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Abstract: Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries., (Copyright © 2024 by the American College of Sports Medicine.)

Objective: This study sought to (1) collate the experiences of university students with concussion history and academic stakeholders through interviews and (2) develop concussion management recommendations for institutions of higher learning using a multidisciplinary Delphi procedure., Setting: Remote semistructured interviews and online surveys., Participants: The first aim of this study included undergraduate university students with concussion history who did not participate in varsity athletics ( n = 21; 57.1% female), as well as academic faculty/staff with experience assisting university students with their postconcussion academic needs ( n = 7; 71.4% female). The second aim enrolled 22 participants (54.5% female) to serve on the Delphi panel including 9 clinicians, 8 researchers, and 5 academic faculty/staff., Design: An exploratory-sequential mixed-methods approach., Main Measures: Semistructured interviews were conducted to unveil barriers regarding the return-to-learn (RTL) process after concussion, with emergent themes serving as a general framework for the Delphi procedure. Panelists participated in 3 stages of a modified Delphi process beginning with a series of open-ended questions regarding postconcussion management in higher education. The second stage included anonymous ratings of the recommendations, followed by an opportunity to review and/or modify responses based on the group's consensus., Results: The results from the semistructured interviews indicated students felt supported by their instructors; however, academic faculty/staff lacked information on appropriate academic supports and/or pathways to facilitate the RTL process. Of the original 67 statements, 39 achieved consensus (58.2%) upon cessation of the Delphi procedure across 3 main categories: recommendations for discharge documentation (21 statements), guidelines to facilitate a multidisciplinary RTL approach (10 statements), and processes to obtain academic supports for students who require them after concussion (8 statements)., Conclusions: These findings serve as a basis for future policy in higher education to standardize RTL processes for students who may need academic supports following concussion., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete's perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research., Competing Interests: Competing interests: OHA is a Senior Physiotherapist at University Hospitals Dorset NHS Foundation Trust (England) and is Para Football Physiotherapy Lead/Para Football Classification Lead at the Football Association (England). He also works on a consultancy basis with the Football Association as the squad physiotherapist to the England Cerebral Palsy Football squad and teaches a course on the Football Association’s Advanced Trauma and Medical Management in Football course on a consultancy basis. He has a Visiting Senior Lecturer position at the University of Portsmouth, England (unpaid). He sits on several disability sport committees, including Para Football Foundation as Medical Unit Co-Lead (unpaid), the International Federation of Cerebral Palsy Football as Medical and Sports Science Director (unpaid) and the International Blind Sports Association as Medical Committee member (unpaid). He has Associate Editor positions at the British Journal of Sports Medicine (unpaid) and BMJ Open Sports & Exercise Medicine (unpaid). He is also an Institutional Ethics Committee external member for World Rugby (unpaid) and co-chair of the Concussion in Para Sport Group (unpaid). CAB is an Associate Professor of PM&R Journal at Spaulding Rehabilitation Hospital/Harvard Medical School and Chief Medical Officer at Spaulding Rehabilitation Hospital. She receives grant funding from the US Center for Disease Control and Prevention and the US National Institute on Disability, Independent Living, and Rehabilitation Research. She serves on the Board of Directors of the US Olympic & Paralympic Committee (unpaid) as well as on the International Paralympic Committee Medical Committee (unpaid) and the IOC Medical & Scientific Commission (unpaid). She serves as an Associate Editor of the British Journal of Sports Medicine (unpaid) and the PM&R Journal (unpaid). SPB Current or past research funding from the National Institutes of Health; US Centers for Disease Control and Prevention; Department of Defence (DoD)—USA Medical Research Acquisition Activity, National Collegiate Athletic Association (NCAA); National Athletic Trainers’ Association Foundation; NFL/Under Armour/GE; Simbex and ElmindA. He has consulted for US Soccer (paid), US Cycling (unpaid), University of Calgary SHRed Concussions external advisory board (unpaid), medicolegal litigation and received speaker honorarium and travel reimbursements (including Concussion in Sport Group (CISG)) for talks given. He is the coauthor of Biomechanics of Injury (3rd Edition) and has a patent pending on Brain Metabolism Monitoring Through CCO Measurements Using All-Fiber-Integrated Super-Continuum Source (US Application No 17/164,490). He is/was on the editorial boards (all unpaid) for Journal of Athletic Training (2015 to present), Concussion (2014 to present), Athletic Training & Sports Health Care (2008 to present) and British Journal of Sports Medicine (2008–2019). RCC Senior Advisor NFL Head Neck & Spine Committee NOCSAE and Chair Scientific Advisory Committee Co-Founder, Medical Director Concussion Legacy Foundation Royalties Houghton Mifflin Harcourt Legal Expert Opinion. GAD is a member of the Scientific Committee of the Sixth International Conference on Concussion in Sport; an honorary member of the AFL Concussion Scientific Committee; Section Editor, Sport and Rehabilitation, Neurosurgery and has attended meetings organised by sport organisations including NFL, NRL, IIHF, IOC and FIFA; however has not received any payment, research funding or other monies from these groups other than for travel costs. JD is the co-founder and board member of CISG and Senior Advisor to BJSM. RJE is a paid consultant for the NHL and cochair of the NHL/NHLPA Concussion Subcommittee. He is also a paid consultant and chair of the Major League Soccer concussion committee and a consultant to the US Soccer Federation. He previously served as a neuropsychology consultant to Princeton University Athletic Medicine and EyeGuide. He is currently a co-principal investigator (PI) for a grant funded by the