How to identify and manage sports related concussions in primary care
BMJ 2023; 382 doi: https://doi.org/10.1136/bmj-2022-073161 (Published 18 September 2023) Cite this as: BMJ 2023;382:e073161
- Michael McLarnon, foundation year 1 doctor1,
- Neil Heron, clinical lecturer, NIHR clinical lecturer23
- 1Belfast Health and Social Care Trust, Belfast, Northern Ireland
- 2Centre for Public Health, Queen’s University Belfast, Belfast
- 3School of Medicine, Keele University, Newcastle-under-Lyme, UK
- Correspondence to N Heron N.Heron{at}qub.ac.uk
What you need to know
Concussion rehabilitation should last at least 20 days for non-elite sport participants, with a dedicated relative rest period of 24-48 hours and then phased return to work, education, and finally, sport
No return to competitive sport should occur before day 21 following concussion in non-elite athletes
Recovery from concussion varies, but for most people, symptoms will resolve within two weeks. If symptoms have not settled within four weeks, refer patients to a concussion specialist, eg, a consultant in sport and exercise medicine or a neurologist with a specialist interest
A 20 year old female amateur footballer comes to your GP practice following a head collision on the pitch two days ago. She felt unsteady at the time of the collision, has had a headache since, and is finding it difficult to concentrate.
Sports related concussion (SRC) is defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.”123 It is typically caused by a direct blow to the head, face, neck, or elsewhere on the body, with force transmitted to the head. It generally causes rapid onset transient neurological dysfunction, including presenting with headache or difficulty concentrating (however, this may be delayed in some cases) and is not associated with structural injury to the brain or pathology on neuro-imaging. One study in Canada reported an average annual incidence of one concussion per 87 residents.4
SRC is relevant to primary care because head injuries and potential SRC are common presentations from events such as rugby tackles or falling off a bicycle or horse. Patients are often advised to see their GP for concussion symptoms, and recent UK Concussion Guidelines for Non-Elite (Grassroots) Sport recommend that anyone who still has symptoms after 28 days should seek medical advice from their GP.5 Additionally, all concussion …
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