1. John Brooks, academic clinical fellow general practice12,
  2. Simon Kemp, chief medical officer3,
  3. Aisha Newth, general practitioner and primary care faculty development lead2,
  4. Richard Sylvester, consultant neurologist4
  1. 1The Population Health Research Institute, St. George’s University of London, UK;
  2. 2Department of Primary Care and Public Health, Imperial College London, UK
  3. 3Rugby Football Union, Twickenham, UK
  4. 4Homerton University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to John Brooks johnbrooks{at}doctors.org.uk
  • Accepted 14 October 2016

What you need to know

  • Concussion is temporarily altered brain function after head trauma, and typically resolves over 7-10 days

  • Thinking and remembering, mood, sleep, behaviour, and consciousness can be affected, and people commonly report headache and altered balance

  • Suggest mental and physical rest followed by a graduated return to work or school, and finally to exercise and sport

A graduated return to sport is recommended after injury (see infographic), such as low risk training drills

A 16 year old hit his head on the knee of another player during a sports match two days ago. He was taken to the emergency department, diagnosed with concussion, and discharged with head injury advice. His mother is concerned that he still has a headache and difficulty concentrating. He wants to return to playing sport as soon as possible.

Concussion is a clinical diagnosis made after a head injury with consequent associated signs, symptoms, and neurological or cognitive impairment1 (infographic). These usually have a rapid onset and typically recover spontaneously within 7-10 days. Loss of consciousness occurs in <10% of incidents.2 Collision and high impact sports,3 such as rugby, hockey, soccer, motor sports, boxing, and horse riding, carry a higher risk. Most recommendations on the management and recovery from concussion are based on international expert consensus; in the absence of strong evidence.1 Routine brain imaging is not advised.

What you should cover

Ask how the injury was sustained. Was there significant head trauma or other clinical features suggestive of concussion? The most …

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