British journal of sports medicine
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To review the diagnostic tests and investigations used in the management of sports concussion, in the adult and paediatric populations, to (a) monitor the severity of symptoms and deficits, (b) track recovery and (c) advance knowledge relating to the natural history and neurobiology of the injury. ⋯ The current status of the diagnostic tests and investigations is analysed, and potential directions for future research are provided. Currently, all tests and investigations, with the exception of clinical balance testing, remain experimental. There is accumulating research, however, that shows promise for the future clinical application of functional magnetic resonance imaging in sport concussion assessment and management.
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To determine if there is a gender difference in the incidence and outcomes of sport concussion. ⋯ After evaluating multiple years of concussion data in comparable sports, the evidence indicates that female athletes may be at greater risk for concussion than their male counterparts. There also is some evidence that gender differences exist in outcomes of traumatic brain injury and concussions. Because concussion is a clinical diagnosis often depending on self reporting and with no established biological marker or consistent symptoms/definitions, and because there is evidence that females are more honest in reporting general injuries than males, it is unclear whether the concussion incidence data, while generally consistent in showing a higher risk in females as compared to males in similar sports, is a true difference or is influenced by a reporting bias.
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To examine the published literature relating to the difference in concussion management strategies between elite and non-elite athletes. ⋯ The non-elite athlete may not have the same resources available as the elite athlete (such as the presence of trained medical staff during practice and competition, a concussion programme as part of sideline preparedness, the benefit of neuropsychological or postural testing, as well as consultants with expertise in concussion readily available) and as a result will generally be managed more conservatively. Younger athletes often have a greater incidence of concussion with longer recovery time frames; however, they are often managed with less expertise and with limited resources.
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To examine concussion literature for specific guidelines regarding return to play (RTP) following sport-related concussion in child athletes. To make recommendations regarding the most appropriate RTP guidelines for child athletes following sport-related concussion. ⋯ RTP decisions in children should be made cautiously and should be individualised. No concussed child athlete should be allowed to RTP the same day. Physical and cognitive rest is very important to allow for the resolution of concussion symptoms. Child athletes should remain symptom free for several days before starting a medically supervised stepwise exertion protocol. Further research is needed to elucidate the effects of concussion in children and to determine the most appropriate RTP guidelines. Child-specific concussion assessment tools need to be developed to improve concussion assessment and management in children.