Assessment, Management and Knowledge of Sport-Related Concussion: Systematic Review

Abstract

Background

Sport-related concussions are a subset of mild traumatic brain injuries and are a concern for many sporting activities worldwide.

Objective

To review and update the literature in regard to the history, pathophysiology, recognition, assessment, management and knowledge of concussion.

Methods

Searches of electronic literature databases were performed to identify studies published up until April 2013.

Results

292 publications focussing on concussion met the inclusion criteria, and so they were quality rated and reviewed.

Conclusion

Concussion is hard to recognize and diagnose. Initial sideline assessment via the Sports Concussion Assessment Tool 3 (SCAT3), Child-SCAT3 or King-Devick test should be undertaken to identify athletes with concussion as part of a continuum of assessment modalities and athlete management. Sports medicine practitioners should be cognisant of the definition, extent and nature of concussion, and should work with coaches, athletes and trainers to identify and manage concussions. The most common reason for variations in management of concussion is lack of awareness of—and confusion about—the many available published guidelines for concussion. Future research should focus on better systems and tools for recognition, assessment and management of concussion. Sport participants’ knowledge of concussion should be evaluated more rigorously, with interventions for sports where there is little knowledge of recognition, assessment and appropriate management of concussion.

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References

  1. 1.

    Kirkwood M, Yeates K, Taylor H, et al. Management of pediatric mild traumatic brain injury: a neuropsychological review from injury through recovery. Clin Neuropsychol. 2008;22(5):769–800.

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Khurana V, Kaye A. An overview of concussion in sport. J Clin Neurosci. 2012;19(1):1–11.

    PubMed  Google Scholar 

  3. 3.

    McCrory P, Meeuwisse W, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47(5):250–8.

    PubMed  Google Scholar 

  4. 4.

    Covassin T, Elbin R III, Sarmiento K. Educating coaches about concussion in sports: evaluation of the CDC’s “Heads Up Concussion in Youth Sports” initiative. J School Health. 2012;82(5):233–8.

    PubMed  Google Scholar 

  5. 5.

    De Beaumont L, Brisson B, Lassonde M, et al. Long-term electrophysiological changes in athletes with a history of multiple concussions. Brain Inj. 2007;21(6):631–44.

    PubMed  Google Scholar 

  6. 6.

    McCrory P. Sports concussion and the risk of chronic neurological impairment. Clin J Sports Med. 2011;21(1):6–12.

    Google Scholar 

  7. 7.

    Langlois J, Rutland-Brown W, Wald M. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21(5):375–8.

    PubMed  Google Scholar 

  8. 8.

    Gessel L, Fields S, Collins C, et al. Concussions among United States high school and collegiate athletes. J Athl Train. 2007;42(4):495–503.

    PubMed  PubMed Central  Google Scholar 

  9. 9.

    Powell J, Barber-Foss K. Traumatic brain injury in high school athletes. J Am Med Assoc. 1999;282(10):958–63.

    CAS  Google Scholar 

  10. 10.

    Sosin D, Sniezek J, Thurman D. Incidence of mild and moderate brain injury in the United States, 1991. Brain Inj. 1996;10(1):47–54.

    PubMed  CAS  Google Scholar 

  11. 11.

    Guskiewicz K, Weaver N, Padua D, et al. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. 2000;28(5):643–50.

    PubMed  CAS  Google Scholar 

  12. 12.

    Hunt T, Asplund C. Concussion assessment and management. Clin Sports Med. 2010;29(1):5–17.

    PubMed  Google Scholar 

  13. 13.

    McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport—the 3rd International Conference on Concussion in Sport held in Zurich, November 2008. J Sci Med Sport. 2009;12(3):340–51.

    PubMed  CAS  Google Scholar 

  14. 14.

    Covassin T, Stearne D, Elbin R III. Concussion history and postconcussive neurocognitive performance and symptoms in collegiate athletes. J Athl Train. 2008;43(2):119–24.

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Iverson G, Gaetz M, Lovell M, et al. Cumulative effects of concussion in amateur athletes. Brain Inj. 2004;18(5):433–43.

    PubMed  Google Scholar 

  16. 16.

    Matser E, Kessels A, Lezak M, et al. Neuropsychological impairment in amateur soccer players. J Am Med Assoc. 1999;282(10):971–3.

    CAS  Google Scholar 

  17. 17.

    McCrea M, Guskiewicz K, Marshall S, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. J Am Med Assoc. 2003;290(19):2556–63.

    CAS  Google Scholar 

  18. 18.

    Delaney J, Lacroix V, Leclerc S, et al. Concussions among university football and soccer players. Clin J Sport Med. 2002;12(6):331–8.

    PubMed  Google Scholar 

  19. 19.

    Guskiewicz K, McCrea M, Marshall S, et al. Cumulative effects associated with recurrent concussion in collegiate football players. J Am Med Assoc. 2003;290(19):2549–55.

    CAS  Google Scholar 

  20. 20.

    Kemp S, Hudson Z, Brooks J, et al. The epidemiology of head injuries in English professional rugby union. Clin J Sports Med. 2008;18(3):227–34.

    Google Scholar 

  21. 21.

    Guskiewicz K, Marshall S, Bailes J, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007;39(6):903–9.

    PubMed  Google Scholar 

  22. 22.

    Guskiewicz K, Marshall S, Bailes J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005;57(4):719–26.

    PubMed  Google Scholar 

  23. 23.

    McKee A, Cantu R, Nowinski C, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68(7):709–35.

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    McCrory P, Meeuwisse W, Kutcher J, et al. What is the evidence for chronic concussion-related changes in retired athletes: behavioural, pathological and clinical outcomes? Br J Sports Med. 2013;47(5):327–30.

    PubMed  Google Scholar 

  25. 25.

    Harris A, Voaklander D, Jones C, et al. Time-to-subsequent head injury from sports and recreation activities. Clin J Sport Med. 2012;22(2):91–7.

    PubMed  Google Scholar 

  26. 26.

    Meehan W III, Bachur R. Sport-related concussion. Pediatrics. 2009;123(1):114–23.

    PubMed  Google Scholar 

  27. 27.

    Patel D, Shivdasani V, Baker R. Management of sport-related concussion in young athletes. Sports Med. 2005;35(8):671–84.

    PubMed  Google Scholar 

  28. 28.

    Stroup D, Berlin J, Morton S, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. J Am Med Assoc. 2000;283(15):2008–12.

    CAS  Google Scholar 

  29. 29.

    Liberati A, Altman D, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. Br Med J. 2009;339:b2700.

    Google Scholar 

  30. 30.

    von Elm E, Altman D, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Guidelines for reporting observational studies. Epidemiology. 2007;18(6):800–4.

    Google Scholar 

  31. 31.

    Brouwers M, Kho M, Browman G, et al. AGREE II: advancing guideline development, reporting and evaluation in health care. Can Med Assoc J. 2010;182(18):E839–42.

    Google Scholar 

  32. 32.

    Loosemore M, Knowles C, Whyte G. Amateur boxing and risk of chronic traumatic brain injury: systematic review of observational studies. Br Med J. 2007;335(7624):809–12.

    Google Scholar 

  33. 33.

    Ackery A, Prowidenza C, Tator CH. Concussion in hockey: compliance with return to play advice and follow-up status. Can J Neurol Sci. 2009;36(2):207–12.

    PubMed  Google Scholar 

  34. 34.

    Barnes B, Cooper L, Kirkendall D, et al. Concussion history in elite male and female soccer players. Am J Sports Med. 1998;26(3):433–8.

    PubMed  CAS  Google Scholar 

  35. 35.

    Bazarian J, McClung J, Cheng Y, et al. Emergency department management of mild traumatic brain injury in the USA. Emerg Med J. 2005;22(7):473–7.

    PubMed  PubMed Central  CAS  Google Scholar 

  36. 36.

    Bazarian J, Veenema T, Brayer A, et al. Knowledge of concussion guidelines among practitioners caring for children. Clin Pediatr. 2001;40(4):207–12.

    CAS  Google Scholar 

  37. 37.

