded return-to-play programme.6 In 2008,4 the SCAT was modified to include an assessment of balance and more detailed screening of brain function (the SCAT2) and a brief sideline version was developed to help identify concussions on-site (PocketSCAT2). Management of concussion in specific subpopulations (eg, children) was also considered, with agreement that these …

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    Footnotes

    • Contributor CFF led the development of the item. Each of the co-authors contributed content and editorial input into the manuscript.

    • Funding CFF was supported by an NHMRC Principal Research Fellowship (ID: 565900) and PMc was supported by an NHMRC Practitioner Fellowship. The Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC). This work arose from research conducted through a Victorian Sports Injury Prevention Research Grant from the Department of Planning and Community Development, Victoria, Australia.

    • Competing interests PMc currently receives financial research support from the National Health and Medical Research Council, the University of Melbourne, Victorian Department of Planning and Community Development, Sport and Recreation Division and the Eastern Health Network. Previous competitive grant funding includes the Australian Research Council, International Rugby Board, the University of Melbourne, the University of Otago (NZ), National Hockey League (US), VicHealth, Australian Football League Research Foundation, Royal Australasian College of Surgeons and the Australian Sports Commission. He has a clinical and consulting practice in neurology and sports medicine involving individuals who have sustained concussion and TBI. He has received travel funding from the Medical Commission of the International Olympic Committee (IOC), the International Football Federation (FIFA), the American Academy of Neurology and the Jockey Club (UK). He receives book royalties from McGraw-Hill and from 2001 to 2008 was employed by the British Medical Journal Publishing Group. He has conducted clinical drug trials on antimigraine (Glaxo-Welcome; Janssen-Cliag; Novartis; Parke-Davis; Schering) and antispasticity drugs (Ipsen) through the Eastern Health Clinical Trials Unit in Melbourne. This drug trial work has not involved any financial payment to PMc directly. He received consultancy fees from Axon Sports (USA) for the development of educational material (in 2010 which was not renewed) and has received support since 2001 from CogState Inc. for research costs and the development of educational material. He is a cofounder and shareholder in two biomedical companies involved in eHealth and sports compression garment technologies and does not hold any individual shares in any company related to concussion or brain injury assessment or technology.