Concussion

Concussion

Concussion is a very serious condition often seen in sport and more and more incidents are being reported in contact sports. It can range from mild to very severe depending on the circumstances and is usually caused by a sudden impact to the head from a traumatic (contact) event.

Severe concussions can result in permanent brain injury or even death so all head injuries MUST be taken seriously. Concussion is an injury to the brain caused by impact against the skull. It can, but does not always, involve a loss of consciousness. Symptoms include headaches, dizziness and sickness but the vary depending on severity of injury.

Symptoms of Concussion

Mild cases include symptoms such as slight mental confusion with possibly some memory loss. Mild tinitus (or “ringing in the ear”) may be heard along with mild dizziness and/or a headache. There is likely to be pain in the area of contact or impact. The athlete will often have a normal ability to balance and will usually no have lost consciousness during the incident. The degree of memory loss and the ability to recall information will be variable from athlete to athlete.

Moderate cases include symptoms such as mental confusion with often some memory loss. Moderate tinitus (or “ringing in the ears”) may be heard with moderate dizziness and usually a headache. Overall balance may be altered and the player may experience some nausea (feeling sick) or even vomiting (being sick). Loss of consciousness may happen but will this will usually last no longer than 5 minutes. The degree of memory loss and the ability to recall information will be variable from athlete to athlete.

Severe cases will more than likely result in mental confusion lasting for 5 minutes or more. Severe ringing in the ears or tinitus may be experienced. Prolonged loss of memory of events before the accident may occur. Loss of consciousness for more than 5 minutes is possible along with an increase in blood pressure and a decrease in heart rate.

Assessment

If a concussion is suspected the athlete should ALWAYS be removed immediately from the training pitch or match and should not be left alone. You should always seek professional medical advice to determine the extent of the head injury and in no circumstances should the athlete return to playing sport until they have been fully assessed by a doctor.

SCAT 3 Test is used by a doctor to assess how bad the injury. SCAT stands for Sport Competition Anxiety Test and has been developed over a number of years to be sensitive enough to detect subtle symptoms and monitor the progress of an athlete. The test consists of a number of questions and short tests to assess the athlete’s symptoms, their ability to balance and their ability to memorise and recall information.

The doctor will perform a SCAT 3 test as soon after the incident as possible and then repeat the test over a period of a number of days or weeks until the results are back to normal. It should be noted that this may take a number of weeks to normalise.

SCAT 3 for information purposes only can be downloaded here – this must always be carried out by a medical doctor

Treatment

The main treatment iis resting from all activities until the symptoms start to subside. As the symptoms decrease the doctor will allow the athlete to slowly and progressively start exercising with constant monitoring.

Return to Playing Sport

This should be a gradual step-by-step process and should always be supervision by a qualified medical person, usually a doctor. When the athlete does not have any symptoms at rest then they may be able to start light exercise which may include stationary cycling or walking. If the symptoms do not return during or after this, then the next step is to perform sports specific activity without contact, for example running. If at any stage the symptoms return, then the athlete will be instructed to take a step back in the process.

The next stage is on-field practice without contact and the final stage is full contact sport. All of these stages are closely monitored by the medical professional and symptoms are constantly assessed. Although this may seem to be a slow process t the athlete, the step by step progression is absolutely vital to the athlete’s health and must be taken seriously.

Post Concussion Syndrome

This is a complication with symptoms which occur after the main symptoms of the original injury have gone. If the athlete experiences strange symptoms such as loss of taste or smell, anxiety or depression among a number of potential symptoms then they must seek medical advice immediately.

Read more on Post Concussion Syndrome.

“Second Impact” Syndrome (SIS)

This is a condition where a second impact takes place before the symptoms for the first hit have cleared up. This can cause a sudden swelling of the brain and can result in death. It can happen days or weeks after the first impact. There have been a number of high profile cases in the media in where athletes have reportedly suffered SIS. For this reason and knowing that even the mildest of concussions can lead to SIS is why all must be taken seriously.

On field management

What to do if a head injury is sustained or suspected during a match or competition.

Every time a player sustains a head injury during a game they could be at risk or a more serious structural brain injury. It is not always possible to diagnose such an injury at the time it is sustained because the patient may be confused and difficult to examin, or where the brain injury comes on gradually post injury.

A more serious structural brain injury may be suspected if:

  • There has been a high speed impact or trauma with the head contacting a hard surface or body part such as the knee.
  • Symptoms worsen over time for example nausea or headaches.
  • The patient has lost consciousness immediately after the impact, or they have fallen unconscious for a sustained period of time.
  • The patient has a seizure or fit.
  • Bleeding or fluid leaking from the nose or ear which could be evidence of a skull fracture.
  • Focal neurological deficit is found when examining the patient. This  would be seen as a problem withbrain function that affects a specific location for example part of the face. It can also refer to memory loss and emotional changes.

If a player is suspected of having a structural head or brain injury then they should be taken to hospital that can deal with head injuries immediately. A brain scan will be required to check for bleeding within the brain itself.

If a player is suspected of having a structural head or brain injury then they should be taken to hospital immediately. A brain scan will be required to check for bleeding within the brain itself.

Immediate first aid

The priorities that the on field sports injury professional will deal with when approaching an injury are based on the principles of Dr ABC:

  • D for danger. Ensure the player and any staff assisting are not in further danger for example from any game play still occurring.
  • R for response. Is the player responding? Can they talk? Are they conscious?
  • A is for Airway. Remove any objects such as mouth guards from the mouth and ensure the airway is clear.
  • B is for breathing. Ensure the patient is able to breath sufficiently.
  • C is for circulation. Make sure the patient has a pulse and blood is circulating ok.

Once the above has been achieved then the next priority is to remove the player from the field, first checking for any neck or spinal cord injury. This may appear as tenderness in the neck, deformity or if the patient complains of neck pain. If this is supected then they should not be moved until they have been immobilized in a brace.

If the patient is unconscious then a neck injury should be suspected until it can be discounted.

Examination

If there is a doctor present pitch side and there is no neck injury suspected then a full neurological examination can be done, usually back in the changing rooms where it is quiet. It is possible the patient will be disorientated, uncooperative or convulsing. If a suitably qualified person is not present then the patient should be taken to hospital. It is vital to establish an accurate diagnosis as the consequences of missing something could be fatal.

The SCAT3 assessment tool for concussion is used to help diagnosis. Once concussion has been confirmed then the patient must be continually monitored right up until full recovery.

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