1. David W. Lawrence, MD, CCFP(SEM), Dip Sport Med, MPH (Cand)
The 5th Consensus Statement on Concussion Statement (Berlin) A 15 Minute Update
David W. Lawrence, MD, CCFP(SEM), Dip Sport Med, MPH (Cand)

2. Overview Definition & Diagnosis Signs and Symptoms Sideline Evaluation
Management
Neuropsychological Evaluation
Persistent Symptoms
Residual Effects
Prevention
SCAT5

3. Definition & Diagnosis
Traumatic brain injury
Caused either by a direct or transmitted force to the head
Rapid onset of short-lived impairment of neurological function that resolves spontaneously.
Functional disturbance rather than a structural injury
no abnormality is seen on standard structural neuroimaging studies.
Range of clinical signs and symptoms.
The clinical signs and symptoms cannot be explained by other conditions:
drug, alcohol, medications, other injuries, or other comorbidities

4. Signs and Symptoms Symptoms and signs are non-specific to concussion
The suspected diagnosis of SRC can include one or more of the following clinical domains:
Symptoms:
somatic, cognitive, and/or emotional symptoms
Physical signs
Balance impairment
Behavioural changes
Cognitive impairment
Sleep/wake disturbance

5. Sideline Evaluation ? Concussion Immediately removed
Clear signs
(LOC, posturing, Sz)
Suspected concussion with no signs
Immediately removed
Sideline screening
Diagnostic evaluation
Concussion
No concussion

6. Sideline evaluation SCAT5 Sideline video review Occulomotor screening
Reaction time
Objective assessment to exclude more serious injury is critical.

7. Acute Management
Concussion is suspected, the athlete should be removed from the sporting environment
Re-evaluation with consideration of neuroimaging to r/o more severe imaging

8. Concussion Investigations
No investigations recommended for concussion-specific management.
Biomarkers are important research tools but require further validation prior to clinical use.

9. Rest Insufficient evidence to prescribing complete rest.
After a brief period of rest during the acute phase (24–48 hours) after injury, patients can begin subsymptom threshold progression.

10. RTA

11. RTL

12. Rehabilitation Additional multidisciplinary interventions
psychological rehabilitation
cervical rehabilitation
vestibular rehabilitation
active rehabilitation
pharmacological treatment

13. Neuropsychological Assessment
NP assessment has been previously described as the ‘cornerstone’ of concussion management
NP testing has clinical value and contributes significant information
NP assessment should not be the sole basis of management decisions
Post-injury NP testing is not required for all athletes
Should be performed by a trained and accredited neuropsychologist.
Brief computerised cognitive evaluation tools are not substitutes for complete NP assessment.
Baseline or pre-season NP testing not felt to be required as a mandatory aspect of every assessment.

14. Post-Concussion Syndrome Persistent Symptoms
Failure of normal clinical recovery
symptoms that persist beyond expected time frames (ie, >10–14 days in adults and >4 weeks in children).
Does not reflect a single pathophysiological entity
Constellation of non-specific post-traumatic symptoms
May be linked to coexisting and/ or confounding factors
Does not necessarily reflect ongoing physiological injury to the brain

15. Establishing Recovery
“Difficult task”

16. Special Populations Elite athletes: Child and adolescent:
no difference
Child and adolescent:
Children and adolescents should not return to sport until they have successfully returned to school.
Early introduction of symptom-limited physical activity is appropriate.

17. Chronic Traumatic Encephalopathy Residual Effects and Sequelae
Clinicians need to be mindful of the potential for long-term problems in the management of all athletes.
Literature on long-term consequences of exposure to recurrent head trauma is inconsistent.
There is much more to learn about the potential cause-and-effect relationships of repetitive head-impact exposure and concussions.

18. CTE
The potential for developing chronic traumatic encephalopathy (CTE) must be a consideration
Distinct tauopathy with an unknown incidence in athletic populations.
Cause-and-effect relationship bw CTE and concussion has not yet been demonstrated
The notion that repeated concussion or subconcussive impacts cause CTE remains unknown.

19. Prevention Helmets: Mouth guards: Intrinsic risk factors:
Evidence is limited for an overall effect
There is sufficient evidence in skiing/snowboarding to recommend use to prevent overall head injuries
Mouth guards:
Meta-analysis suggests a non-significant trend towards a protective effect in collision sports
Intrinsic risk factors:
No evidence
Extrinsic risk factors (i.e. rule & policy changes)
Strong evidence

20. SCTA5
The SCAT is useful immediately after injury in differentiating concussed from non-concussed athletes
Its utility appears to decrease significantly 3–5 days after injury.
The symptom checklist, however, does demonstrate clinical utility in tracking recovery.
Baseline testing may be useful, but is not necessary for interpreting post-injury scores.