    Bazarian J, Zhu T, Blyth B, et al. Subject-specific changes in brain white matter on diffusion tensor imaging after sports-related concussion. Magn Reson Imaging. 2012;30(2):171–80.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Beckwith J, Greenwald R, Chu J, et al. Head impact exposure sustained by football players on days of diagnosed concussion. Med Sci Sport Exerc. 2013;45(4):737–46.

    Google Scholar 

  39. 39.

    Beckwith J, Greenwald R, Chu J, et al. Timing of concussion diagnosis is related to head impact exposure prior to injury. Med Sci Sport Exerc. 2013;45(4):747–54.

    Google Scholar 

  40. 40.

    Bernstein D. Information processing difficulty long after self-reported concussion. J Int Neuropsychol Soc. 2002;8(5):673–82.

    PubMed  Google Scholar 

  41. 41.

    Bloom G, Loughead T, Shapcott E, et al. The prevalence and recovery of concussed male and female collegiate athletes. Eur J Sport Sci. 2008;8(5):295–303.

    Google Scholar 

  42. 42.

    Bramley H, Patrick K, Lehman E, et al. High school soccer players with concussion education are more likely to notify their coach of a suspected concussion. Clin Pediatr. 2012;51(4):332–6.

    Google Scholar 

  43. 43.

    Breedlove E, Robinson M, Talavage T, et al. Biomechanical correlates of symptomatic and asymptomatic neurophysiological impairment in high school football. J Biomech. 2012;45(7):1265–72.

    PubMed  Google Scholar 

  44. 44.

    Broglio S, Schnebel B, Sosnoff J, et al. Biomechanical properties of concussions in high school football. Med Sci Sports Exerc. 2010;42(11):2064–71.

    PubMed  PubMed Central  Google Scholar 

  45. 45.

    Broglio SP, Eckner J, Martini D, et al. Cumulative head impact burden in high school football. J Neurotrauma. 2011;28(10):2069–78.

    PubMed  Google Scholar 

  46. 46.

    Brolinson P, Manoogian S, McNeely D, et al. Analysis of linear head accelerations from collegiate football impacts. Curr Sports Med Rep. 2006;5(1):23–8.

    PubMed  Google Scholar 

  47. 47.

    Broshek D, Kaushik T, Freeman J, et al. Sex differences in outcome following sports-related concussion. J Neurosurg. 2005;102(5):856–63.

    PubMed  Google Scholar 

  48. 48.

    Chrisman S, Schiff M, Rivara F. Physician concussion knowledge and the effects of mailing the CDC’s “Heads Up” toolkit. Clin Ped. 2011;50(11):1031–9.

    Google Scholar 

  49. 49.

    Coldren R, Kelly M, Parrish R, et al. Evaluation of the Military Acute Concussion Evaluation for use in combat operations more than 12 hours after injury. Mil Med. 2010;175(7):477–81.

    PubMed  Google Scholar 

  50. 50.

    Collins M, Grindel S, Lovell M, et al. Relationship between concussion and neuropsychological performance in college football players. J Am Med Soc. 1999;282(10):964–70.

    CAS  Google Scholar 

  51. 51.

    Colvin A, Mullen J, Lovell M, et al. The role of concussion history and gender in recovery from soccer-related concussion. Am J Sports Med. 2009;37(9):1699–704.

    PubMed  Google Scholar 

  52. 52.

    Covassin T, Swanik C, Sachs M. Sex differences and the incidence of concussions among collegiate athletes. J Athl Train. 2003;38(3):238–44.

    PubMed  PubMed Central  Google Scholar 

  53. 53.

    Covassin T, Swanik C, Sachs M, et al. Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes. Br J Sports Med. 2006;40:923–7.

    PubMed  PubMed Central  CAS  Google Scholar 

  54. 54.

    Covassin T, Elbin R III, Stiller-Ostrowski J. Current sport-related concussion teaching and clinical practices of sports medicine professionals. J Athl Train. 2009;44(4):400–4.

    PubMed  PubMed Central  Google Scholar 

  55. 55.

    Covassin T, Elbin R, Larson E, et al. Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms. Clin J Sport Med. 2012;22(2):98–104.

    PubMed  Google Scholar 

  56. 56.

    Covassin T, Elbin R, Harris W, et al. The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med. 2012;40(6):1303–12.

    PubMed  Google Scholar 

  57. 57.

    Delaney J, Lacroix V, Leclerc S, et al. Concussions during the 1997 Canadian football league season. Clin J Sport Med. 2000;10(1):9–14.

    PubMed  CAS  Google Scholar 

  58. 58.

    Duma S, Manoogian S, Bussone W, et al. Analysis of real-time head accelerations in collegiate football players. Clin J Sport Med. 2005;15(1):3–8.

    PubMed  Google Scholar 

  59. 59.

    Echemendia R, Julian L. Mild traumatic brain injury in sports: neuropsychology’s contribution to a developing field. Neuropsychol Rev. 2001;11(2):69–88.

    PubMed  CAS  Google Scholar 

  60. 60.

    Echlin P. Editorial: a prospective study of physician-observed concussion during a varsity university ice hockey season. Part 1 of 4. Neurosurg Focus. 2012;33(6):E1.

    PubMed  Google Scholar 

  61. 61.

    Emery C, Kang J, Shrier I, et al. Risk of injury associated with bodychecking experience among youth hockey players. Can Med Assoc J. 2011;183(11):1249–56.

    Google Scholar 

  62. 62.

    Erlanger D, Saliba E, Barth J, et al. Monitoring resolution of postconcussion symptoms in athletes: preliminary results of a web-based neuropsychological test protocol. J Athl Train. 2001;36(3):280–7.

    PubMed  PubMed Central  Google Scholar 

  63. 63.

    Esposito G, Van Horn J, Weinberger D, et al. Gender differences in cerebral blood flow as a function of cognitive state with PET. J Nucl Med. 1996;37(4):559–64.

    PubMed  CAS  Google Scholar 

  64. 64.

    Field M, Collins M, Lovell M, et al. Does age play a role in recovery from sports related concussion? A comparison of high school and collegiate athletes. J Pediatr. 2003;142(5):546–53.

    PubMed  Google Scholar 

  65. 65.

    Frommer L, Gurka K, Cross K, et al. Sex differences in concussion symptoms of high school athletes. J Athl Train. 2011;46(1):76–84.

    PubMed  PubMed Central  Google Scholar 

  66. 66.

    Galetta K, Barrett J, Allen M, et al. The King-Devick test as a determinant of head trauma and concussion in boxers and MMA fighters. Neurology. 2011;76(17):1456–62.

    PubMed  PubMed Central  CAS  Google Scholar 

  67. 67.

    Galetta K, Brandes L, Maki K, et al. The King-Devick test and sports-related concussion: study of a rapid visual screening tool in a collegiate cohort. J Neurol Sci. 2011;309(1–2):34–9.

    PubMed  Google Scholar 

  68. 68.

    Galetta M, Galetta K, McCrossin J, et al. Saccades and memory: baseline associations of the King-Devick and SCAT2 SAC tests in professional ice hockey players. J Neurol Sci. 2013;328(1–2):28–31.

    PubMed  Google Scholar 

  69. 69.

    Genuardi F, King W. Inappropriate discharge instructions for youth athletes hospitalized for concussion. Pediatrics. 1995;95(2):216–8.

    PubMed  CAS  Google Scholar 

  70. 70.

    Giebel S, Kothari R, Koestner A, et al. Factors influencing emergency medicine physicians’ management of sports-related concussions: a community-wide study. J Emerg Med. 2011;41(6):649–54.

    PubMed  Google Scholar 

  71. 71.

    Gordon KE, Dooley JM, Wood EP. Is migraine a risk factor for the development of concussion? Br J Sports Med. 2006;40(2):184–5.

    PubMed  PubMed Central  CAS  Google Scholar 

  72. 72.

    Gronwall D, Wrightson P. Cumulative effect of concussion. Lancet. 1975;2(7943):995–7.

    PubMed  CAS  Google Scholar 

  73. 73.

