Concussion in Sport

Traumatic brain injury from a direct blow or impulsive force to the head, face or neck, causing functional (not structural) disturbance. Standard imaging is normal. Based on the Amsterdam 2022 consensus (published 2023).

Recognition

Domain	Features
Somatic	Headache, neck pain, nausea, dizziness, balance problems
Cognitive	Fogginess, slowed processing, poor concentration, amnesia
Emotional	Irritability, sadness, anxiety
Sleep	Drowsiness, sleeping more or less
Observable	Confusion, blank stare, unsteady gait, tonic posturing

Loss of consciousness occurs in fewer than 10%. Its absence does not exclude concussion.

Highest incidence

rugby, ice hockey, American football. Collision mechanism matters more than sport.

Red flags

worsening headache, repeated vomiting, seizure, focal deficit, double vision, neck pain, GCS below 15.

Recognise and remove

“If in doubt, sit them out.” Removal is immediate, and there is no same-day return at any age.

Tool	User	Timing
CRT6	Anyone, sideline	Immediate
SCAT6	Clinicians, age 13+	First 72 hours
Child SCAT6	Clinicians, age 8 to 12	First 72 hours
SCOAT6	Clinicians	From 72 hours

SCAT6 supports diagnosis but is never stand-alone.

Graduated return to sport

Symptom-limited activity
Light to moderate aerobic exercise
Sport-specific exercise, no head impact
Non-contact training drills
Full-contact practice (after medical clearance)
Return to competition

Each step lasts at least 24 hours.
Symptoms rise more than 2/10 for over an hour: drop back a step, retry next day.
Relative rest for 24 to 48 hours only. Early light activity is therapeutic.
Run return-to-learn in parallel. School comes first in children.
Final clearance is medical, never by coach, parent or athlete.

Timeframes

adults need at least about 1 week to complete the strategy. Amsterdam sets no shorter paediatric minimum, but children recover more slowly. Typical unrestricted return is around 3 weeks (pooled mean 19.8 days).

Complications

Persisting symptoms beyond 4 weeks: about 30% of children and adolescents.
Second impact syndrome: rare, contested, potentially fatal.
Higher musculoskeletal injury risk after premature return.
CTE: linked to repetitive head impact in autopsy studies. Causation is unresolved.

References

Patricios et al., Br J Sports Med 2023, doi:10.1136/bjsports-2023-106898
Echemendia et al., SCAT6, Br J Sports Med 2023, doi:10.1136/bjsports-2023-107036
Davis et al., Child SCAT6, Br J Sports Med 2023, doi:10.1136/bjsports-2023-106853

Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.