American Medical Society for Sports Medicine
AMSSM Publishes Updated Position Statement on Concussion in Sport
LEAWOOD, KAN – The American Medical Society for Sports Medicine (AMSSM) has released its latest position statement, Concussion in Sport 2019, an update to its 2013 position statement on Concussion in Sport. The 2019 statement is targeted toward practicing sports medicine physicians but may be useful for other providers. It underscores the need for accurate, multi-modal diagnosis, highlights the trend toward more active management of concussion and the evidence supporting it, and examines the concept of clinical profiles. The position statement also identifies 12 areas where future concussion research should be directed.
Sport-related concussion (SRC) is a common injury in recreational and organized sport. Over the past 30 years, there has been significant progress in our scientific understanding of SRC, which in turn has driven the development of clinical guidelines for diagnosis, assessment and management of SRC. In addition to a growing need for knowledgeable healthcare professionals to provide evidence-based care for athletes with SRC, media attention and legislation have created awareness and, in some cases, fear about many issues and unknowns surrounding SRC. AMSSM formed a writing group to review the existing literature on SRC, update its previous 2013 position statement, and to address current evidence and knowledge gaps regarding SRC. The absence of definitive outcomes-based data is challenging and requires relying on the best available evidence integrated with clinical experience and patient values. This statement reviews the definition, pathophysiology and epidemiology of SRC, the diagnosis and management of both acute and persistent concussion symptoms, the short-term and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The AMSSM is committed to best clinical practices, evidence-based research and educational initiatives that positively impact the health and safety of athletes.
“This position statement reflects our evolving understanding of SRC and reflects a terrific collaborative effort by people with a variety of viewpoints,” said lead author Kim Harmon, MD, who serves as a sports medicine physician and professor at the University of Washington, head team physician for UW football and is a past AMSSM President. “Our expectation is that this will be very useful and practical for sports medicine physicians and others who care for those with SRC.”
The position statement can be viewed by visiting the British Journal of Sports Medicine website, https://bjsm.bmj.com/content/53/4/213. It will be concurrently published on the Clinical Journal of Sport Medicine website, https://journals.lww.com/cjsportsmed/pages/default.aspx.
AMSSM represents over 3,800 sports medicine physicians who have completed specialty training in sports medicine after a residency program in family medicine, internal medicine, pediatrics, emergency medicine, or physical medicine and rehabilitation, many of whom have extensive expertise in concussion evaluation and management, including serving as sideline team physicians at all levels of sport. SRC is an important topic for sports medicine physicians and there is a rapidly expanding knowledge base in this area. SRC has become a focus of both public concern and media attention. The purpose of this statement is to provide a narrative review of the existing literature and best practices to assist healthcare providers with the evaluation and management of SRC, and to establish the level of evidence, current knowledge gaps and areas requiring additional research. The first AMSSM position statement on SRC was published in 2013 and this is an update to that statement.
Written by a team of sports medicine physicians experienced in sideline and office evaluation and management of SRC, actively engaged in SRC research, and with demonstrated leadership in the area of SRC, as well as selected content experts, this statement was intended for sports medicine physicians who are specially trained to provide sports concussion care from the acute injury to return-to play. The AMSSM is also hopeful that this information can support other healthcare professionals as they care for patients with concussions.
The statement concludes that sport-related concussion is a complex, heterogeneous brain injury that typically resolves clinically in 1-4 weeks. The diagnosis of concussion is challenging as it relies on self-reported symptoms that can be caused by other common conditions and there are no readily available objective diagnostic tests to confirm the diagnosis. Sports medicine physicians and others who diagnose concussion should be familiar with the psychometric properties of the sideline and office assessment tools they are using. After a brief period of rest, acutely concussed patients can be encouraged to gradually and progressively increase physical and cognitive activity while staying below their symptom-exacerbation thresholds. In cases of prolonged symptoms, a multidisciplinary team experienced in the diagnosis and treatment of concussion should be considered. Further research is necessary to better understand the potential long-term effects from concussions and repetitive sub-concussive impacts, as well as incidence, prevalence and modifiable risk factors. There are many beneficial aspects to participation in sport and exercise that should be balanced against the concern for concussion. The AMSSM supports continued research in the area of SRC to enhance safe participation in sport.
“This statement is an important document representing 'state of the art' and current standards of care for concussion in sport,” said AMSSM President Chad Asplund, MD, MPH. “It will be valuable for those who care for sports related concussion, as well as for the safety of athletes and active people.”
About the AMSSM: AMSSM is a multi-disciplinary organization of more than 3,800 sports medicine physicians dedicated to education, research, advocacy and the care of athletes of all ages. The majority of AMSSM members are primary care physicians with fellowship training and added qualification in sports medicine who then combine their practice of sports medicine with their primary specialty. AMSSM includes members who specialize solely in non-surgical sports medicine and serve as team physicians at the youth level, NCAA, NFL, MLB, NBA, WNBA, MLS and NHL, as well as with Olympic and Paralympic teams. By nature of their training and experience, sports medicine physicians are ideally suited to provide comprehensive medical care for athletes, sports teams or active individuals who are simply looking to maintain a healthy lifestyle. www.amssm.org
NOTE: For more information, please contact the AMSSM, 4000 W. 114th St., Suite 100, Leawood, KS 66211, (913) 327-1415.