    Guilmette T, Malia L, McQuiggan D. Concussion understanding and management among New England high school football coaches. Brain Inj. 2007;21(10):1039–47.

    PubMed  Google Scholar 

  74. 74.

    Guskiewicz K, Mihalik J, Shankar V, et al. Measurement of head impacts in collegiate football players; relationship between head impact biomechanics and acute clinical outcome after concussion. Neurosurgery. 2007;61(6):1244–53.

    PubMed  Google Scholar 

  75. 75.

    Hanlon E, Bir C. Real-time head acceleration measurements in girls youth soccer. Med Sci Sports Exerc. 2012;44(6):1102–8.

    PubMed  Google Scholar 

  76. 76.

    Hollis S, Stevenson M, McIntosh A, et al. Incidence, risk, and protective factors of mild traumatic brain injury in a cohort of Australian nonprofessional male rugby players. Am J Sports Med. 2009;29(12):2328–33.

    Google Scholar 

  77. 77.

    Hollis S, Stevenson M, McIntosh A, et al. Compliance with return-to-play regulations following concussion in Australian schoolboy and community rugby union players. Br J Sports Med. 2011. doi:10.1136/bjsm.2011.085332.

    Google Scholar 

  78. 78.

    Hootman J, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–9.

    PubMed  PubMed Central  Google Scholar 

  79. 79.

    Iverson G. Predicting slow recovery from sport-related concussion: the new simple–complex distinction. Clin J Sport Med. 2007;17(1):31–7.

    PubMed  Google Scholar 

  80. 80.

    Iverson G, Brooks B, Collins M, et al. Tracking neuropsychological recovery following concussion in sport. Brain Inj. 2006;20(3):245–52.

    PubMed  Google Scholar 

  81. 81.

    Iverson G, Brooks B, Lovell M, et al. No cumulative effects for one or two previous concussions. Br J Sports Med. 2006;40(1):72–5.

    PubMed  PubMed Central  CAS  Google Scholar 

  82. 82.

    Katayama Y, Becker D, Tamura T, et al. Massive increases in extracellular potassium and the indiscriminate release of glutamate following concussive brain injury. J Neurosurg. 1990;73(6):889–900.

    PubMed  CAS  Google Scholar 

  83. 83.

    Kaut K, DePompei R, Kerr J, et al. Reports of head injury and symptom knowledge among college athletes: implications for assessment and educational intervention. Clin J Sport Med. 2003;13(4):213–21.

    PubMed  Google Scholar 

  84. 84.

    Kinart C, Cuppett M, Berg K. Prevalence of migraines in NCAA division 1 male and female basketball players. Headache. 2002;42(7):620–9.

    PubMed  Google Scholar 

  85. 85.

    King D, Hume P, Clark T. First-aid and concussion knowledge of rugby league team management, administrators and officials in New Zealand. N Z J Sports Med. 2010;37(2):52–68.

    Google Scholar 

  86. 86.

    King D, Clark T, Gissane C. Use of a rapid visual screening tool for the assessment of concussion in amateur rugby league: a pilot study. J Neurol Sci. 2012;320(1–2):16–21.

    PubMed  Google Scholar 

  87. 87.

    King D, Brughelli M, Hume P, et al. Concussions in amateur rugby union identified with the use of a rapid visual screening tool. J Neurol Sci. 2013;326(1–2):59–63.

    PubMed  Google Scholar 

  88. 88.

    King D, Gissane C, Brughelli M, et al. Sport-related concussions in New Zealand: a review of 10 years of accident compensation corporation moderate to severe claims and costs. J Sci Med Sport. 2013. doi:10.1016/j.jsams.2013.05.007.

    Google Scholar 

  89. 89.

    Kontos A, Covassin T, Elbin R, et al. Depression and neurocognitive performance after concussion among male and female high school and collegiate athletes. Arch Phys Med Rehab. 2012;93(10):1751–6.

    Google Scholar 

  90. 90.

    Kristman V, Tator C, Kreiger N, et al. Does the apolipoprotein ε4 allele predispose varsity athletes to concussion? A prospective cohort study. Clin J Sport Med. 2008;18(4):322–8.

    PubMed  Google Scholar 

  91. 91.

    Laubscher J, Dijkstra H, Strydom G, et al. Academic consequences of very mild and mild traumatic brain injuries in secondary school rugby players. Afr J Phys Health Educ Recreat Dance. 2010;16(2):221–30.

    Google Scholar 

  92. 92.

    Lebrun C, Mrazik M, Prasad A, et al. Sport concussion knowledge base, clinical practises and needs for continuing medical education: a survey of family physicians and cross-border comparison. Br J Sports Med. 2013;47(1):54–9.

    PubMed  Google Scholar 

  93. 93.

    Len T, Neary J, Asmundson G, et al. Cerebrovascular reactivity impairment after sport-induced concussion. Med Sci Sports Exerc. 2011;43(12):2241–8.

    PubMed  Google Scholar 

  94. 94.

    Lincoln A, Caswell S, Almquist J, et al. Trends in concussion incidence in high school sports: a prospective 11 year study. Am J Sports Med. 2011;39(5):958–63.

    PubMed  Google Scholar 

  95. 95.

    Longhi L, Saatman K, Fujimoto S, et al. Temporal window of vulnerability to repetitive experimental concussive brain injury. Neurosurgery. 2005;56(2):364–74.

    PubMed  Google Scholar 

  96. 96.

    Lovell M, Collins M, Iverson G, et al. Recovery from mild concussion in high school athletes. J Neurosurg. 2003;98(2):296–301.

    PubMed  Google Scholar 

  97. 97.

    Löwenhielm P. Mathematical simulation of gliding contusions. J Biomech. 1975;8(6):351–6.

    PubMed  Google Scholar 

  98. 98.

    Macciocchi S, Barth J, Alves W, et al. Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery. 1996;39(3):510–4.

    PubMed  CAS  Google Scholar 

  99. 99.

    Makdissi M, Darby D, Maruff P, et al. Natural history of concussion in sport: markers of severity and implications in sport. Am J Sports Med. 2010;38(3):464–71.

    PubMed  Google Scholar 

  100. 100.

    Marar M, McIlvain N, Fields S, et al. Epidemiology of concussions among United States high school athletes in 20 sports. Am J Sports Med. 2012;40(4):747–55.

    PubMed  Google Scholar 

  101. 101.

    Martini D, Eckner J, Kutcher J, et al. Sub-concussive head impact biomechanics: comparing differing offensive schemes. Med Sci Sport Exerc. 2013;45(4):755–61.

    Google Scholar 

  102. 102.

    McCaffrey M, Mihalik J, Crowell D, et al. Measurement of head impacts in collegiate football players: clinical measures of concussion after high- and low-magnitude impacts. Neurosurgery. 2007;61(6):1236–43.

    PubMed  Google Scholar 

  103. 103.

    McCrea M, Barr W, Guskiewicz K, et al. Standard regression-based methods for measuring recovery after sport-related concussion. J Int Neuropsychol Soc. 2005;11(1):58–69.

    PubMed  Google Scholar 

  104. 104.

    McCrea M, Hammeke T, Olsen G, et al. Unreported concussion in high school football players: implications for prevention. Clin J Sports Med. 2004;14(1):13–7.

    Google Scholar 

  105. 105.

    McKee A, Stein T, Nowinski C, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136(1):43–64.

    Google Scholar 

  106. 106.

    McKinlay A, Bishop A, McLellan T. Public knowledge of ‘concussion’ and the different terminology used to communicate about mild traumatic brain injury (MTBI). Brain Inj. 2011;25(7–8):761–6.

    PubMed  CAS  Google Scholar 

  107. 107.

    Meehan W III, d’Hemecourt P, Comstock R. High school concussions in the 2008–2009 academic year. Am J Sports Med. 2010;38(12):2405–9.

    PubMed  PubMed Central  Google Scholar 

  108. 108.

    Mihalik J, Stump J, Collins M, et al. Posttraumatic migraine characteristics in athletes following sports-related concussion. J Neurosurg. 2005;102(5):850–5.

