4 “if in doubt, sit them out” Medical assessment of concussion The diagnosis of concussion should be made by a medical practitioner after a clinical history and examination that includes a range of domains including mechanism of injury, symptoms and signs, cognitive functioning and neurological assessment including balance testing8,13 . The SCAT59,10 is the internationally recommended concussion assessment tool and covers the above-mentioned domains. It should not be used in isolation but as part of the overall clinical assessment. Computerised neurocognitive testing can be undertaken as part of the assessment but again, it should not be used in isolation14 . Baseline neurocognitive testing in the pre-season period can be useful for comparison with post-injury scores. Many programs however have reference ranges that can be applied in the absence of a baseline test. There are currently no serum biomarkers or genetic testing that assist in the diagnosis of concussion15 . Blood tests are not indicated for uncomplicated concussion. Medical imaging is not indicated in the diagnosis or management of uncomplicated concussion15 . Medical imaging may be indicated however where there is suspicion of more serious head or brain injury3 . Where resources allow, sporting organisations could use modern technology such as pitch-side instant video replay, to enhance the ability to detect and manage concussion14 . Predictors of clinical recovery While the medical practitioner assessing the athlete with suspected concussion should make optimal use of available assessment tools, clinical judgement remains a cornerstone of concussion diagnosis and management. Predictors of clinical recovery may assist the clinician with management of the concussed athlete3,16 . Such factors can be associated with a more protracted recovery time and they may include the following16 : > > high severity of acute and subacute concussive symptoms > > a high number of concussive symptoms > > prolonged loss of consciousness (greater than one minute) > > post-concussive seizure > > previous history of concussion > > age of the athlete (a more conservative approach is indicated in children and adolescents)17 > > female gender > > history of depression, anxiety, or migraine Managing concussion Head-injury advice should be given to all athletes with concussion and to their carers. Any athlete with suspected or confirmed concussion should remain in the company of a responsible adult and not be allowed to drive. They should be advised to avoid alcohol and check medications with their doctor. Specifically, they should avoid aspirin, non-steroidal anti-inflammatory drugs, sleeping tablets and sedating pain medications.