2 “if in doubt, sit them out” 2.  AIS-AMA POSITION STATEMENT ON CONCUSSION IN SPORT Introduction Sport-related concussion is a growing health concern in Australia. It affects athletes at all levels of sport from the part-time recreational athlete to the full-time professional. Concerns about the incidence, and possible health ramifications for athletes, have led to an increased focus on the importance of diagnosing and managing the condition safely and appropriately1,2 . Parents, coaches, athletes, medical practitioners and others involved in sport are seeking information regarding the best management of sport-related concussion. Participant safety and welfare is paramount when dealing with all concussion incidents. The Australian Institute of Sport (AIS) is Australia’s peak high-performance sport agency. The Australian Medical Association (AMA) is the peak membership organisation representing the registered medical practitioners (doctors) and medical students of Australia. Both AIS and AMA have clear and unequivocal focus on ensuring the safety and welfare of Australians participating in sport. Funded by the Australian Government, this position statement aims to: > > provide improved safety and health outcomes for all people who suffer concussive injuries while participating in sport, > > assist all sporting organisations and clubs to align their policy and procedures to the most up-to-date evidence, > > protect the integrity of sport through the consistent application of best practice protocols and guidelines, > > provide a platform to support the development of national policy for the management of concussion in Australia. What is concussion? Concussion is a traumatic brain injury, induced by biomechanical forces to the head or anywhere on the body, which transmits an impulsive force to the head3,4 . It causes short-lived neurological impairment and the symptoms may evolve over the hours or days following the injury. The symptoms should resolve without medical intervention3 . Rest, followed by gradual return to activity, is the main treatment5 . Evidence from animal and functional imaging studies points toward a series of interrelated biochemical and physiological changes that impair neuronal function6,7 . Recognising concussion Recognising concussion can be difficult. The symptoms and signs are variable, non-specific and may be subtle. Onlookers should suspect concussion when an injury results in a knock to the head or body that transmits a force to the head. A hard knock is not required, concussion can occur from relatively minor knocks. There may be obvious signs of concussion such as loss of consciousness, brief convulsions or difficulty balancing or walking. However, the signs of concussion can be more subtle. The Sport Concussion Assessment Tool (SCAT5) identifies 22 possible symptoms8-10 . > > headache > > ‘don’t feel right’ > > ‘pressure in the head’ > > difficulty concentrating > > neck pain > > difficulty remembering > > nausea or vomiting > > fatigue or low energy > > dizziness > > confusion > > blurred vision > > drowsiness > > balance problems > > sensitivity to light > > more emotional > > sensitivity to noise > > irritability > > feeling slowed down > > sadness > > feeling like ‘in a fog’ > > nervous or anxious > > trouble falling asleep (if applicable)