    PubMed  Google Scholar 

  109. 109.

    Moser R, Glatts C, Schatz P. Efficacy of immediate and delayed cognitive and physical rest for treatment of sports-related concussion. J Pediatr. 2012;161(5):922–6.

    PubMed  Google Scholar 

  110. 110.

    Moser R, Schatz P, Jordan B. Prolonged effects of concussion in high school athletes. Neurosurgery. 2005;57(2):300–6.

    PubMed  Google Scholar 

  111. 111.

    Naunheim R, Standeven J, Richter C, et al. Comparison of impact data in hockey, football, and soccer. J Trauma. 2000;48(5):938–41.

    PubMed  CAS  Google Scholar 

  112. 112.

    Notebaert A, Guskiewicz K. Current trends in athletic training practice for concussion assessment and management. J Athl Train. 2005;40(4):320–5.

    PubMed  PubMed Central  Google Scholar 

  113. 113.

    O’Donoghue E, Onate J, Van Lunen B, et al. Assessment of high school coaches’ knowledge of sport-related concussion. Athl Train Sports Health Care. 2009;1(3):120–32.

    Google Scholar 

  114. 114.

    Pardini D, Stump J, Lovell M, et al. The post-concussion symptom scale (PCSS): a factor analysis. Br J Sports Med. 2004;38(5):661.

    Google Scholar 

  115. 115.

    Parkinson D. Concussion. Mayo Clin Proc. 1977;52(8):492–9.

    PubMed  CAS  Google Scholar 

  116. 116.

    Pellman E, Viano D, Tucker A, et al. Concussion in professional football: location and direction of helmet impacts—Part 2. Neurosurgery. 2003;53(6):1328–41.

    PubMed  Google Scholar 

  117. 117.

    Pellman E, Viano D, Tucker A, et al. Concussion in professional football: reconstruction of game impacts and injuries. Neurosurgery. 2003;53(4):799–814.

    PubMed  Google Scholar 

  118. 118.

    Pellman E, Viano D, Casson I, et al. Concussion in professional football: injuries involving 7 or more days out-part 5. Neurosurgery. 2004;55(5):1100–19.

    PubMed  Google Scholar 

  119. 119.

    Pettersen J. Does rugby headgear prevent concussion? Attitudes of Canadian players and coaches. Br J Sports Med. 2002;36(1):19–22.

    PubMed  PubMed Central  CAS  Google Scholar 

  120. 120.

    Pleacher M, Dexter W, Heinz W. Concussion management by primary care providers. Br J Sports Med. 2006;40(1):e2.

    PubMed  PubMed Central  CAS  Google Scholar 

  121. 121.

    Prins M, Hales A, Reger M, et al. Repeat traumatic brain injury in the juvenile rat is associated with increased axonal injury and cognitive impairments. Dev Neuropsychol. 2011;32(5–6):510–8.

    Google Scholar 

  122. 122.

    Prins M, Giza C. Repeat traumatic brain injury in the developing brain. Int J Dev Neurosci. 2011;30(3):185–90.

    PubMed  Google Scholar 

  123. 123.

    Reed N, Taha T, Keightley M, et al. Measurement of head impacts in youth ice hockey players. Int J Sports Med. 2010;31(11):826–33.

    PubMed  CAS  Google Scholar 

  124. 124.

    Schaal K, Tafflet M, Nassif H, et al. Psychological balance in high level athletes: gender-based differences and sport-specific patterns. PLoS One. 2011;6(5):e19007.

    PubMed  PubMed Central  CAS  Google Scholar 

  125. 125.

    Schneider K, Zernicke R. Computer simulation of head impact: estimation of head-injury risk during soccer heading. Int J Sport Biomech. 1988;4(4):358–71.

    Google Scholar 

  126. 126.

    Schulz M, Marshall S, Mueller F, et al. Incidence and risk factors for concussion in high school athletes, North Carolina, 1996–1999. Am J Epidemiol. 2004;160(10):937–44.

    PubMed  Google Scholar 

  127. 127.

    Shultz S, Bao F, Omana V, et al. Repeated mild lateral fluid percussion brain injury in the rat causes cumulative long-term behavioral impairments, neuroinflammation, and cortical loss in an animal model of repeated concussion. J Neurotrauma. 2012;20(2):281–94.

    Google Scholar 

  128. 128.

    Shultz S, MacFabe D, Foley K, et al. Sub-concussive brain injury in the Long–Evans rat induces acute neuroinflammation in the absence of behavioral impairments. Behav Brain Res. 2012;229(1):145–52.

    PubMed  CAS  Google Scholar 

  129. 129.

    Sim A, Terryberry-Spohr L, Wilson K. Prolonged recovery of memory functioning after mild traumatic brain injury in adolescent athletes. J Neurosurg. 2008;108(3):511–6.

    PubMed  Google Scholar 

  130. 130.

    Slobounov S, Slobounov E, Sebastianelli W, et al. Different rate of recovery in athletes after first and second concussion episodes. Neurosurgery. 2007;61(2):338–44.

    PubMed  Google Scholar 

  131. 131.

    Snoek J, Minderhoud J, Wilmink J. Delayed deterioration following mild head injury in children. Brain. 1984;107(1):15–36.

    PubMed  Google Scholar 

  132. 132.

    Solomon G, Haase R. Biopsychosocial characteristics and neurocognitive test performance in National Football League players: an initial assessment. Arch Clin Neuropsych. 2008;23(5):563–77.

    Google Scholar 

  133. 133.

    Spiotta A, Shin J, Bartsch A, et al. Subconcussive impact in sports: a new era of awareness. World Neurosurg. 2011;75(2):175–8.

    PubMed  Google Scholar 

  134. 134.

    Sullivan S, Bourne L, Choie S, et al. Understanding of sport concussion by the parents of young rugby players: a pilot study. Clin J Sports Med. 2009;19(3):228–30.

    Google Scholar 

  135. 135.

    Sye G, Sullivan S, McCrory P. High school rugby players’ understanding of concussion and return to play guidelines. Br J Sports Med. 2006;40(12):1003–5.

    PubMed  PubMed Central  Google Scholar 

  136. 136.

    Talavage T, Nauman E, Breedlove E, et al. Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion. J Neurotrauma. 2013. doi:10.1089/neu.2010.1512.

    PubMed  Google Scholar 

  137. 137.

    Tavazzi B, Vagnozzi R, Signoretti S, et al. Temporal window of metabolic brain vulnerability to concussions: oxidative and nitrosative stresses—Part II. Neurosurgery. 2007;61(2):390–6.

    PubMed  Google Scholar 

  138. 138.

    Terrell T, Bostick R, Abramson R, et al. APOE, APOE promoter, and tau genotypes and risk for concussion in college athletes. Clin J Sport Med. 2008;18(1):10–7.

    PubMed  Google Scholar 

  139. 139.

    Tierney R, Mansell J, Higgins M, et al. Apolipoprotein E genotype and concussion in college athletes. Clin J Sport Med. 2010;20(6):464–8.

    PubMed  Google Scholar 

  140. 140.

    Tierney R, Sitler M, Swanik C, et al. Gender differences in head-neck segment dynamic stabilization during head acceleration. Med Sci Sports Exerc. 2005;37(2):272–9.

    PubMed  Google Scholar 

  141. 141.

    Vagnozzi R, Signoretti S, Cristofori L, et al. Assessment of metabolic brain damage and recovery following mild traumatic brain injury: a multicentre, proton magnetic resonance spectroscopic study in concussed patients. Brain. 2010;133(11):3232–42.

    PubMed  Google Scholar 

  142. 142.

    Vagnozzi R, Signoretti S, Tavazzi B, et al. Temporal window of metabolic brain vulnerability to concussion: a pilot 1H-magnetic resonance spectroscopic study in concussed athletes—part III. Neurosurgery. 2008;62(6):1286–95.

    PubMed  Google Scholar 

  143. 143.

    Valovich McLeod T, Schwartz C, Bay R. Sport-related concussion misunderstandings among youth coaches. Clin J Sports Med. 2007;17(2):140–2.

