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ObjectiveTo determine what tests and measures accurately diagnose persisting post-concussive symptoms (PPCS) in children, adolescents and adults following sport-related concussion (SRC).DesignA systematic literature review.Data sourcesMEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL and SPORTDiscus through March 2022.Eligibility criteriaOriginal, empirical, peer-reviewed findings (cohort studies, case-control studies, cross-sectional studies and case series) published in English and focused on SRC. Studies needed to compare individuals with PPCS to a comparison group or their own baseline prior to concussion, on tests or measures potentially affected by concussion or associated with PPCS. Results: Of 3298 records screened, 26 articles were included in the qualitative synthesis, including 1016 participants with concussion and 531 in comparison groups; 7 studies involved adults, 8 involved children and adolescents and 11 spanned both age groups. No studies focused on diagnostic accuracy. Studies were heterogeneous in participant characteristics, definitions of concussion and PPCS, timing of assessment and the tests and measures examined. Some studies found differences between individuals with PPCS and comparison groups or their own pre-injury assessments, but definitive conclusions were not possible because most studies had small convenience samples, cross-sectional designs and were rated high risk of bias.ConclusionThe diagnosis of PPCS continues to rely on symptom report, preferably using standardised symptom rating scales. The existing research does not indicate that any other specific tool or measure has satisfactory accuracy for clinical diagnosis. Future research drawing on prospective, longitudinal cohort studies could help inform clinical practice.

ObjectiveTo analyse the safety of a multidisciplinary concussion management protocol where a team therapist is involved in return-to-play (RTP) decisions.DesignProspective, pre- post-intervention cohort study over 4 seasons of competitionSettingSchool-based American football program (4 teams; grades 8–12)Participants:672 players x year (11–17 year old) for a total of 27741 athlete-exposure.InterventionA protocol based on the Concussion In Sport Group recommendations was implemented. A computerised neuropsychological (CNP) test was used at baseline and prior to clearance for unrestricted training. For seasons 1–2, the protocol required the team physician to make all RTP decision while defined criteria allowed the team physiotherapist to make the vast majority of the RTP decisions over seasons 3–4.Outcome measuresThe primary outcome was the early recurrence (ER) of concussion symptoms following RTP (defined as during the same season).ResultsA total of 119 concussions were identified (55 and 64 for the first and last 2 seasons, respectively; incidence rate 4, 3: 1000 athlete-exposures). At the time of the first clearance decision, the CNP test contributed to a negative RTP decision in 67% of cases. During seasons 1–2 no ER was observed. During season 3 one injury unrelated to football resulted in one case of ER prior to clearance and, during season 4, one case of ER occurred during the second game, 11 days after clearance.ConclusionsSafe management of concussions was achieved whether the team physician or the team therapist was responsible for the application of the terms of the protocol.Competing interestsPierre FréÉééééémont chair of the Canadian Concussion Collaborative.éÉéééééÉdith Castonguay is the physiotherapist for the football program described in this study.Francesco Pepe-Esposito is Head coach of the football program described in this study.None.

ObjectiveTo analyse the potential ways to reunite the mTBI and concussion constructs in order to harmonise screening, diagnosis and management.DesignNarrative review.SettingIn Quebec, the initial management of concussions sustained in a sport or school-based setting falls under the authority of the Ministry of education and sports whereas the Ministry of health governs the clinical management of mTBI. The recent work of a task force on concussions in Quebec has emphasised the need to achieve a unified understanding and operationalization of the two constructs so that persons affected receive consistent information and care.Main resultsSport and school-based concussion management is generally based on the Concussion In Sport Group definition whereas the Quebec health care system relies on the 5 diagnostic criteria proposed by the WHO task force in 2004. Although the 5 classification criteria of mTBI include normal values, the actual definition requires the presence of one or more abnormal criteria. In a public health care system, such a definition structures access to limited public resources. However unfavourable evolution can occur in the absence of phenomena such as LOC or PTA. Yet these cases represent a potentially serious health condition if proper identification and management is not initiated.ConclusionSo far, sport, education and health care stakeholders in Quebec have agreed that the constructs of concussion and TBI must be revisited and better integrated. This process raises challenges and opportunities in terms of operationalization and management. Studies on prognostic indicators should guide this analysis.ConclusionCompeting interests Pierre Frééémont is chair of the Canadian Concussion Collaborative.None.