Review article
Sport related concussion – Potential for biomarkers to improve acute management

https://doi.org/10.1016/j.jocn.2018.07.002Get rights and content

Highlights

  • Mild traumatic brain injury.

  • Chronic traumatic encephalopathy.

  • Concussion management.

  • Concussion biomarkers – MRI, blood.

Abstract

Sport-related concussion is a common form of mild traumatic brain injury that is now recognised as a serious health issue. Growing evidence suggests concussion may result in long-term and severe neurological disabilities. Recent research into the diagnosis and management of concussion may provide new approaches to concussion management that limit the potential long-term adverse effects of concussion. This paper summarises the problem of sport-related concussion and reviews key factors (sex, age, genetics) that may modify concussion outcomes. Current sport-related concussion tools are described. Analysis of emerging methods of acute concussion diagnosis using objective fluid and neuroimaging biomarkers is provided. These new concussion biomarkers have the potential to change management of sport-related concussion.

Introduction

Our understanding of sport-related concussion and its adverse health consequences is increasing. Historically, concussion describes an alteration in mental state caused by biomechanical forces to the head that usually spontaneously resolves over a short period of time [1], [2], [3]. Some recent evidence suggests concussion may have longer-term consequences. Press coverage of high-profile athletes retiring due to the effects of concussions has intensified debate about safe management of head trauma in sport [4], [5]. With an estimated 1.6–3.8 million sport-related concussions in the USA each year the health care community and policy makers are under increased pressure for consensus on how to protect athletes from the serious consequences of concussion [6], [7]. Disagreement and uncertainty exists amongst medical practitioners and sports administrators about how to manage sport-related concussion [2]. Clear guidelines and translatable methods of concussion management are needed to protect and care for athletes who are at risk of head knocks at all competition levels. This paper will provide an overview of sports-related concussion, including common signs and symptoms, incidence rates, and important modifiable factors (e.g. sex, age, and genetics). After reviewing existing concussion diagnosis and management tools we present promising new methods of concussion management.

Section snippets

Definition, signs, symptoms

Concussion is described as a type of mild traumatic brain injury (TBI), on the less-severe end of the brain injury spectrum [1], [2], [3]. Concussion is caused by a direct blow to the head or from impact elsewhere on the body that causes biomechanical force, acceleration and/or deceleration to be transmitted to the brain [8]. This triggers complex pathophysiological processes that cause rapid alteration in conscious state [2], [3]. Loss of consciousness often occurs in more severe cases.

Current concussion management

Current sport-related concussion management is centered on a symptom free waiting period (of variable length) of cognitive and physical rest before allowing the athlete to begin graduated activity before gaining medical clearance to return to play [1], [2]. A variety of concussion tools are available to guide clinical diagnosis and management of concussion, the most common of which are outlined below.

Emerging concussion management tools

Considering the potential long-term effects of concussions, and the concerns and limitations with current management methods, recent research efforts have attempted to identify more sensitive and/or objective indicators of concussion and recovery that may one day supplement or replace symptom-based concussion management.

Conclusion

Concussion remains a difficult injury to define, diagnose and monitor. We currently rely on symptom based assessment tools that may not capture the full spectrum of concussion injuries and time to recovery. Research into genetics, age and gender differences in concussed athletes is expanding our understanding of the complexity of concussive injuries and individual differences in susceptibility to injury. Objective concussion biomarkers may reduce the uncertainty surrounding diagnosis,

Sources of support

SRS is funded by a fellowship from the Australian NHMRC.

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