Sport related concussion

 

Taken directly from an article in New England journal of medicine in 2025.

“After a plausible mechanism of injury (e.g., vigorous acceleration–deceleration of the head, the head being struck by a hard object, or the head striking the ground), concussion-related symptoms and signs typically appear or worsen within minutes to hours but sometimes may be delayed for up to 72 hours.  Cervical injury often accompanies concussion and, if untreated, may delay recovery.  Loss of consciousness is uncommon after sport-related concussion and typically lasts less than a minute.

“Concussion or mild traumatic brain injury affects approximately 42 million persons worldwide each year. in the U.S. there are, Annually, 1.6 to 3.8 million sport-related concussions. 

" Risk factors include previous concussion, game or match play (as opposed to practice sessions), adolescent age, attention deficit–hyperactivity disorder or learning disability, and personal or family history of migraine or mental health problems.

“In a recent cohort study, female soccer players had a higher incidence of concussion than male soccer players, and regardless of sex, the incidence of concussion was higher among goalkeepers than among forwards.

“American Congress of Rehabilitation Medicine defines concussion as a mild traumatic brain injury when neuroimaging is normal or not clinically indicated.

"Diagnosis depends on relevant signs and symptoms appearing within 72 hours after injury as well as on vestibular and oculomotor findings.

“Abnormal vestibular findings..the patient walks in a straight line with one foot in front of the other..and oculomotor findings are common on exam and help to establish the diagnosis. Light headedness can occur and some people with concussions are initially unable to exercise to the maximum expected level.

“Symptoms and signs may present immediately, or evolve over minutes or hours, and typically resolves within days to weeks.  Approximately one third of untreated adolescents will have symptoms that persist for more than 4 weeks. 

"Light physical activity and graduated aerobic exercise that are tailored to symptoms and heart rate should be initiated within 24 to 72 hours after injury.  Activity is tailored to symptoms and heart rate.  The approach typically facilitates recovery and reduces the incidence of symptoms that persist beyond 28 days.  Recent observational data show that an early return to school is usually associated with faster recovery.”

https://www.nejm.org/doi/exam/10.1056/NEJMcp2400691

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