Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children.

OBJECTIVES: To systematically review the scientific literature regarding the assessment of sport-related concussion (SRC) in the subacute phase (3-30 days) and provide recommendations for developing a Sport Concussion Office Assessment Tool (SCOAT6). DATA SOURCES: MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, CINAHL, SPORTDiscus and Web of Science searched from 2001 to 2022. Data extracted included study design, population, definition of SRC diagnosis, outcome measure(s) and results. ELIGIBILITY CRITERIA: (1) Original research, cohort studies, case-control studies, diagnostic accuracy and case series with samples >10; (2) SRC; (3) screening/technology that assessed SRC in the subacute period and (4) low risk of bias (ROB). ROB was performed using adapted Scottish Intercollegiate Guidelines Network criteria. Quality of evidence was evaluated using the Strength of Recommendation Taxonomy classification. RESULTS: Of 9913 studies screened, 127 met inclusion, assessing 12 overlapping domains. Results were summarised narratively. Studies of acceptable (81) or high (2) quality were used to inform the SCOAT6, finding sufficient evidence for including the assessment of autonomic function, dual gait, vestibular ocular motor screening (VOMS) and mental health screening. CONCLUSION: Current SRC tools have limited utility beyond 72 hours. Incorporation of a multimodal clinical assessment in the subacute phase of SRC may include symptom evaluation, orthostatic hypotension screen, verbal neurocognitive tests, cervical spine evaluation, neurological screen, Modified Balance Error Scoring System, single/dual task tandem gait, modified VOMS and provocative exercise tests. Screens for sleep disturbance, anxiety and depression are recommended. Studies to evaluate the psychometric properties, clinical feasibility in different environments and time frames are needed. PROSPERO REGISTRATION NUMBER: CRD42020154787.

Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022.

For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete's perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.

The ups and downs of trampolines: Injuries associated with backyard trampolines and trampoline parks.

OBJECTIVE: To compare characteristics associated with backyard trampoline injuries (BTI) and trampoline park injuries (TPI) using records from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP). METHODS: eCHIRPP records for trampoline injuries (2012 to 2016) were extracted using variable codes and narratives, and injuries were examined among individuals 17 years and younger. Descriptive estimates for BTI and TPI, as well as age and sex adjusted odds ratios (OR) for the mechanism, source, body part and type of injury associated with TPIs relative to BTIs, are presented. RESULTS: Trampoline injuries are increasing in Canada (P<0.01). Patients with TPIs were older than those with BTIs. Relative to BTIs, TPIs were more associated with impact as the mechanism (OR 2.6, 95% CI: 2.2 to 3.1), trampoline beds as the source (OR 1.7, 95% CI: 1.4 to 2.1), lower extremity as the body part (OR 3.7, 95% CI: 3.0 to 4.4) and sprains as the type of injury (OR 2.0, 95% CI: 1.6 to 2.4). In contrast, another jumper (OR 0.5, 95% CI: 0.4 to 0.6) or fall (OR 0.4, 95% CI: 0.4 to 0.6) as the mechanism, surface (OR 0.7, 95% CI: 0.5 to 0.9) or another jumper (OR 0.5, 95% CI: 0.4 to 0.7) as the source, face or neck (OR 0.6, 95% CI: 0.4 to 0.7) as the body part, and lacerations (OR 0.6, 95% CI: 0.3 to 0.9) or soft tissue injury (OR 0.7, 95% CI: 0.6 to 0.9) as the type of injury were more associated with BTIs relative to TPIs. CONCLUSION: Trampoline parks result in injuries different than those from backyard trampolines. This examination into the distinct injury characteristics can help to inform future prevention measures.

What factors must be considered in 'return to school' following concussion and what strategies or accommodations should be followed? A systematic review.

OBJECTIVE: To evaluate the evidence regarding (1) factors affecting return to school (RTS) and (2) strategies/accommodations for RTS following a sport-related concussion (SRC) in children and adolescents. DESIGN: A systematic review of original studies specifically addressing RTS following concussion in the paediatric and sporting context. DATA SOURCES: MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid) electronic databases and the grey literature OpenGrey, ClinicalTrials.gov and Google Advanced. ELIGIBILITY CRITERIA: Studies were included if they were original research on RTS following SRC in children aged 5-18 years published in English between 1985 and 2017. RESULTS: A total of 180 articles were identified; 17 articles met inclusion criteria. Several factors should be considered for RTS after concussion, including: symptomatology; rest following injury; age/grade; and course load. On RTS after concussion, 17%-73% of students were provided academic accommodations or experienced difficulty with RTS. Students were more likely to obtain academic accommodations in schools with a concussion policy if they had a medical RTS letter and had regular medical follow-up after concussion. CONCLUSIONS: Schools should have a concussion policy and offer individualised academic accommodations to students recovering from SRC on RTS; a medical letter should be provided to facilitate provision/receipt of academic accommodations; students should have early, regular medical follow-up following SRC to help with RTS and monitor recovery; students may require temporary absence from school after SRC; clinicians should assess risk factors/modifiers that may prolong recovery and require more intensive academic accommodations. PROSPERO REGISTRATION NUMBER: CRD42016039184.

Sport-related concussion: Evaluation and management.

