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.
