Lancet Neurology editorial calls for ‘gamechanger’ in concussion management

While accepting that gaps in knowledge about concussions exist, the editorial board for The Lancet Neurology called for more practical guidelines for both neurologists and lay observers in managing concussions, particularly those sustained while playing sports.

Sideline questionnaires and assessments for non-physicians exist, but they don’t provide a full solution. The Standardized Assessment of Concussion has a sensitivity as low as 80 percent, according to some reports, and the American Academy of Neurology’s (AAN) quick reference mobile app has yet to have its validity tested in practice.

“In the absence of robust data on these parameters, current knowledge will need to be molded into pragmatic guidelines with more focus on practical and across-the-board applicability,” wrote the authors in an article published in the May issue of The Lancet Neurology.

Two recently released updates to guidelines—from the 4th International Conference in Sport in Zurich and from the multidisciplinary guideline development subcommittee of AAN—stressed removal from play and monitored reintegration for athletes suspected of concussion, but fall short in offering further practical advice, according to the editorial.

“Although the Zurich guidelines, which represent the views of multiple sports agencies, go further than the AAN guidelines to formulate what little is known into workable guidelines, the message will still be lost unless it can apply all the way down, from the elite sporting arenas to the most informal sports meetings,” wrote the authors. “Looking to the long term, an across profession consultation on the link between concussive injuries and neurodegeneration needs to be convened. Only then can questions on exposure levels, concurrent risk and protective factors, time to development, diagnosis, and management be answered.”

Until more functional guidelines are developed, the editorial suggests extreme caution and medical investigation in response to suspected head injury. Preventative measures, rule changes and protective equipment changes also should be implemented, according to the authors. “Such changes will inevitably take time to implement and will undoubtedly meet with resistance, but their increased prominence would be a welcome addition to the next update of the respective guidelines.”

For more on concussions in sports, please read “Say what?: Tablet-based speech analysis system could catch concussions” and “NYU Langone launches Concussion Center, talks brain injury research.”