NFL (NFL-Long) through Boston Children’s Hospital. He occasionally provides expert testimony in matters related to mild traumatic brain injury (mTBI) and sports concussion and occasionally receives honoraria and travel support/reimbursement for professional meetings. CAE holds external peer-reviewed research funding from Canadian Institutes of Health Research, Canada Foundation for Innovation, IOC Medical and Scientific Committee, NFL Play Smart Play Safe Program and World Rugby. She is an Associate Editor of BJSM (unpaid) and has received travel and accommodation support for meetings where she has presented. She is an external advisory board member for HitIQ. NF-D International independent FIFA Concussion Advisory Group. GOTS Concussion Committee Innovation and Technology Panel, UK Department for Digital, Culture, Media and Sport. International Consensus Group on Concussion in Sports (CISG), NINDSCDE Sports Concussion CDE Subacute Subgroup (National Institutes of Health). IFAB Concussion Expert Group. Member of Swiss Neurology Society, Swiss Society for Clinical Neurophysiology, European Neuro-Ophthalmology Society and CISG. Editorial Board Member of Journal of Concussion, Journal of Science and Medicine in Football. GF has received travel expenses to attend academic meetings from World Rugby. He has also collaborated on research projects with World Rugby as chief or co-investigator. He is a previous associate editor of the British Journal of Sports Medicine. He has not received any other payments or support from any sporting or commercial bodies. CCG discloses the following: Grants/research support: HitIQ (2022–2023); NIH NINDS (R01 NS110757 2019–2024); NINDS (U54 NS121688 2021-2026); UCLA Brain Injury Research Center, UCLA Steve Tisch BrainSPORT programme, Easton Clinic for Brain Health. Clinical Consultant (provide clinical care to athletes): NBA, NFL-Neurological Care Program, NHL/NHLPA, Los Angeles Lakers Advisory Board (non-compensated): Major League Soccer, NBA and US Soccer Federation. Advisory Board (compensated): Highmark Interactive Medicolegal: One or two cases annually Speaker’s bureau: None. Stock shareholder: Highmark Interactive stock options (2018). Other financial or material support: book royalties—Blackwell/Wiley Publishing: prioritized. Neurological differential diagnosis. KMG has received grant funding from NFL for the NFL LONG study. He also serves on the NCAA Scientific Advisory Board in an unpaid capacity. BH works full time as a paid employee of the NCAA as Senior Vice President, Sport Science Institute, and as Chief Medical Officer. I serve as a volunteer advisory member for: US Football Medical Advisory Panel; CrashCourse by TeachAids; NBJA Youth Health & Wellness Working Group; External Advisory Board, DIAGNOSE CTE (Boston University). I am on the Board of Directors for the US Tennis Association, the Grand Slam Board; the International Tennis Integrity Agency and the Datalys Center. I am chair of the International Tennis Federation Sports Science & Medicine Commission. SAH is co-founder and senior advisor of the Sports Institute at UW Medicine (unpaid). Centers for Disease Control and Prevention and National Center for Injury Prevention and Control Board Pediatric Mild Traumatic Brain Injury Guideline Workgroup (unpaid). CISG (travel support). NCAA Concussion Safety Advisory Group (unpaid). Team Physician, Seattle Mariners. Former Team Physician, Seattle Seahawks. Occasional payment for expert testimony. Travel support for professional meetings. GLI serves as a scientific advisor for NanoDX, Sway Operations and Highmark. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mTBIs (including former athletes) and on the topic of suicide. He has received past research support or funding from several test publishing companies, including ImPACT Applications, CNS Vital Signs and Psychological Assessment Resources (PAR). He receives royalties from the sales of one neuropsychological test (WCST-64). He has received travel support and honorariums for presentations at conferences and meetings. He has received research funding as a PI from the NFL and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of NFL Players Association Members. He has received research funding from the Wounded Warrior Project. He acknowledges unrestricted philanthropic support from ImPACT Applications, the Mooney-Reed Charitable Foundation, the National Rugby League, Boston Bolts and the Schoen Adams Research Institute at Spaulding Rehabilitation. JK declares the following affiliations: NBA. US Ski and Snowboard. US Olympic & Paralympic Committee. NHL Players’ Association. Major League Soccer Players’ Association. NFL Players’ Association. NeuroSync. Cognivue. JJL receives grant/research support from NIH, DoD and AMSSM. He is a member of the Scientific Advisory Board for Neuronasal, Highmark Innovations and Quadrant Biosciences. Minority stock options in Highmark Innovations and 360 Concussion Care. Expert consultant to NCAA. Consults with NFL and NHL teams on athlete care but does not receive any compensation from these organizations. He is on the Editorial Board of Journal of Head Trauma and Rehabilitation. DM Neuropsychologist and lawyer—legal practice in Medical Law. Legal representation provided to parties in personal injury legal proceedings. Former member of AFL Concussion Working Group—no remuneration. Past legal advisor to Cricket Australia and the AFL. Legal advisor to various professional sporting clubs. Past ARF concussion research funding received through the Florey Institute of Neuroscience & Mental Health. Member of the AFL Grievance Tribunal—no remuneration received. Legal advisor to private schools. Lectures (neuropsychology/law) to education providers—no remuneration. Cricket Victoria—former Director/Chair—no remuneration. Melbourne Grammar School—Audit & Risk Committee Member—no remuneration. CISG Board Member—no remuneration. Travel support to attend the 2022 CISG meeting. Abstained from discussions in the 2022 CISG consensus process in relation to ‘chronic traumatic encephalopathy, neuropathological change and trauatic encephalopathy syndrome'and 'potential long-term sequelae'. MM Sport and exercise medicine physician working in private consulting practice. Shareholder of Olympic Park Sports Medicine Centre in Melbourne. Ex-senior physician at the Hawthorn Football Club (AFL). Ex-Chief Executive Officer of the AFL Doctors Association. Research grants received from the Australian Football League, outside the submitted work. Travel support received from the Australian Football League, FIFA and