Treating concussion in sport
Sir, – You have quite correctly highlighted the concern about sport-related concussion and particularly the steps taken in rugby in its prevention and management both by medics and lay persons (Sport, December 18th).
The medical community within the IRB has fully embraced the recommendations as propounded by an expert group of scientists and clinicians who met for two days in Zurich, resulting in the Concussion in Sport Consensus Statement (2013).
Of particular importance, this document again confirms that the clinical presentation and assessment of concussions are multifactorial, and that signs and symptoms evolve and resolve over very variable periods of time and thus require constant and repeated expert assessments. Furthermore, children and young adults require a much more conservative approach in managing suspected concussion.
The decision to allow a rugby player to return to play is best made by doctors who are themselves familiar with this consensus protocol.
Concern has been expressed about rugby’s introduction of the Pitch Side Concussion Assessment (PSCA) whereby a player can be taken off the field for five minutes, allowing doctors to make a call as to whether he/she has indeed suffered a suspected concussion and if so, be removed permanently.
It is important to understand that the PSCA is only a supporting tool in our concussion management strategy and was only designed to be used by doctors working at the elite level of the game to assist with the assessment of a player with a head injury, and only where the diagnosis is not immediately obvious.
Medicine is not an exact science and no more so in concussion management. Nor is the PSCA an exact or perfect tool; but no perfect tool exists at present.
As with other sports, it is not the protocols that are at fault, perhaps, but their implementation; and doctors with an understanding of the available knowledge of concussion must continue to be guided by one of the principal precepts in medicine, Primum non nocere (first do no harm). – Yours, etc,
W ARTHUR TANNER,