6 “if in doubt, sit them out” Education It has been demonstrated that general knowledge about concussion, although improved over the past few years with the use of guidelines and education materials, is not yet optimal26-28 . Education programmes must target the various groups involved in sport-related concussion in order to effectively improve awareness and understanding in the community26,29 . The athletes themselves need to have a good understanding of concussion in order to appreciate the importance of reporting symptoms and complying with rest and return to sport advice30 . Parents and coaches must also be able to recognise the symptoms and signs of concussion in order to detect concussions at the community sport level where there is no medical supervision present28,31 . Sporting and medical organisations continue to develop specific recommendations around concussion in order to educate their own participants. However, the complexity of the return to sport protocol has been highlighted as a potential barrier for community sport32 . Concussion research priorities There is a clear need for well-designed prospective research to inform the diagnosis and management of concussion. Areas that require priority in terms of resource allocation include the biological processes underlying concussion, the impact of concussion on long-term health, the impact of concussion on special groups such as children and the degree of effectiveness of concussion education programs. There also needs to be ongoing research to constantly improve clinical tools used in the diagnosis and management of concussion. Key Points for coaches, parents and athletes > > Concussion is a type of brain injury that occurs from a knock to head or body. > > Recognising concussion is critical to ensure appropriate management and prevention of further injury. > > The Concussion Recognition Tool 5 (CRT5) is recommended to help recognise the signs and symptoms of concussion. This can be freely downloaded at bjsm.bmj.com/content/bjsports/early/2017/04/26/ bjsports-2017-097508CRT5.full.pdf > > First aid principles apply in the management of the athlete with suspected concussion. This includes observing first aid principles for protection of the cervical spine. > > Any athlete suspected of having concussion should be removed from sport and not allowed to return to sport that day. This athlete should be reviewed by a medical practitioner. > > Features that suggest more serious injury and should prompt immediate emergency department referral include neck pain, increased confusion, agitation or irritability, repeated vomiting, seizure, weakness or tingling/ burning in the arms or legs, reduced level of consciousness, severe or increasing headache, or unusual behaviour. > > When assessing a patient with suspected concussion, a medical practitioner will ask about details of the event as well as past medical history and then assess the patient including asking about symptoms, signs, testing memory function and concentration, balance and neurological function. > > There is no single test that can determine whether someone has sustained a concussion, your doctor may not order blood tests or medical imaging unless they wish to exclude other more serious injuries. > > Once a diagnosis of concussion has been confirmed the main treatment for concussion is rest. After 24 – 48 hours of rest, moderate intensity physical activity is allowed as long as such activity does not cause a significant and sustained deterioration in symptoms. > > The activity phase should proceed as outlined below with a minimum of 24 hours spent at each level. The activity should only be upgraded if there has been no recurrence of symptoms during that time. If this occurs there should be a ‘step down’ to the previous level for at least 24 hours (after symptoms have resolved): - - return to daily activities (including school/work) that do not provoke symptoms - - light aerobic activity (at an intensity that can easily be maintained whilst having a conversation), until symptom-free - - basic sport-specific drills which are non-contact and with no head impact - - more complex sport-specific drills without contact (may add resistance training) - - full contact practice following medical review - - normal competitive sporting activity. > > Children and adolescents take longer to recover from concussion. They should be advised to wait a