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You get a concussion, they’ve got to take you out of the game. So if you can hide it and conceal it as much as possible, you pay for it the next day, but you’ll be able to … stay in the game.

Washington Redskins fullback Mike Sellers


Although head injuries are common in all contact sports, the vast majority of head injuries are minor. Sports in which minor head injuries are seen include football, boxing, gymnastics, horse riding, and martial arts. The incidence ranges from 0.25–4 per 1000 player hours of exposure in professional team sports. Amateur horse jumping jockeys have the highest concussion rate of any sport (95 concussions per 1000 player hours of exposure), followed by professional jumps and flat jockeys.


Head injuries of all levels are a medical emergency because they can prove fatal. Severe head injuries are discussed in Chapter 47. The clinician’s role in the management of acute head injuries is to (i) recognize the problem, (ii) ensure immediate resuscitation, and (iii) transfer the injured sportsperson to the appropriate facility. In this chapter we discuss:


  • definition of concussion

  • prevention of concussion

  • clinically relevant pathophysiology

  • management of the concussed sportsperson

  • complications of concussion

  • return-to-play issues.


The chapter helps the reader to learn to diagnose and manage concussions in sport using the Sport Concussion Assessment Tool 2 (SCAT2)1 (Fig. 17.2) and the Pocket SCAT22 (Fig. 17.3).


We emphasize the SCAT2 tools, as they result from 10 years of collaboration by global experts who met most recently at the 3rd International Consensus Conference on Concussion in Sport held in Zurich in November 2008 (Fig. 17.1).

Figure 17.1

The most recent international consensus meeting on concussion was held in Zurich, Switzerland, 2008 and the proceedings published in the British Journal of Sports Medicine in May 2009.

Graphic Jump Location

Practice Pearl

The SCAT tools (Figs 17.2 and 17.3) and Consensus statement3 have been used internationally to assist clinicians and sportspeople reach “quality decisions” (Chapter 3) about return to play (RTP) following concussion.


Definition of concussion


“Concussion” is the term commonly used to describe a subtype of head injury. It is worth noting that the terms “concussion” and “mild traumatic brain injury” refer to entirely different injury constructs and the terms cannot be used interchangeably. While concussion is a subset of MTBI, the converse is not true.


Many publications on concussion refer to the Glasgow Coma Scale as a means of classifying traumatic brain injury (TBI). This is a validated and widely used measure of conscious state used in the assessment of TBI. Its primary role is in the measurement of serial change in ...

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