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Abstract
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In the 21st century, there has been tremendous international interest in improving our ability to identify sport-related concussion and to medically manage the injury more effectively.1-7 Some signs of concussion can be obvious and dramatic, such as traumatic loss of consciousness (LOC) while in an upright position with a free-fall to the field or ice. Enormous collisions on the field of play occur in many sports, typically without injury—and sometimes lesser collisions result in a concussion. Over decades, the medical and scientific community has codified a number of visible signs of concussion such as (i) LOC; (ii) post-traumatic seizure; (iii) disturbed balance upon standing, gait instability when leaving the field or ice, or perturbations in postural stability on medical examination elicited by Romberg stances with the eyes closed; (iv) amnesia for events before or after the injury; and (v) post-traumatic confusion and disorientation, sometimes accompanied by a blank, vacant, or a somewhat bewildered facial expression.8-12 Common symptoms of concussion, reported by the athlete in the first 30 min or first 24 h include headaches, dizziness, mental fogginess, nausea, and difficulty with concentration.13-15 Over the past 15 yr, it has become a priority to recognize the injury as soon as possible, remove that athlete from participation, and begin a medical management process designed to promote clinical recovery and to encourage a safe and gradual return to play.1
Video review studies of concussion have been conducted in diverse sports, such as Australian football,16-18 ice hockey,19,20 rugby union,21-23 rugby league,24-29 lacrosse,30-32 and taekwondo.33 Through this research, we have learned that the observable signs of concussion appear to be sensitive to concussion diagnoses when reviewing known injuries, but when an entire season is reviewed, certain signs have been observed to occur frequently and were not specific (ie, they occurred without reflecting a concussion). There has been considerable interest in translating this video research into practice by improving medical surveillance systems for the in-game detection of suspected concussion. The availability of sideline (ie, in-game/live) video review for use by team medical staff is potentially a useful adjunct to assist with the decision-making process, especially in situations where the initial signs of concussion are fleeting or go unnoticed by team medical staff. Recently, the international collision sport medical community is attempting to move towards uniformity in reviewing34 and defining35 video signs of concussion. Uniform criteria for video signs of concussion are not easily applied to all sports because of differences in game characteristics, impact or tackle techniques, protective and/or playing equipment (eg, helmeted or not), playing styles, playing surface (eg, field vs ice), and the playing arena. These factors influence, in diverse ways, the lines of sight and ability to visualize and document certain signs. To provide a practical, uniform process for the in-game video review of possible concussion, World Rugby has established a set of criteria as a guide for match day medical staff, outlining important phases in the interpretation of a potential concussion injury event.36 The National Rugby League (NRL) in Australia has invested in the establishment of a centralized ‘medical bunker,’ a system that uses trained observers who watch the game live and tag any event deemed worthy of review by the team medical staff. The National Football League (NFL) has introduced a standardised, reliable, efficient, and evidence-based protocol for concussion diagnosis and management that includes Unaffiliated Neurotrauma Consultants, Booth Certified Athletic Trainer Spotter, and the ability to call a medical time out.37 The National Hockey League introduced enumerated videos signs of concussion that if one or more signs are observed (either by team staff, or by designated off-ice ‘spotters’ whose role was to watch games in real time through broadcast video feeds and who can communicate with the on-ice staff) to mandate an off-ice examination ...
Keywords: American football
Language: en |