the IOC to attend and present at international conferences. Member of the Scientific Committee for the Sixth International Conference on Concussion in Sport. Honorary member of the International CISG. Honorary member of the Australian Rugby Union Concussion Advisory Group. Independent Concussion Consultant for World Rugby. GTM discloses grants from the US DoD—TBI Endpoints Development Initiative (Grant no W81XWH-14-2-0176), TRACK-TBI Precision Medicine (Grant no W81XWH-18-2-0042) and TRACK-TBI NETWORK (Grant no W81XWH-15-9-0001); NIHNINDS—TRACK-TBI (Grant no U01NS086090) and the NFL Scientific Advisory Board—TRACK-TBI LONGITUDINAL. US Department of Energy supports GTM for a precision medicine collaboration. One Mind has provided funding for TRACK-TBI patients’ stipends and support to clinical sites. He has received an unrestricted gift from the NFL to the UCSF Foundation to support the research efforts of the TRACK-TBI NETWORK. GTM has also received funding from NeuroTruama Sciences to support TRACK-TBI data curation efforts. Additionally, Abbott Laboratories has provided funding for add-in TRACK-TBI clinical studies. MAM has received research funding to the Medical College of Wisconsin from the National Institutes of Health (NIH), Department of Veterans Affairs, US Centers for Disease Control and Prevention, DoD, NCAA, NFL and Abbott Laboratories. He receives book royalties from Oxford University Press. He serves as a clinical consultant to Milwaukee Bucks, Milwaukee Brewers and Green Bay Packers, and is Co-Director of the NFL Neuropsychology Consultants without compensation. He serves as a consultant for NeuroTrauma Sciences. He receives travel support and speaker honorariums for professional activities. MJM Chair, Ethics Expert Group, WADA (2021–2023) (paid). Member, International Boxing Association, Ethics and Integrity Committee, (2021–2022; resigned October 2022) (paid). Chair, Therapeutic Use Exemption Fairness Committee (2020 to present) (paid). Member, Steering Group, Sex Segregation in Sport, IAAF/World Athletics, (2019–2020) (unpaid). Member, International Ice Hockey Federation, Ethics and Integrity Committee (2019–2021) (paid). Member, IOC Consensus Statement Expert Group on Injuries in Children and Adolescents (2017) (unpaid). Member, Ethics Expert Group, WADA (2016–2021) (unpaid). Member, IOC Consensus Statement Expert Group on Pain Management (2016) (unpaid). WM is employed as the Chief Medical Officer of the NHL. JSP is an Editor of BJSM for which he receives a honorarium. He is an unpaid consultant to the World Rugby Concussion Advisory Group for which he also serves as an Independent Concussion Advisor (fee per consultation). Other unpaid positions include being medical advisor to South African Rugby, Co-chair of the Scientific Committee, 6th International Conference on Concussion in Sport (travel and accommodation subsidised), Board member of the CISG and a Scientific Advisory Board Member of EyeGuide. LKP CASEM Board Member, President-Elect 2022–2023 NIH R34 Grant for EPICC Study (Eye Problems In Concussed Children), Site PI. Speaker at various conferences. CISG member. Expert panellist for the Sixth International Conference on Concussion in Sport (travel and accommodation subsidised). MP declares the following: Consultant, Chief Medical Officer, Major League Soccer. Senior Advisor, NFL Head, Neck & Spine Committee. FA Research Task Force Committee member. UK Concussion Foundation Protocol Forum. US Soccer Medical Advisory Committee. CDC Concussion Consultant. CISG expert panel. NOCSAE Scientific Advisory Committee. IOC Mental Health Working Group. USOPC Mental Health Advisory Committee. Team Physician, US Soccer. Received funding for research; NCAA-CARE-DoD 2.0, ended 2020. He received honoraria and reimbursement for travel for speaking and conferences amended. He has written chapters for UpToDate and received royalties for the Netter’s Sports Medicine textbook. He has provided work as an expert for cases involving concussion, team physician and other sports medicine topics. KJS has received grant funding from the Canadian Institutes of Health Research, NFL Scientific Advisory Board, IOC Medical and Scientific Research Fund, World Rugby, Mitacs Accelerate, University of Calgary with funds paid to her institution and not to her personally. She is an Associate Editor of BJSM (unpaid), independent consultant to World Rugby and has received travel and accommodation support for meetings where she has presented. She led and coordinated the writing of the systematic reviews that informed the Sixth International Conference on Concussion in Sport and Amsterdam Consensus Statement, for which she received an educational grant to assist with the administrative costs associated with the writing of the reviews (with funds paid to her institution and not to her personally). She is a member of the AFL Concussion Scientific Committee (unpaid position) and Brain Canada (unpaid position). She works as a physiotherapy consultant and treats athletes of all levels of sport from grassroots to professional. MT is employed full-time as the CEO and Medical Director of ICHIRF—a paid post he has held since April 2015. Hon Medical Adviser to the Professional Riders Insurance Scheme (PRIS)—discretionary Honorarium. Member of the Premier League Head Injury Advisory Group—no remuneration. Director of ICHIRF Ireland—no remuneration. Honorary Medical Adviser to the Concussion Foundation—no remuneration. Member of the expert panel for the Department of Digital, Culture, Media and Sport review into concussion in amateur sport—no remuneration. Attendance at conferences or meetings as a guest speaker—reimbursement of travel expenses, complimentary registration and payment of hotel accommodation and meals by the organising committee. No stocks or options in any concussion-related company. No consultancies, board or editorial positions related to concussion. KOY is Editor-in-Chief of the journal Neuropsychology and receives an editorial stipend from the American Psychological Association. He is an unpaid consulting editor for the journals Archives of Clinical Neuropsychology and Journal of Head Trauma Rehabilitation. He is an unpaid member of the Scientific Advisory Committee for Brain Injury Canada. He is the chair of the Canadian Concussion Network, which is funded by a grant from the Canadian Institutes of Health Research (CIHR) to his institution; he is the principal applicant for the grant but receives no income from it. He is a PI on another grant from CIHR from which he derives no income. He is a co-investigator on