A new medical consensus document, the Concussion in Sport Group statement, has been released following the latest medical conference on the subject of concussion in sport.
The 5th International Consensus Conference on Concussion in Sport was held last October in Berlin, Germany and brought together 425 participants from 25 countries for a two-day conference.
The Berlin CISG statement came about following the discussions of the CISG (Concussion in Sport Group) Expert Panel, a group of 35 medical experts from leading medical and sports organizations, who met following the conclusion of the conference.
Each recommendation in the Berlin CISG statement is supported by a detailed systematic review of the current published evidence on that topic. Approximately 60,000 papers were screened in the review process for this meeting. The Berlin CISG statement is a summary of those reviews and the expert discussions.
“The Berlin CISG statement summarizes the “CISG 11R” – Recognize, Remove, Re-evaluate, Rest, Rehabilitate, Refer, Recovery, Return to Play, Reconsider, Residual effects, Risk reduction, which should facilitate the process for managing physician,” said Prof. Jiri Dvorak, senior adviser to the Swiss Concussion Center.
The purpose of the conference was twofold. The first objective was to present a summary of new evidence-based research that covers all aspects of concussions including definition, management, investigations, treatment, Return to Sport protocol, prevention, and knowledge transfer.
With the evidence-based research presented by the world's experts and researchers in concussion in sport, the second objective was to reach an agreement amongst the expert panelists. The Berlin Consensus Statement summarizes the meeting outcomes that can be used by physicians and healthcare professionals involved in the care of injured athletes at the recreational, elite or professional level.
The Berlin CISG statement includes an update on the Concussion Recognition Tool (CRT5), the Sport Concussion Assessment Tool (SCAT5) and the Child Sport Concussion Assessment Tool (Child SCAT5), all three of which are currently being employed in a large number of sport federations and professional leagues.
This update to the SCAT3 (now called SCAT5 following the fifth edition of the Conference) includes new methods designed to improve the clinical and cognitive examination, as well as recommendations for return to sport and school following concussion.
“While there is certainly some advances made in the latest consensus, more research and discussions are needed before new investigation and treatment methods can be seriously considered,” said Dr. Mark Aubry, Chief Medical Officer for the IIHF.
“We felt that advanced neuroimaging and biomarker blood tests are showing better promise but still can only be used as research tools.”
The Berlin CISG statement also gave updates on Return to Sport, the point by which an athlete is recovered from injury and can participate again in his sport. It noted that athletes recovering from concussion should be exercising earlier following the injury, provided that this does not cause concussion symptoms to reappear. Specific therapy for vestibular (balance) problems or cervical spine problems was also highlighted.
The new additions to the Child SCAT5 addressed return to school, specifically stating that children 12-and-under who suffer concussions should be encouraged to resume normal activity and return to school as soon as possible within a 3-5 day window as long as symptoms do not flare up. The Berlin CISG statement also recommends that all schools develop concussion policies, provide academic accommodations for injured students, and educate staff on the effects of concussion on learning during the recovery phase.
The Berlin Consensus also stated that the link between chronic traumatic encephalopathy and concussions or subconcussive impacts is inconclusive.
In terms of prevention, the Berlin CISG statement found that the removal of body checking from Peewee level (under-13) in ice hockey has significantly decreased the risk of concussions.
The idea of a “consensus conference” – where the world’s top medical professionals would gather to present new research and review and discuss established practice – has been a successful and highly influential process since 2001. Leading the push for the creation of the CISG was IIHF Chief Medical Officer Dr. Mark Aubry, former FIFA Chief Medical Officer and the Senior Consultant of the Swiss Concussion Center Prof. Dr. Jiri Dvorak; Founding Chair of the University of Calgary Sport Injury Prevention Research Centre Dr. Willem (Winne) Meeuwisse, and Florey Institute (Melbourne, Australia) neurologist Associate Professor Paul McCrory.Click here to access the complete Berlin CISG statement