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INTRODUCTION

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I’ve been knocked out a few times in there, but I have no idea how many concussions I’ve ever had.

Hulk Hogan

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Although head injuries are common in all contact sports, the vast majority are minor. Sports in which minor head injuries are commonly observed include equestrian sports, various codes of football, boxing, gymnastics and martial arts. The incidence ranges from 0.25–9 per 1000 player hours of exposure in professional team sports. Amateur point-to-point (cross-country) jockeys have the highest concussion rate of any sport (95 concussions per 1000 player hours of exposure), followed by professional jumps and flat jockeys. With increasing media awareness, more concussions are being reported; however, direct epidemiological comparisons between sports are limited by methodological issues.

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Head injuries of all levels are a medical emergency because they can prove fatal if misdiagnosed or incorrectly managed. The clinician’s role in the management of acute head injuries is to (i) recognise the problem, (ii) ensure immediate resuscitation (if required) and (iii) transfer the injured athlete to the appropriate facility.

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In this chapter we cover the following topics:

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  • definition

  • prevention of concussion

  • clinically relevant pathophysiology

  • management of the concussed athlete

  • complications of concussion

  • return to play issues.

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The chapter helps the reader to learn to diagnose and manage concussions in sport using the Sport Concussion Assessment Tool 3 (SCAT3TM)1 (Fig. 20.2), the Pocket Concussion Recognition ToolTM (Pocket CRT)2 (Fig. 20.3) and Child SCAT3TM (Fig. 20.6).

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Figure 20.1

The Concussion in Sport Group met in Berlin in October 2016. Their updated consensus statement and systematic reviews will be available in peer-reviewed journals including the British Journal of Sports Medicine (BJSM) by May 2017

COVER REPRODUCED WITH PERMISSION FROM BMJ GROUP AND CONCUSSION IN SPORT GROUP

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Figure 20.3

Pocket Concussion Recognition Tool™ (CRT)2

REPRODUCED WITH PERMISSION FROM BRITISH JOURNAL OF SPORTS MEDICINE

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We emphasise that the SCAT3 tools and the Pocket CRT are critical aspects of concussion management, as they are the result of more than 10 years of global collaboration and development by experts, at the 4th International Consensus Conference on Concussion in Sport held in Zurich in November 2012 (Fig. 20.1). These tools are designed to standardise ...

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