research grants from CIHR, the US NIH, Brain Canada Foundation and NFL Scientific Advisory Board; he derives income only from the grant from the NIH. He serves as a member of a CIHR grant review panel for which he receives a small honorarium. He receives book royalties from Guilford Press and Cambridge University Press. He has received travel support and honorarium for presentations to multiple organisations. He serves or has served on the following committees/boards for which he receives honorarium: (1) Independent Data Monitoring Committee, Care for Post-Concussive Symptoms EffecCveness (CARE4PCS-2) Trial, National Institute for Child Health and Human Development; (2) Observational Study Monitoring Board, Approaches and Decisions in Acute Pediatric TBI (ADAPT) Trial, National Institute of Neurological Disorders and Stroke National Research Advisory Council; (3) National Pediatric Rehabilitation Resource Center, Center for Pediatric Rehabilitation: Growing Research, Education, and Sharing Science, Virginia Tech University., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6)., Data Sources: Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation., Eligibility Criteria: (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC., Data Extraction: Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool., Results: Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children., Conclusion: Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes., Prospero Registration Number: CRD42020154787., Competing Interests: Competing interests: CMB reports affiliations with the Cleveland Browns (National Football League) and Cleveland Monsters (American Hockey League), a board position in the Sports Neuropsychology Society, and occasional expert consulting fees. AMB reports receiving an honorarium for administrative aspects of the concussion consensus reviews and grant funding from Social Sciences and Humanities Research Council. She is also a Sport Information Resource Centre board member and Canadian Athletic Therapists Association committee member. BLB reports grants from the National Institute on Aging and National Institute of Neurological Disorders and Stroke and travel support for professional conferences. JMB reports is a part-time employee of the National Hockey League and a member of the NHL/NHLPA Concussion subcommittee. He is the neuropsychology consultant to Major League Soccer's Sporting KC and has served as a consultant to EyeGuide. JSB is supported by the University of Calgary, the Natural Sciences and Engineering Research Council (CGSD3-559333-2021), and an honorarium for the methods author work associated with Reviews two and four. GAD is a member of the Scientific Committee of the 6th International Consensus Conference on Concussion in Sport; an honorary member of the AFL Concussion Scientific Committee; Section Editor, Sport and Rehabilitation, NEUROSURGERY; and has attended meetings organised by sporting organisations including the NFL, NRL, IIHF, IOC and FIFA; however has not received any payment, research funding or other monies from these groups other than for travel costs. RJE is a paid consultant for the National Hockey League and co-chair of the National Hockey League/National Hockey League Players' Association Concussion Subcommittee, Major League Soccer’s Concussion Committee and the US Soccer Federation. He provides expert testimony in matters related to mild traumatic brain injury and reports a grant from Boston Children’s Hospital (subaward from the National Football League) and travel support for the CIS conference and other professional conferences, an unpaid board member of CISG and a member of the Scientific Committee of the 6th International Consensus Conference on Concussion in Sport. He has served in leadership roles (unpaid) in professional organisations. CCG discloses the following: Grants/Research Support: Hit-IQ (2022-2023); NIH NINDS (R01 NS110757 2019-2024); NINDS (U54 NS121688 2021-2026); UCLA Brain Injury Research Center, UCLA Steve Tisch BrainSPORT program, Easton Clinic for Brain Health Clinical Consultant (provide clinical care to athletes): NBA, NFL-Neurological Care Program, NHL/NHLPA, Los Angeles Lakers Advisory Board (non-compensated): Major League Soccer, National Basketball Association, US Soccer Federation. Advisory Board (compensated): Highmark Interactive; Medicolegal: One or two cases annually. Stock Shareholder: Highmark Interactive stock options (2018). Book royalties – Blackwell/Wiley Publishing: Prioritized Neurological Differential Diagnosis. GG Reports grant funding from CDC TEAM and OnTRACK grants, NIMH APNA grant, royalties from PAR, consulting fees from NFL Baltimore Ravens, Zogenix International and Global Pharma Consultancy, and travel support for professional meetings. He is a member of USA Football Medical Advisory Panel. KMG reports compensation from National Collegiate Athletic Association for other services and grants from Boston Children’s Hospital (subaward from the National Football League). SH is co-founder and senior advisor, The Sports Institute at UW Medicine (unpaid), Centers for Disease Control and Prevention and National Center for Injury Prevention and Control Board Pediatric Mild Traumatic Brain Injury Guideline Workgroup (unpaid), CISG (travel support), NCAA Concussion Safety Advisory Group (unpaid), Team Physician, Seattle Mariners, Former Team Physician, Seattle Seahawks, occasional payment for expert testimony, travel support for professional meetings. DH reports research support from the Eunice Kennedy Shriver National Institute of Child Health & Human Development, the National Institute of Neurological Disorders And Stroke, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, 59th Medical Wing Department of the Air Force, MINDSOURCE Brain Injury Network, the Tai Foundation and the Colorado Clinical and Translational Sciences Institute (UL1 TR002535‐05) and he serves on the Scientific/Medical Advisory Board of Synaptek. Concussion research grant support from Football Research. MM reports grants/contracts from Florey Institute of Neuroscience and Mental Health, consulting fees from AFL, Olympic Park Sports Medicine Centre, Cabrini and Epworth Health, World Rugby, Hawthorn Football Club and AFL Doctors Association. He has received travel support for attending professional conferences, has/had leadership roles in CISG, International Consensus Conference in Sport meeting and Australian Rugby Union, a shareholder in Olympic Park Sports Medicine Centre, and honorary research associations with several university groups. SK reports