Intended for healthcare professionals


Concussion and sport

BMJ 2013; 347 doi: (Published 25 September 2013) Cite this as: BMJ 2013;347:f5748
  1. Adel Helmy, neurosurgery registrar1,
  2. Mukul Agarwal, sports and musculoskeletal physician2,
  3. Peter J Hutchinson, National Institute for Health Research professor (neurotrauma)1
  1. 1Department of Clinical Neurosciences, Division of Academic Neurosurgery, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
  2. 2Blackheath Hospital, London, UK
  1. pjah2{at}

Players with symptoms and signs of concussion should not continue or return to play until these resolve

The diagnosis of concussion and some aspects of its management remain contentious, particularly in the context of continuing to play sport and return to play after concussion. The latest Zurich consensus statement on concussion in sport addresses some of these problems and variations in the definition, clinical assessment, and management of concussion.1

Definitions of concussion vary and include mechanistic, pathophysiological, and clinical features.1 These complex definitions are necessary for research but have little practical use for most clinicians, including those “pitch or track side.” A more pragmatic definition of a “traumatically induced, usually transient, disturbance of brain function that involves complex pathophysiological processes” is a diagnosis made in retrospect and provides little help with early clinical decision making.2

Some authors use the term concussion synonymously with mild traumatic brain injury (head trauma and Glasgow coma score (GCS) 14 or 15), whereas others consider concussion a distinct pathological phenomenon that lacks any structural abnormality on traditional neuroimaging. In reality, there is likely to be a continuum of brain injury from the mild end of the spectrum, of which concussion is a subset, to more severe injuries. Rotational forces leading to transient distortion of intracerebral tissues seem an important element of the injury mechanism, which partly explains why concussion may be seen with rotational injuries even where there is no impact to the head. Although advanced magnetic resonance imaging can now identify abnormalities in concussed patients,3 correlation …

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