    Google Scholar 

  144. 144.

    Viano D, Pellman E. Concussion in professional football: biomechanics of the striking player—part 8. Neurosurgery. 2005;56(2):266–80.

    PubMed  Google Scholar 

  145. 145.

    Viano DC, Casson IR, Pellman EJ. Concussion in professional football: biomechanics of the struck player—part 14. Neurosurgery. 2007;61(2):313–27 discussion 27–28.

    PubMed  Google Scholar 

  146. 146.

    Voller B, Benke T, Benedetto K, et al. Neuropsychological, MRI and EEG findings after very mild traumatic brain injury. Brain Inj. 1999;13(10):821–7.

    PubMed  CAS  Google Scholar 

  147. 147.

    Williamson I, Goodman D, Delaney J. Converging evidence for the under-reporting of concussions in youth ice hockey. Br J Sports Med. 2006;40(2):128–32.

    PubMed  PubMed Central  CAS  Google Scholar 

  148. 148.

    Zuckerman S, Solomon G, Forbes J, et al. Response to acute concussive injury in soccer players: is gender a modifying factor? J Neurosurg. 2012;10(6):504–10.

    Google Scholar 

  149. 149.

    Alla S, Sullivan SJ, Hale L, et al. Self-report scales/checklists for the measurement of concussion symptoms: a systematic review. Br J Sports Med. 2009;43(Suppl 1):i3–12.

    PubMed  Google Scholar 

  150. 150.

    Berrigan L, Marshall S, McCullagh S, et al. Quality of clinical practice guidelines for persons who have sustained mild traumatic brain injury. Brain Inj. 2011;25(7–8):742–51.

    PubMed  Google Scholar 

  151. 151.

    Broglio S, Puetz T. The effect of sport concussion on neurocognitive function, self-report symptoms and postural control: a meta-analysis. Sports Med. 2008;38(1):53–67.

    PubMed  Google Scholar 

  152. 152.

    Canadian Paediatric Society. Identification and management of children with sport-related concussion. Paediatric Child Health. 2006;11(7):420–8.

    Google Scholar 

  153. 153.

    Davis G, Purcell L. The evaluation and management of acute concussion differs in young children. Br J Sports Med. 2013. doi:10.1136/bjsports-2012-092132.

    Google Scholar 

  154. 154.

    Echemendia R, Herring S, Bailes J. Who should conduct and interpret the neuropsychological assessment in sports-related concussion? Br J Sports Med. 2009;43(Suppl 1):i32–5.

    PubMed  Google Scholar 

  155. 155.

    Echemendia R. Cerebral concussion in sport: an overview. J Clin Sports Psych. 2012;6(3):207–30.

    Google Scholar 

  156. 156.

    Echemendia R, Iverson G, McCrea M, et al. Advances in neuropsychological assessment of sport-related concussion. Br J Sports Med. 2013;47(5):294–8.

    PubMed  Google Scholar 

  157. 157.

    Eckner J, Kutcher J. Concussion symptoms scales and sideline assessment tools: a critical literature update. Curr Sports Med Rep. 2010;9(1):8–15.

    PubMed  Google Scholar 

  158. 158.

    Ellemberg D, Henry L, Macciocchi S, et al. Advances in sport concussion assessment: from behavioral to brain imaging measures. J Neurotrauma. 2009;26(12):2365–82.

    PubMed  Google Scholar 

  159. 159.

    Gasquoine P. Historical perspectives on postconcussion symptoms. Clin Neurophysiol. 1998;12(3):315–24.

    Google Scholar 

  160. 160.

    Giza C, Kutcher J, Ashwal S, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013. doi:10.1212/WNL.0b013e31828d57dd.

    PubMed Central  Google Scholar 

  161. 161.

    Grady M, Master C, Gioia G. Concussion pathophysiology: rationale for physical and cognitive rest. Pediatr Ann. 2012;41(9):377–8.

    PubMed  Google Scholar 

  162. 162.

    Johnson E, Kegel N, Collins M. Neuropsychological assessment of sport-related concussion. Clin Sports Med. 2011;30(1):73–88.

    PubMed  Google Scholar 

  163. 163.

    Leclerc S, Lassonde M, Delaney J, et al. Recommendations for grading of concussion in athletes. Sports Med. 2001;31(8):629–36.

    PubMed  CAS  Google Scholar 

  164. 164.

    Makdissi M, Davis G, Jordan B, et al. Revisiting the modifiers: how should the evaluation and management of acute concussions differ in specific groups? Br J Sports Med. 2013;47(5):314–20.

    PubMed  Google Scholar 

  165. 165.

    Marshall C. Sports-related concussion: a narrative review of the literature. J Can Chiropr Assoc. 2012;56(4):299–310.

    PubMed  PubMed Central  Google Scholar 

  166. 166.

    McCrory P, Berkovic S. Second impact syndrome. Neurology. 1998;50(3):677–83.

    PubMed  CAS  Google Scholar 

  167. 167.

    McCrory P, Davis G, Makdissi M. Second impact syndrome or cerebral swelling after sporting head injury. Curr Sports Med Rep. 2012;11(1):21–3.

    PubMed  Google Scholar 

  168. 168.

    McCrory P, Meeuwisse W, Echemendia R, et al. What is the lowest threshold to make a diagnosis of concussion? Br J Sports Med. 2013;47(5):268–71.

    PubMed  Google Scholar 

  169. 169.

    New Zealand Guidelines Group. Traumatic brain injury: diagnosis, acute management and rehabilitation. Wellington: New Zealand Guidelines Group (NZGG); 2006.

    Google Scholar 

  170. 170.

    Peloso P, Carroll L, Cassidy J, et al. Critical evaluation of the existing guidelines on mild traumatic brain injury. J Rehabil Med. 2004;43(Suppl):106–12.

    PubMed  Google Scholar 

  171. 171.

    Putukian M. The acute symptoms of sport-related concussion: diagnosis and on-field management. Clin Sports Med. 2011;30(1):49–61.

    PubMed  Google Scholar 

  172. 172.

    Putukian M, Aubry M, McCrory P. Return to play after sports concussion in elite and non-elite athletes? Br J Sports Med. 2009;43(Suppl_1):i28–31.

    PubMed  Google Scholar 

  173. 173.

    Rusnak M, Mauritz W, Lecky F, et al. Evaluation of traumatic brain injury guidelines using AGREE instrument. Bratisl Lek Listy. 2008;109(8):374–80.

    PubMed  CAS  Google Scholar 

  174. 174.

    Ropper A, Gorson K. Concussion. N Engl J Med. 2007;356(2):116–72.

    Google Scholar 

  175. 175.

    Randolph C, McCrea M, Barr W. Is neurological testing useful in the management of sport-related concussion? J Athl Train. 2005;40(3):139–54.

    PubMed  PubMed Central  Google Scholar 

  176. 176.

    Tavender E, Bosch M, Green S, et al. Quality and consistency of guidelines for the management of mild traumatic brain injury in the emergency department. Acad Emerg Med. 2011;18(8):880–9.

    PubMed  Google Scholar 

  177. 177.

    Tommasone B, Valovich McLeod T. Contact sport concussion incidence. J Athl Train. 2006;41(4):470–2.

    PubMed  PubMed Central  Google Scholar 

  178. 178.

    Buchanan K, Slattery DE, Klauer K. Emergency physician knowledge and practice habits when evaluating youth sports-related concussion in the emergency department. Ann Emerg Med. 2011;58(4):S185.

    Google Scholar 

  179. 179.

    Collie A, Maruff P, Makdissi M, et al. Statistical procedures for determining the extent of cognitive change following concussion. Br J Sports Med. 2004;38:273–8.

    PubMed  PubMed Central  CAS  Google Scholar 

  180. 180.

    Heitger M, Jones R, Anderson T. A new approach to predicting postconcussion syndrome after mild traumatic brain injury based upon eye movement function. In: Conference Proceedings of the IEEE Engineering in Medicine and Biology Society, Vancouver, BC; 2008. p. 3570-3.