that he is Medical Services Director, Rugby Football Union. CLM reports no financial COI. She holds leadership positions with several organisations: American College of Sports Medicine, American Medical Society for Sports Medicine, Pediatric Research in Sports Medicine, Council on Sports Medicine and Fitness, American Academy of Pediatrics, Untold Foundation, Pink Concussions, Headway Foundation and the editorial boards of Journal of Adolescent Health, Frontiers in Neuroergonomics, Exercise, Sport and Movement. WPM receives royalties from ABC-Clio publishing, Springer International and Wolters Kluwer. His research is funded by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and a grant from the National Football League. DN receives consulting fees from the CFL and travel support for professional conferences. He is a team physician for the NHL and CFL. He is CMO for the CFL and a member of NHL and CFL committees. JP Editor BJSM (honorarium). Member of World Rugby Concussion Advisory Group (unpaid). Independent Concussion Consultant for World Rugby (fee per consultation) Medical consultant to South African Rugby (unpaid). Co-chair of the Scientific Committee, 6th International Conference on Concussion in Sport (unpaid). Board member of the Concussion in Sport Group (unpaid). Scientific Board member, EyeGuideTM (unpaid). MP reports receiving a travel stipend for attending CIS meeting and other professional conferences, grant funds from NCAA-CARE 2.0, royalties from Netters’ Sports Medicine, consulting fees from Major League Soccer as CMO and occasional expert testimony. She is a member of several professional boards and advisory panels. KJS has received grant funding from the Canadian Institutes of Health Research, National Football League Scientific Advisory Board, International Olympic Committee Medical and Scientific Research Fund, World Rugby, Mitacs Accelerate, University of Calgary with funds paid to her institution and not to her personally. She is an Associate Editor of BJSM (unpaid) and has received travel and accommodation support for meetings where she has presented. She is coordinating the writing of the systematic reviews that will inform the 6th International Consensus on Concussion in Sport, for which she has received an educational grant to assist with the administrative costs associated with the writing of the reviews. She is a member of the AFL Concussion Scientific Committee (unpaid position) and Brain Canada (unpaid positions). She works as a physiotherapy consultant and treats athletes of all levels of sport from grass roots to professional. JvI reports CIHR Postdoctoral Fellowship Award, UOMBRI Grant, travel stipend from CTRC and Founder of R2P Concussion Management. TCVM is a paid member of the NFL Head, Neck and Spine Committee and an unpaid member of the USA Swimming Concussion Task Force. SRW reports honoraria and travel support for professional meetings and leadership positions in World Federation of Athletic Training and Therapy and Outcomes, International Traumatic Brain Injury Research Initiative. DS reports grants from World Rugby, New Zealand Rugby Foundation and Otago Science into Action. JK, NB, JCA-L, ZP: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To systematically review the scientific literature regarding factors to consider when providing advice or guidance to athletes about retirement from contact or collision sport following sport-related concussion (SRC), and to define contraindications to children/adolescent athletes entering or continuing with contact or collision sports after SRC., Data Sources: Medline, Embase, SPORTSDiscus, APA PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials were searched systematically., Study Eligibility Criteria: Studies were included if they were (1) original research, (2) reported on SRC as the primary source of injury, (3) evaluated the history, clinical assessment and/or investigation of findings that may preclude participation in sport and (4) evaluated mood disturbance and/or neurocognitive deficits, evidence of structural brain injury or risk factors for increased risk of subsequent SRC or prolonged recovery., Results: Of 4355 articles identified, 93 met the inclusion criteria. None of the included articles directly examined retirement and/or discontinuation from contact or collision sport. Included studies examined factors associated with increased risk of recurrent SRC or prolonged recovery following SRC. In general, these were low-quality cohort studies with heterogeneous results and moderate risk of bias. Higher number and/or severity of symptoms at presentation, sleep disturbance and symptom reproduction with Vestibular Ocular Motor Screen testing were associated with prolonged recovery and history of previous concussion was associated with a risk of further SRC., Conclusion: No evidence was identified to support the inclusion of any patient-specific, injury-specific or other factors (eg, imaging findings) as absolute indications for retirement or discontinued participation in contact or collision sport following SRC., Prospero Registration Number: CRD42022155121., Competing Interests: Competing interests: MMakdissi is sport and exercise medicine physician working in private consulting practice. He is a shareholder of Olympic Park Sports Medicine Centre in Melbourne and consultant to the Australian Football League (AFL, chief medical officer) and an Independent Concussion Consultant for World Rugby. He is a former team physician at the Hawthorn Football Club (AFL) and former chief executive officer of the AFL Doctors Association. He has received research grants from the AFL, outside the submitted work and is a chief instigator (unpaid) on projects receiving grants from the Australian Government Department of Health Medical Research and Future Fund. He is on the editorial board of the BJSM (unpaid) and JSAMS (unpaid). He has received travel support from the AFL, FIFA and the International Olympic Committee to attend and present at international conferences. He is a member of the Scientific Committee for the 6th International Consensus Conference on Concussion in Sport (unpaid), International Concussion in Sport Group (unpaid), Australian Rugby Union Concussion Advisory Group (unpaid). RC serves as a scientific advisor for the National Football League’s (NFL) Head Neck and Spine Committee, VP and Chair of the Scientific Advisory Committee for the National Operating Committee on Standards for Athletic Equipment (NOCSAE), and as cofounder and medical director of the Concussion Legacy Foundation. He currently receives