Safe treatment of sport related concussion

Sport related concussion is a hot item. The Health Council of the Netherlands published its report on concussions in 2003 and there is much concern about the negative health effects of sports related concussion. Neuropsychological testing has recently been endorsed as a 'cornerstone' of concussion management by the Vienna and Prague meetings of the Concussion in Sport group. Neuropsychological testing is particularly important given the unreliability of athletes self-reporting following injury. Merely relying on the athlete's subjective reporting of symptoms may result in the premature return of the athlete to the playing field, potentially exposing him/her to additional injury. The goal of this retrospective cohort study is to evaluate the sensitivity of a post-concussion symptom scale versus neuropsychological testing for the diagnosis of sport-related concussion. High School and college athletes diagnosed with a concussion were tested two days post injury. Their post-injury neuropsychological performance and symptom score was compared to their pre-injury baseline test results. Sixty-four percent of the 170 concussed athletes reported a significant increase in symptoms compared to baseline at two days post-injury. Eighty three percent of the concussed sample demonstrated significantly worse neuropsychological test results compared to their own baseline performance. Ninety-three percent of the sample had either abnormal neuropsychological test results or a significant increase in symptoms, when compared to their own baseline. Therefore, utilisation of both symptoms and neuropsychological test results resulted in an increased yield of 29% over reliance on symptoms alone. Relying purely on the patient's self reported symptoms following concussion is likely to result in the under diagnosis of concussion and may result in premature return to play. The addition of neuropsychological testing increases diagnostic accuracy