  181. 181.

    King A, Yang K, Zhang L, et al. Is head injury caused by linear or angular acceleration? IRCOBI Conference, Lisbon, Portugal; 2003. p. 1–12.

  182. 182.

    McCrea M. Standardized mental status assessment of sports concussion. Clin J Sports Med. 2001;11(3):176–81.

    CAS  Google Scholar 

  183. 183.

    Valovich McLeod T, Bay R, Lam K, et al. Representative baseline values on the Sport Concussion Assessment Tool 2 (SCAT2) in adolescent athletes vary by gender, grade, and concussion history. Am J Sports Med. 2012;40(4):927–33.

    PubMed  Google Scholar 

  184. 184.

    Zuckerman S, Odom M, Lee Y, et al. 145 sport-related concussion and age: number of days to neurocognitive baseline. Neurosurgery. 2012;71(2):E558.

    Google Scholar 

  185. 185.

    American Academy Neurology. Practice parameter: the management of concussion in sports. Neurology. 1997;48:581–5.

    Google Scholar 

  186. 186.

    American Congress of Rehabilitation Medicine. Definition of a mild traumatic brain injury. J Head Trauma Rehabil. 1993;8(3):86–7.

    Google Scholar 

  187. 187.

    Aubry M, Cantu R, Dvorak J, et al. Summary and agreement statement of the First International Conference on Concussion in Sport, Vienna 2001. Br J Sports Med. 2002;36(1):3–7.

    Google Scholar 

  188. 188.

    Colorado Medical Society. Report of the Sports Medicine Committee: Guidelines for the Management of Concussions in Sport (Revised). Denver: Colorado Medical Society; 1991.

    Google Scholar 

  189. 189.

    Cushman J, Agarwal N, Fabian T, et al. Practice management guidelines for the management of mild traumatic brain injury: The EAST practice management guidelines work group. J Trauma. 2001;51(5):1016–26.

    PubMed  CAS  Google Scholar 

  190. 190.

    Gianotti S, Hume P. Concussion sideline management intervention for rugby union leads to reduced concussion entitlement claims. Neuro Rehab. 2007;22(3):181–9.

    Google Scholar 

  191. 191.

    Guskiewicz K, Register-Mihalik J, McCrory P, et al. Evidence-based approach to revising the SCAT2: introducing the SCAT3. Br J Sports Med. 2013;47(5):289–93.

    PubMed  Google Scholar 

  192. 192.

    Halstead M, Walter K. The council on sports medicine fitness. Clinical report—sport-related concussion in children and adolescents. Pediatrics. 2010;126(3):597–615.

    PubMed  Google Scholar 

  193. 193.

    Harmon K, Drezner J, Gammons M, et al. American Medical Society for sports medicine position statement: concussion in sport. Br J Sports Med. 2013;47(1):15–26.

    PubMed  Google Scholar 

  194. 194.

    McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005;39(4):196–204.

    PubMed  PubMed Central  CAS  Google Scholar 

  195. 195.

    McCrory P, Meeuwisse W, Johnston K, et al. Sports medicine update: sport concussion assessment tool 2. Scand J Med Sci Sports. 2009;19:452.

    PubMed  Google Scholar 

  196. 196.

    Makdissi M, Cantu R, Johnston K, et al. The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms? Br J Sports Med. 2013;47(5):308–13.

    PubMed  Google Scholar 

  197. 197.

    State of Colorado. Rule 17 Exhibit 10: Traumatic Brain Injury Medical Treatment Guidelines. In: Department of Labor and Employment, editor. Division of Workers’ Compensation: State of Colorado; 2006.

  198. 198.

    Kutcher J, McCrory P, Davis G, et al. What evidence exists for new strategies or technologies in the diagnosis of sports concussion and assessment of recovery? Br J Sports Med. 2013;47(5):299–303.

    PubMed  Google Scholar 

  199. 199.

    Putukian M, Raftery M, Guskiewicz K, et al. Onfield assessment of concussion in the adult athlete. Br J Sports Med. 2013;47(5):285–8.

    PubMed  Google Scholar 

  200. 200.

    Simma B, Lütschg J, Callahan J. Mild head injury in pediatrics: algorithms for management in the ED and in young athletes. Am J Emerg Med. 2013. doi:10.1016/j.ajem.2013.04.007.

    PubMed  Google Scholar 

  201. 201.

    Schneider K, Iverson G, Emery C, et al. The effects of rest and treatment following sport-related concussion: a systematic review of the literature. Br J Sports Med. 2013;47(5):304–7.

    PubMed  Google Scholar 

  202. 202.

    Simma B, Jonas D, Lütschg J. Mile head injury in young athletes. Paediatrica. 2013;24(1):14–7.

    Google Scholar 

  203. 203.

    Vos P, Battistin L, Birbamer G, et al. EFNS guideline on mild traumatic brain injury: report of an EFNS task force. Eur J Neurol. 2002;9(3):207–19.

    PubMed  CAS  Google Scholar 

  204. 204.

    Barkhoudarian G, Hovda D, Giza C. The molecular pathophysiology of concussive brain injury. Clin Sports Med. 2011;30(1):33–48.

    PubMed  Google Scholar 

  205. 205.

    Barnes G. Cognitive processes involved in smooth pursuit eye movements. Brain Cogn. 2008;68(3):309–26.

    PubMed  CAS  Google Scholar 

  206. 206.

    Broglio S, Guskiewicz K. Concussion in sports: the sideline assessment. Sports Health. 2009;1(5):361–9.

    PubMed  PubMed Central  Google Scholar 

  207. 207.

    Baugh C, Stamm J, Riley D, et al. Chronic traumatic encephalopathy: neurodegeneration following repetitive concussive and subconcussive brain trauma. Brain Imaging Behav. 2012;6(2):244–54.

    PubMed  Google Scholar 

  208. 208.

    Broglio S, Eckner J, Paulson H, et al. Cognitive decline and aging: the role of concussive and subconcussive impacts. Exerc Sport Sci Rev. 2012;40(3):138–44.

    PubMed  PubMed Central  Google Scholar 

  209. 209.

    Cantu R. Posttraumatic retrograde and antegrade amnesia: pathophysiology and implications in grading and safe return to play. J Athl Train. 2001;36(3):244–8.

    PubMed  PubMed Central  Google Scholar 

  210. 210.

    Cantu R. Guidelines for return to contact sports after a cerebral contusion. Phys Sports Med. 1986;14(10):75–6, 79, 83.

    Google Scholar 

  211. 211.

    Cantu R. Second impact syndrome. Clin Sports Med. 1998;17(1):37–44.

    PubMed  CAS  Google Scholar 

  212. 212.

    Committee on Head Injury Nomenclature of Congress of Neurological Surgeons. Glossary of head injury, including some definitions of injury to the cervical spine. Clin Neurol. 1966;12:386–94.

    Google Scholar 

  213. 213.

    Conidi F. Sports-related concussion: the role of the headache specialist. Headache. 2012;52(s1):15–21.

    PubMed  Google Scholar 

  214. 214.

    Covassin T, Elbin R III. The cognitive effects and decrements following concussion. Open J Sports Med. 2010;1(1):55–61.

    Google Scholar 

  215. 215.

    Covassin T, Elbin R, Crutcher B, et al. The management of sport-related concussion: considerations for male and female athletes. Transl Stroke Res. 2013;4(4):420–4.

    Google Scholar 

  216. 216.

    Dashnaw M, Petraglia A, Bailes J. An overview of the basic science of concussion and subconcussion: where we are and where we are going. Neurosurg Focus. 2012;33(6):E5.

    PubMed  Google Scholar 

  217. 217.

    Davis G, Makdissi M. Concussion tests: clarifying potential confusion regarding sideline assessment and cognitive testing. Br J Sports Med. 2012;46(14):959–60.

    PubMed  Google Scholar 

  218. 218.

    De Beaumont L, Henry L, Gosselin N. Long-term functional alterations in sports concussion. Neurosurg Focus. 2012;33(6):E8.

    PubMed  Google Scholar 

  219. 219.