research support from the NINDS UNITE and Diagnose CTE grants. He has received travel support and honorariums for presentations at conferences and meetings. He receives royalties from Houghton Mifflin Hardcourt publishing. He has a clinical and consulting practice in forensic neurology and neurosurgery, including expert testimony, especially individuals with traumatic brain and spinal cord injuries. He is a member of the National Collegiate Athletic Association Student-Athlete Concussion Injury Litigation Medical Science Committee. RJE is a paid consultant for the NHL and co-chair of the NHL/NHLPA Concussion Subcommittee. He is also a paid consultant and chair of the Major League Soccer concussion committee, and a consultant to the US Soccer Federation. He previously served as a neuropsychology consultant to Princeton University Athletic Medicine and EyeGuide. He is currently a co-PI for a grant funded by the NFL (NFL-Long) through Boston Children’s Hospital. He occasionally provides expert testimony in matters related to mTBI and sports concussion, and occasionally receives honoraria and travel support/reimbursement for professional meetings. JC has nothing to disclose. GAD is a member of the Scientific Committee of the 6th International Consensus Conference on Concussion in Sport; an honorary member of the AFL Concussion Scientific Committee; Section Editor, Sport and Rehabilitation, NEUROSURGERY; and has attended meetings organised by sporting organisations including the NFL, NRL, IIHF, IOC and FIFA; however, has not received any payment, research funding or other monies from these groups other than for travel costs. PF is a coinvestigator on a research grant from the NFL’s ’Play Smart. Play Safe’ Initiative and an Executive Review committee member of the Canadian Concussion Network (financed by CIHR). He received honorarium for an expert group discussion on blood biomarkers for concussion in December 2020. AH has nothing to disclose. SHerring cofounder and senior advisor, The Sports Institute at UW Medicine (unpaid), Centers for Disease Control and Prevention and National Center for Injury Prevention and Control Board Pediatric Mild Traumatic Brain Injury Guideline Workgroup (unpaid), NCAA Concussion Safety Advisory Group (unpaid), Team Physician, Seattle Mariners, Former Team Physician, Seattle Seahawks, Concussion in Sport Group (travel support), occasional payment for expert testimony, travel support for professional meetings. SHinds provides client consultation services for military/veteran health, neuroscience, health, sports medicine, neurodegenerative disease, neurotrauma, nuclear medicine, molecular imaging, nuclear and radiation accidents and incidents, and health equity. Consult services includes support to Prevent Biometrics; advisor to Synaptek; advisor/consultant for the Collaborative Neuropathology Network Characterizing Outcomes of TBI (CONNECT-TBI); advisor to NanoDX; and reviewer for Peer Reviewed Alzheimer’s Disease Research Program. SHinds is chief of Health Equity and Deputy Medical Director for the NFL Players Association, Medical Director for the MLS Players Association. He receives grant support (no income) from the following: Co-PI, Long-term Impact of Military-relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC); Advisory Board member to Concussion Legacy Foundation Project Enlist; Advisory Board member to the University of Michigan Concussion Center; advisor to Gryphon Bio; ad hoc reviewer for VA Brain Health Research; invited reviewer to Congressionally Directed Medical Research Programs; National Academy of Science, Engineering, and Medicine ’Accelerating Progress in TBI Research and Care’; NASEM TBI Forum committee member (currently inactive); contributor to Post-traumatic Epilepsy Former Department of Defense work: NFL Scientific Advisory Board member; NCAA-DoD CARE Medical Advisory Board Member; DoD Brain Health Research Coordinating Officer and Medical Advisor to the Principal Assistant for Research and Technology (PAR&T), US Army Medical Research and Development Command (USAMRDC); Ex Officio National Advisory Neurological Disorders and Stroke (NANDSC) Council Member. BJ has nothing to disclose. SK Medical Services Director, Rugby Football Union (paid), Member of the World Rugby Concussion Expert Group, Member of the FIFA Concussion Expert Group (paid), Member of the FA Independent Concussion Expert Group. MMakdissi reports research grants from the US NIH, US Department of Defense, US CDC, US Department of Veterans Affairs, Abbott Laboratories, NFL and NCAA, and consultancy with the Green Bay Packers and Neurotrauma Sciences. MMcNamee 1. Chair, Ethics Expert Group, WADA (2021–2023) (paid) 2. Member, International Boxing Association, Ethics and Integrity Committee, (2021–2022; resigned October 2022) (paid) 3. Chair, Therapeutic Use Exemption Fairness Committee (2020–) (paid) 4. Member, Steering Group, Sex Segregation in Sport, IAAF/World Athletics, (2019–2020) (unpaid) 5. Member, International Ice Hockey Federation, Ethics and Integrity Committee (2019–2021) (paid) 6. Member, International Olympic Committee Consensus Statement Expert Group on Injuries in Children and Adolescents (2017) (unpaid) 7. Member, Ethics Expert Group, WADA (2016–2021) (unpaid) 8. Member, International Olympic Committee Consensus Statement Expert Group on Pain Management (2016)) (unpaid). SN has nothing to disclose. JP Editor BJSM (honorarium); Member of World Rugby Concussion Advisory Group (unpaid); Independent Concussion Consultant for World Rugby (fee per consultation); Medical consultant to South African Rugby (unpaid); Co-chair of the Scientific Committee, 6th International Conference on Concussion in Sport (unpaid); Board member of the CISG (unpaid); Scientific Board member, EyeGuideTM (unpaid). MP declares the following: Consultant, CMO, Major League Soccer; Senior Advisor, NFL Head, Neck NCAA-CARE- DoD 2.0, ended 2020; Have received honoraria and reimbursement for travel for speaking and conferences attended; Have written chapters for UpToDate, and received royalties for the Netter’s Sports Medicine textbook; Have provided work as an expert for cases involving concussion, team physician and other sports medicine topics. SS has nothing to disclose. MT is employed full-time as the CEO and Medical Director of ICHIRF—a paid post he has held since April 2015. Hon Medical Adviser to the Professional Riders Insurance Scheme (PRIS)—discretionary honorarium. Member of the Premier League Head Injury Advisory Group (HIAG)—no remuneration. Director of ICHIRF Ireland—no remuneration. Honorary