Concussion is a common injury among children and adolescents participating in organized sports and recreational activities. Any child or youth who sustains a concussion should be removed from play immediately and medically evaluated as soon as possible. Cognitive and physical rest are recommended to allow symptoms to resolve. Cognitive rest may require temporary school absence and/or a modified class work or homework load. After symptoms have completely resolved at rest and a full return to school is achieved, the student can progress through a medically supervised, stepwise exertion protocol to return to play. Everyone involved in child and youth sports must recognize the signs and symptoms of concussion, and ensure that any child or adolescent suspected of sustaining a concussion is properly evaluated and managed by qualified medical personnel. The present statement replaces a previous Canadian Paediatric Society position statement published in 2006 and revised in 2012.

Les commotions cérébrales sont courantes chez les enfants et les adolescents qui s'adonnent à des sports organisés et à des activités récréatives. Tout enfant ou adolescent qui est victime d'une commotion cérébrale doit être retiré du jeu immédiatement et subir une évaluation médicale le plus vite possible. Un repos cognitif et physique est recommandé afin de favoriser la résolution des symptômes. Le repos cognitif peut exiger une absence temporaire de l'école ou un aménagement du travail en classe ou des devoirs. Après la disparition totale de tous les symptômes au repos et le retour à l'école à temps plein, l'élève peut suivre un protocole d'effort graduel pour retourner au jeu, sous supervision médicale. Quiconque évolue dans le milieu du sport chez les enfants et les adolescents doit connaître les signes et symptômes de commotion cérébrale et s'assurer qu'un enfant ou un adolescent chez qui on craint une commotion cérébrale soit évalué convenablement et pris en charge par du personnel compétent. Le présent document de principes remplace celui qui a été publié par la Société canadienne de pédiatrie en 2006 et révisé en 2012.

The evaluation and management of acute concussion differs in young children.

BACKGROUND: There are many reasons why concussion in children needs to be considered different from adults. The Zurich (2008) recommendations on the management of concussion in children are restricted to children less than to 10 years of age. It does not include recommendations for children aged 5-10 years. The aim of this study is to review the current literature on (1) concussion assessment at the sideline and during recovery stages, especially in the age group 5-15 years, and (2) the management of concussion in children and adolescents. METHODS: A literature review using the MEDLINE database was undertaken. Articles were selected that included evaluation and/or management in children aged 5-15 years. RESULTS: There are no sideline assessment tools validated for use in this age group. There are a number of different symptom scales that have been validated during different stages of the follow-up assessment in children. No single paediatric concussion assessment tool has been validated for use from sideline through to all stages of recovery. Reliability studies have been published on Balance Error Scoring System in children, but validity studies in this age group have not been published. The management of concussion includes withdrawal from play on the day and cognitive and physical rest. The priority of concussion management in children is to return to learn; while this is usually rapid, there are some children in whom a graduated return to school is required, which should include a number of accommodations. CONCLUSIONS: A young child is physically, cognitively and emotionally very different from adults, and requires the use of a different set of tools for the diagnosis, recovery-assessment and management of concussion. Age-specific, validated diagnostic tools are required, and management of concussion in children should focus attention on return to learn before considering return to play.

Sport nutrition for young athletes.

Nutrition is an important part of sport performance for young athletes, in addition to allowing for optimal growth and development. Macronutrients, micronutrients and fluids in the proper amounts are essential to provide energy for growth and activity. To optimize performance, young athletes need to learn what, when and how to eat and drink before, during and after activity.

La nutrition est une partie importante de la performance sportive des jeunes athlètes, sans compter qu'elle favorise une croissance et un développement optimaux. Il est essentiel de consommer la bonne quantité de macronutriments, de micronutriments et de liquides pour fournir l'énergie nécessaire à la croissance et aux activités. Pour optimiser leur performance, les jeunes athlètes doivent apprendre quoi, quand et comment manger et boire avant, pendant et après l'activité.

Evaluation and management of children and adolescents with sports-related concussion.

Concussions are common sport injuries, and are particularly common among children and adolescents involved in organized sports and recreational activities. Symptoms of concussion can be subtle, and may be overlooked by athletes, coaches/trainers and parents. If a child or youth sustains a concussion, they should immediately be removed from play and assessed by a physician as soon as possible. The athlete should rest from physical and cognitive activities to allow for recovery from concussion. Once symptoms have completely resolved at rest, the athlete can progress through a medically supervised stepwise exertion protocol before being medically cleared to return to play. It is imperative that everyone involved in child and youth sports be aware of the signs and symptoms of concussion so that an accurate and timely diagnosis can be made, and proper evaluation and management instituted. The present position statement replaces the previous document published in 2006.

Boxing participation by children and adolescents: A joint statement with the American Academy of Pediatrics.

Thousands of boys and girls younger than 19 years of age participate in boxing in North America. Although boxing provides benefits for participants, including exercise, self-discipline and self-confidence, the sport of boxing encourages and rewards deliberate blows to the head and face. Participants in boxing are at risk of head, face and neck injuries, including chronic and even fatal neurological injuries. Concussions are one of the most common injuries occurring in boxing. Because of the risk of head and facial injuries, the Canadian Paediatric Society and the American Academy of Pediatrics vigorously oppose boxing as a sport for children and adolescents. These organizations recommend that physicians oppose boxing in youth and encourage patients to participate in alternative sports in which intentional head blows are not central to the sport.