    Denny-Brown D, Russell W. Experimental cerebral concussion. Brain. 1940;64(2–3):93–164.

    Google Scholar 

  220. 220.

    DeKosky S, Ikonomovic M, Gandy S. Traumatic brain injury—football, warfare, and long-term effects. N Engl J Med. 2010;363(14):1293–6.

    PubMed  CAS  Google Scholar 

  221. 221.

    Dick R. Is there a gender difference in concussion incidence and outcomes? Br J Sports Med. 2009;43(Suppl 1):i46–50.

    PubMed  Google Scholar 

  222. 222.

    Doolan A, Day D, Maerlender A, et al. A review of return to play issues and sports-related concussion. Ann Biomed Eng. 2012;40(1):106–13.

    PubMed  Google Scholar 

  223. 223.

    Elbin R, Covassin T, Henry L, et al. Sport-related concussion: “how many is too many?”. Transl Stroke Res. 2013;4(4):425–31.

    Google Scholar 

  224. 224.

    Erlander D, Kutner K, Barth J, et al. Neuropsychology of sports-related head injury: dementia pugilistica to post concussion syndrome. Clin Neurophysiol. 1999;13(2):193–209.

    Google Scholar 

  225. 225.

    Giza C, DiFiori J. Pathophysiology of sport-related concussion: an update on basic science and translational research. Sports Health Multidiscip Approach. 2011;3(1):46–51.

    Google Scholar 

  226. 226.

    Giza C, Hovda D. The neurometabolic cascade of concussion. J Athl Train. 2001;36(3):228–35.

    PubMed  PubMed Central  Google Scholar 

  227. 227.

    Greenwald R, Chu J, Beckwith J, et al. A proposed method to reduce underreporting of brain injury in sports. Clin J Sport Med. 2012;22(2):83–5.

    PubMed  Google Scholar 

  228. 228.

    Grindel S, Lovell M, Collins M. The assessment of sport-related concussion: the evidence behind neuropsychological testing and management. Clin J Sports Med. 2001;11(3):134–43.

    CAS  Google Scholar 

  229. 229.

    Guskiewicz K, Mihalik J. Biomechanics of sport concussion: quest for the elusive injury threshold. Exerc Sport Sci Rev. 2011;39(1):4–11.

    PubMed  Google Scholar 

  230. 230.

    Guskiewicz K, Mihalik J. The biomechanics and pathomechanics of sport-related concussion: foundations of sport-related brain injuries. In: Slobounov S, Sebastianelli W, editors. Foundations of sport-related brain injuries. New York: Springer; 2006. p. 65–83.

    Google Scholar 

  231. 231.

    Halstead M. Historical perspectives on concussion. In: Apps J, Walter K, editors. Pediatric and adolescent concussion: diagnosis, management and outcomes. New York: Springer; 2012. p. 3–7.

    Google Scholar 

  232. 232.

    Halstead M, Walter K. Clinical report—sport-related concussion in children and adolescents. Pediatrics. 2010;126(3):597–611.

    PubMed  Google Scholar 

  233. 233.

    Harvey D, Freeman J, Broshek D, et al. Sports injuries. In: Silver J, McAllister T, Yudofsky S, editors. Textbook of traumatic brain injury. 2nd ed. London: American Psychiatric Publishing, Inc.; 2011. p. 427–38.

    Google Scholar 

  234. 234.

    Hodgson L. Working in sport and exercise medicine - be prepared! Part 2. SportEx Med. 2011;48(April):24–34.

    Google Scholar 

  235. 235.

    Holburn A. Mechanics of head injuries. Br Med Bull. 1945;3(6):147–9.

    Google Scholar 

  236. 236.

    Iverson G. Sport-related concussion. In: Schoenberg M, Scott J, editors. The little black book of neuropsychology: a syndrome-based approach. 1st ed. New York: Springer; 2011. p. 721–44.

    Google Scholar 

  237. 237.

    Iverson G, Lange R. Mild traumatic brain injury. In: Schoenberg M, Scott J, editors. The little black book of neuropsychology: a syndrome-based approach. 1st ed. New York: Springer; 2011. p. 697–719.

    Google Scholar 

  238. 238.

    Johnston K, McCrory P, Mohtadi G, et al. Evidence-based review of sport-related concussion: clinical science. Clin J Sports Med. 2001;11(3):150–9.

    CAS  Google Scholar 

  239. 239.

    Kelly J, Nichols J, Filley C, et al. Concussion in sports: guidelines for the prevention of catastrophic outcome. J Am Med Assoc. 1991;266(20):2867–9.

    CAS  Google Scholar 

  240. 240.

    Kirkwood M, Yeates K, Wilson P. Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics. 2006;117(4):1359–71.

    PubMed  Google Scholar 

  241. 241.

    Kontos A, Collins M, Russo S. An introduction to sports concussion for the sports psychology consultant. J App Sport Psychol. 2004;16:220–35.

    Google Scholar 

  242. 242.

    Kutcher J, Eckner J. At-risk populations in sports related concussion. Curr Sports Med Rep. 2010;9(1):16–20.

    PubMed  Google Scholar 

  243. 243.

    Laker S. Epidemiology of concussion and mild traumatic brain injury. PM R. 2011;3(10, S2):S354–8.

    PubMed  Google Scholar 

  244. 244.

    Laurer H, Lenzlinger P, McIntosh T. Models of traumatic brain injury. Eur J Trauma. 2000;26(3):95–100.

    Google Scholar 

  245. 245.

    Len T, Neary J. Cerebrovascular pathophysiology following mild traumatic brain injury. Clin Physiol Funct Imaging. 2011;31(2):85–93.

    PubMed  CAS  Google Scholar 

  246. 246.

    Lisberger S, Morris E, Tychsen L. Visual motion processing and sensory-motor integration for smooth pursuit eye movements. Annu Rev Neurosci. 1987;10(1):97–129.

    PubMed  CAS  Google Scholar 

  247. 247.

    Lovell M. The management of sports-related concussion: current status and future trends. Clin Sports Med. 2009;28(1):95–111.

    PubMed  Google Scholar 

  248. 248.

    Lovell M, Collins M, Bradley J. Return to play following sports-related concussion. Clin Sports Med. 2004;23(3):421–41.

    PubMed  Google Scholar 

  249. 249.

    Ma R, Miller C, Hogan M, et al. Sports-related concussion: assessment and management. J Bone Jt Surg Am. 2012;94(17):1618–27.

    Google Scholar 

  250. 250.

    Maddocks D, Dicker G, Saling M. The assessment of orientation following concussion in athletes. Clin J Sports Med. 1995;5(1):32–5.

    CAS  Google Scholar 

  251. 251.

    Malcolm D. Medical uncertainty and clinician-athlete relations: the management of concussion injuries in rugby union. Soc Sport J. 2009;26(2):191–210.

    Google Scholar 

  252. 252.

    McCrory P. You can run but you can’t hide: the role of concussion severity scales in sport. Br J Sports Med. 1999;33(5):297–8.

    PubMed  CAS  Google Scholar 

  253. 253.

    McCrory P, Berkovic S. Concussion: the history of clinical and pathophysiological concepts and misconceptions. Neurology. 2001;57(12):2283–9.

    PubMed  CAS  Google Scholar 

  254. 254.

    McCrory P. Does second impact exist? Clin J Sports Med. 2001;11(3):144–9.

    CAS  Google Scholar 

  255. 255.

    McCrory P, Berkovic SF. Concussion. Neurology. 2001;57(12):2283–9.

    PubMed  CAS  Google Scholar 

  256. 256.

    McCrory P. When to retire after concussion? Br J Sports Med. 2001;35(6):380–2.

    PubMed  PubMed Central  CAS  Google Scholar 

  257. 257.

    McGrath N. Supporting the student-athlete’s return to the classroom after a sport-related concussion. J Athl Train. 2010;45(5):492–8.

    PubMed  PubMed Central  Google Scholar 

  258. 258.

    McLean A, Anderson W. Biomechanics of closed head injury. In: Reilly P, Bullock R, editors. Head injury. London: Chapman & Hall; 1997. p. 25–37.