Medical Adviser to the Concussion Foundation—no remuneration. Member of the expert panel for the Dept of Digital, Culture, Media and Sport review into concussion in amateur sport—no remuneration. Attendance at conferences or meetings as a guest speaker—reimbursement of travel expenses, complimentary registration and payment of hotel accommodation and meals by the organising committee. No stocks or options in any concussion-related company. No consultancies, board or editorial positions related to concussion. KJS has received grant funding from the CIHR, NFL Scientific Advisory Board, International Olympic Committee Medical and Scientific Research Fund, World Rugby, Mitacs Accelerate, University of Calgary, with funds paid to her institution and not to her personally. She is an Associate Editor of BJSM (unpaid), Independent consultant to World Rugby and has received travel and accommodation support for meetings where she has presented. She coordinated the writing of the systematic reviews that informed Amsterdam International Consensus on Concussion in Sport, for which she has received an educational grant to assist with the administrative costs associated with the writing of the reviews (with funds paid to her institution). She is a member of the AFL Concussion Scientific Committee (unpaid position), Brain Canada (unpaid positions) and Board member of the Concussion in Sport Group (CISG) (unpaid). She works as a physiotherapy consultant and treats athletes of all levels of sport from grass roots to professional., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To systematically review the scientific literature regarding the assessment of sport-related concussion (SRC) in the subacute phase (3-30 days) and provide recommendations for developing a Sport Concussion Office Assessment Tool (SCOAT6)., Data Sources: MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, CINAHL, SPORTDiscus and Web of Science searched from 2001 to 2022. Data extracted included study design, population, definition of SRC diagnosis, outcome measure(s) and results., Eligibility Criteria: (1) Original research, cohort studies, case-control studies, diagnostic accuracy and case series with samples >10; (2) SRC; (3) screening/technology that assessed SRC in the subacute period and (4) low risk of bias (ROB). ROB was performed using adapted Scottish Intercollegiate Guidelines Network criteria. Quality of evidence was evaluated using the Strength of Recommendation Taxonomy classification., Results: Of 9913 studies screened, 127 met inclusion, assessing 12 overlapping domains. Results were summarised narratively. Studies of acceptable (81) or high (2) quality were used to inform the SCOAT6, finding sufficient evidence for including the assessment of autonomic function, dual gait, vestibular ocular motor screening (VOMS) and mental health screening., Conclusion: Current SRC tools have limited utility beyond 72 hours. Incorporation of a multimodal clinical assessment in the subacute phase of SRC may include symptom evaluation, orthostatic hypotension screen, verbal neurocognitive tests, cervical spine evaluation, neurological screen, Modified Balance Error Scoring System, single/dual task tandem gait, modified VOMS and provocative exercise tests. Screens for sleep disturbance, anxiety and depression are recommended. Studies to evaluate the psychometric properties, clinical feasibility in different environments and time frames are needed., Prospero Registration Number: CRD42020154787., Competing Interests: Competing interests: GAD is a member of the Scientific Committee of the 6th International Consensus Conference on Concussion in Sport; an honorary member of the AFL Concussion Scientific Committee; Section Editor, Sport and Rehabilitation, NEUROSURGERY; and has attended meetings organised by sporting organisations including the NFL, NRL, IIHF, IOC and FIFA; however, has not received any payment, research funding or other monies from these groups other than for travel costs. RJE is a paid consultant for the NHL and co-chair of the NHL/ NHLPA Concussion Subcommittee. He is also a paid consultant and chair of the Major League Soccer concussion committee, and a consultant to the US Soccer Federation. He previously served as a neuropsychology consultant to Princeton University Athletic Medicine and EyeGuide. He is currently a co-PI for a grant funded by the NFL (NFL-Long) through Boston Children’s Hospital. He occasionally provides expert testimony in matters related to MTBI and sports concussion, and occasionally receives honoraria and travel support/reimbursement for professional meetings. PF is a coinvestigator on a research grant from the NFL’s 'Play Smart. PlaySafe.' Initiative and an Executive committee member of the Canadian Concussion Network (financed by the Canadian Institute of Health Research). He received honorarium for an Expert group discussion on blood biomarkers for concussion in December 2020. GWF has received travel expenses to attend academic meetings from World Rugby. He has also collaborated on research projects with World Rugby as chief or co-investigator. He is previous associate editor of the British Journal of Sports Medicine. He has not received any other payments or support from any sporting or commercial bodies. He has no other conflicts of interest. KGH is Research Development Director, Pac-12 Conference Member, Pac-12 Brain Trauma Task Force Member, NFL Head Neck and Spine Committee Deputy Editor, British Journal of Sports Medicine Head Football Physician, University of Washington Dr. K. Alix Hayden has nothing to disclose. SAH Co-founder and senior advisor, The Sports Institute at UW Medicine (unpaid), Centers for Disease Control and Prevention and National Center for Injury Prevention and Control Board Pediatric Mild Traumatic Brain Injury Guideline Workgroup (unpaid), Concussion in Sport Group (travel support), NCAA Concussion Safety Advisory Group (unpaid),Team Physician, Seattle Mariners, Former Team Physician, Seattle Seahawks, occasional payment for expert testimony, travel support for professional meetings ML is the CMO GB Boxing, CMO GB Snowsports. NE Director GB Taekwondo. NE Director SWA (share options). Director Active Movement. Director GB Obstacle course racing. Founder and medical board member of Safe MMA. Director of Marylebone Health Group. Private medical practice at ISEH 170 Tottenham Court Road. Private medical practice Marylebone Health Group. MMa Sport and exercise medicine physician working in private consulting practice. Shareholder of Olympic Park Sports Medicine Centre in Melbourne. Ex-senior