    Google Scholar 

  259. 259.

    Meaney D, Smith D. Biomechanics of concussion. Clin Sports Med. 2011;30(1):19–31.

    PubMed  PubMed Central  Google Scholar 

  260. 260.

    Moser RS, Schatz P. A case for mental and physical rest in youth sports concussion: it’s never too late. Front Neurol. 2012;3:171.

    PubMed  PubMed Central  Google Scholar 

  261. 261.

    Ommaya A, Gennarelli T. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. Brain. 1974;97(4):633–54.

    PubMed  CAS  Google Scholar 

  262. 262.

    Patel D, Reedy V. Sport-related concussion in adolescents. Pediatr Clin N Am. 2010;57(3):649–70.

    Google Scholar 

  263. 263.

    Post A, Oeur A, Hoshizaki T, et al. The influence of centric and non‐centric impacts to American football helmets on the correlation between commonly used metrics in brain injury research. International Research Council on Biomechanics of Injury Conference (IRCOBI). Dublin, Ireland; 2012.

  264. 264.

    Pearce J. Observations on concussion. Eur Neurol. 2008;59(3–4):113–9.

    PubMed  CAS  Google Scholar 

  265. 265.

    Saunders R, Harbaugh R. The second impact in catastrophic contact-sports head trauma. J Am Med Assoc. 1984;252(4):538–9.

    CAS  Google Scholar 

  266. 266.

    Shaw N. The neurophysiology of concussion. Prog Neurobiol. 2002;67:281–344.

    PubMed  CAS  Google Scholar 

  267. 267.

    Shrey D, Griesbach G, Giza C. The pathophysiology of concussions in youth. Phys Med Rehabil Clin N Am. 2011;22(4):577–602.

    PubMed  PubMed Central  Google Scholar 

  268. 268.

    Shuttleworth-Edwards A, Radloff S. Compromised visuomotor processing speed in players of rugby union from school through to the national adult level. Arch Clin Neuropsych. 2008;23(5):511–20.

    Google Scholar 

  269. 269.

    Tripoli M, Torg J. Pathophysiology and concussion: a review of the literature. Temple Uni J Ortho Surg Sports Med. 2011;8–15.

  270. 270.

    Upshaw J, Gosserand J, Williams N, et al. Sports-related concussions. Pediatr Emerg Care. 2012;28(9):926–35.

    PubMed  Google Scholar 

  271. 271.

    Wetjen N, Pichelmann M, Atkinson J. Second impact syndrome: concussion and second injury brain consequences. J Am Coll Surg. 2010;211(4):553–7.

    PubMed  Google Scholar 

  272. 272.

    Wojtys E, Hovda D, Landry G, et al. Concussion in sports. Am J Sports Med. 1999;27(5):676–87.

    PubMed  CAS  Google Scholar 

  273. 273.

    Bodin D, Yeates K, Klammer K. Definition and classification of concussion. In: Apps J, Walter K, editors. Pediatric and adolescent concussion: diagnosis, management and outcomes. New York: Springer; 2012. p. 9–19.

    Google Scholar 

  274. 274.

    Piatt J. Traumatic brain injury. In: Legido A, Piatt J, editors. Clinical pediatric neurosciences for primary care. Elk Grove Village: American Academy of Pedicatrics; 2009. p. 145–70.

    Google Scholar 

  275. 275.

    Kegel N, Lovell M. Methods of formal neurocognitive assessment of concussion. In: Apps J, Walter K, editors. Pediatric and adolescent concussion: diagnosis, management and outcomes. New York: Springer; 2012. p. 117–31.

    Google Scholar 

  276. 276.

    Resch J, Driscoll A, McCaffery N, et al. ImPact test-retest reliability: reliably unreliable? J Athl Train. 2013. doi:10.4085/1062-650-48.3.09.

    PubMed  Google Scholar 

  277. 277.

    Allen B, Gfeller J. The Immediate Post-Concussion Assessment and Cognitive Testing battery and traditional neuropsychological measures: a construct and concurrent validity study. Brain Inj. 2011;25(2):179–91.

    PubMed  Google Scholar 

  278. 278.

    Collie A, Maruff P, Makdissi M, et al. CogSport: reliability and correlation with conventional cognitive tests used in post concussion medical evaluations. Clin J Sports Med. 2003;13(1):28–32.

    Google Scholar 

  279. 279.

    Lau B, Collins M, Lovell M. Sensitivity and specificity of subacute computerized neurocognitive testing and symptom evaluation in predicting outcomes after sports-related concussion. Am J Sports Med. 2011;39(6):1209–16.

    PubMed  Google Scholar 

  280. 280.

    Chen J-K, Johnston K, Collie A, et al. A validation of the post concussion symptom scale in the assessment of complex concussion using cognitive testing and functional MRI. J Neurol Neurosurg Psychiatry. 2007;78(11):1231–8.

    PubMed  PubMed Central  Google Scholar 

  281. 281.

    Shuttleworth-Edwards A. Debating the utility of computerised neurocognitive testing in the sports concussion arena. S Afr J Sport Med. 2011;23(4):134–5.

    Google Scholar 

  282. 282.

    Broglio S, Ferrara M, Macciocchi S, et al. Test-retest reliability of computerized concussion assessment programs. J Athl Train. 2007;42(4):509–14.

    PubMed  PubMed Central  Google Scholar 

  283. 283.

    Randolph C. Baseline neuropsychological testing in managing sport-related concussion: does it modify risk? Curr Sports Med Rep. 2011;10(1):21–6.

    PubMed  Google Scholar 

  284. 284.

    McCrory P, Collie A, Anderson V, et al. Can we manage sport related concussion in children the same as adults? Br J Sports Med. 2004;38(5):516–9.

    PubMed  PubMed Central  CAS  Google Scholar 

  285. 285.

    Gualtieri C, Johnson L. Reliability and validity of a computerized neurocognitive test battery, CNS vital signs. Arch Clin Neuropsychol. 2006;21(7):623–43.

    PubMed  Google Scholar 

  286. 286.

    Gioia G, Vaughan C, Sady M. Developmental considerations in pediatric concussion evaluation and management. In: Apps J, Walter K, editors. Pediatric and adolescent concussion: diagnosis, management and outcomes. New York: Springer Science+Business Media; 2012. p. 151–76.

    Google Scholar 

  287. 287.

    Cantu R. Reflections on head injuries in sport and the concussion controversy [editorial]. Clin J Sports Med. 1997;7(1):83–4.

    CAS  Google Scholar 

  288. 288.

    Patton D, McIntosh A, Kleiven S, et al. Injury data from unhelmeted football head impacts evaluated against critical strain tolerance curves. Proc Inst Mech Eng O J Sports Eng Technol. 2012;226(3–4):177–84.

    Google Scholar 

  289. 289.

    Miller J, Wendt J, Potter N. Implications for concussion assessments and return-to-play standards in intercollegiate football: how are the risks managed? J App Sport Mang. 2011;3(1):91–103.

    Google Scholar 

  290. 290.

    Stone K. NerveCenter: August 2011. Ann Neurol. 2011;70(2):A11–4.

    Google Scholar 

  291. 291.

    Talan J. New report links sports concussion to chronic traumatic encephalopathy. Neurol Today. 2008;8(19):12–3.

    Google Scholar 

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Acknowledgments

The authors declare that there are no competing interests associated with the research contained within this manuscript. No sources of funding were utilized in conducting this study. According to the definition given by the International Committee of Medical Journal Editors (ICMJE), the authors listed above qualify for authorship on the basis of making one or more of the substantial contributions to the intellectual content of the manuscript.

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King, D., Brughelli, M., Hume, P. et al. Assessment, Management and Knowledge of Sport-Related Concussion: Systematic Review. Sports Med 44, 449–471 (2014). https://doi.org/10.1007/s40279-013-0134-x

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Keywords

  • Chronic Traumatic Encephalopathy
  • Rotational Acceleration
  • Rugby League
  • Rugby Union
  • Sport Participant