physician at the Hawthorn Football Club (AFL) Ex-Chief Executive Officer of the AFL Doctors Association. Research grants received from the Australian Football League, outside the submitted work. Travel support received from the Australian Football League, FIFA and the International Olympic Committee to attend and present at international conferences. Member of the Scientific Committee for the 6th International Consensus Conference on Concussion in Sport. Honorary member of the International Concussion in Sport Group. Honorary member of the Australian Rugby Union Concussion Advisory Group. Independent Concussion Consultant for World Rugby. MMc has received research funding to the Medical College of Wisconsin from the National Institutes of Health, Department of Veterans Affairs, Centers for Disease Control and Prevention, Department of Defense, National Collegiate Athletic Association, National Football League, and Abbott Laboratories. He receives book royalties from Oxford University Press. He serves as clinical consultant to Milwaukee Bucks, Milwaukee Brewers, and Green Bay Packers, and is Co-Director of the NFL Neuropsychology Consultants without compensation. He serves as consultant for Neurotrauma Sciences. He receives travel support and speaker honorariums for professional activities. JP is an editor of BJSM for which he receives an honorarium. He is an unpaid consultant to the World Rugby Concussion Advisory Group for which he also serves as an Independent Concussion Advisor (fee per consultation). Other unpaid positions include being medical advisor to South African Rugby, Co-chair of the Scientific Committee, 6th International Conference on Concussion in Sport (travel and accommodation subsidised), Board member of the Concussion in Sport Group and a Scientific Advisory Board member of EyeGuideTM. ZP No COI to declare. LP CASEM Board Member, President-Elect 2022-2023NIH R34 Grant for EPICC Study (Eye Problems In Concussed Children), Site PISpeaker at various conferences. MP is a consultant and Chief Medical Officer of Major League Soccer, and serves as a Senior Advisor, for the National Football Leagues’ Head, Neck & Spine Committee. She serves as a member for the FA Research Task Force, the US Soccer Medical Advisory Committee and the NOCSAE Scientific Advisory Committee. She has served as a member of the UK Concussion Foundation Protocol Forum, as a consultant for the CDC Concussion work, as an expert panel member of the Concussion in Sport Group. She is part of the IOC Mental Health Working Group, and the USOPC Mental Health Advisory Committee. She serves as a Team Physician for US Soccer, has received funding for concussion research (NCAA-CARE-DoD 2.0, ended 2020), has received honoraria and reimbursement for travel for speaking and conferences, has written chapters for UpToDate, received royalties for the Netter’s Sports Medicine textbook and has provided work as an expert for cases involving concusports medicine topics. GMS is an owner of a multidisciplinary practice (managinsion, team physician and other sg patients with MSKpain disorders).He is a board member of Hockey Calgary (Calgary, AB, Canada) and Chair of the Alberta Association of Physiotherapy. He received funding for the administrative aspects of the writing of two of the systematic reviews that informed the consensus process. KJS has received grant funding from the Canadian Institutes of Health Research, National Football League Scientific Advisory Board, International Olympic Committee Medical and Scientific Research Fund, World Rugby, Mitacs Accelerate, University of Calgary) with funds paid to her institution and not to her personally. She is an Associate Editor of BJSM (unpaid) and has received travel and accommodation support for meetings where she has presented. She is coordinating the writing of the systematic reviews that will inform the 6th International Consensus on Concussion in Sport, for which she has received an educational grant to assist with the administrative costs associated with the writing of the reviews. She is a member of the AFL Concussion Scientific Committee (unpaid position) and Brain Canada (unpaid positions). She works as a physiotherapy consultant and treats athletes of all levels of sport from grass roots to professional. MT is employed full-time as the CEO and Medical Director of ICHIRF—a paid post he has held since April 2015. Hon Medical Adviser to the Professional Riders Insurance Scheme (PRIS)—discretionary honorarium Member of the Premier League Head Injury Advisory Group (HIAG)—no remuneration Director of ICHIRF Ireland—no remuneration Honorary Medical Adviser to the Concussion Foundation—no remuneration Member of the expert panel for the Dept of Digital, Culture, Media and Sport review into concussion in amateur sport—no remuneration Attendance at conferences or meetings as a guest speaker—reimbursement of travel expenses, complimentary registration and payment of hotel accommodation and meals by the organising committee No stocks or options in any concussion-related company No consultancies, board or editorial positions related to concussion. Jvl is the founder of R2P Concussion Management. NW is Chair, British Paralympic Association (voluntary) IPC Medical Committee Member (voluntary) Concussion in Para Sports (CIPS), founding member (voluntary) BJSM Editorial Board member (voluntary) Sports Horizon, Board of Directors—equity share—see https://www.sportshorizon.co.uk KOY is Editor-in-Chief of the Journal Neuropsychology and receives an editorial stipend from the American Psychological Association. He is an unpaid consulting editor for the journals Archives of Clinical Neuropsychology and Journal of Head Trauma Rehabilitation. He is an unpaid member of the Scientific Advisory Committee for Brain Injury Canada. He is the chair of the Canadian Concussion Network, which is funded by a grant from Canadian Institutes of Health Research (CIHR) to his institution; he is the principal applicant on the grant but receives no income from it. He is a principal investigator on another grant from CIHR from which he derives no income. He is a co-investigator on research grants from CIHR, the US National Institutes of Health (NIH), Brain Canada Foundation, and National Football League Scientific Advisory Board; he derives income only from the grant from NIH. He serves as a member of a CIHR grant review panel for which he receives a small honorarium. He receives book royalties from Guilford Press and Cambridge University Press. He has received travel support and honorarium for presentations to multiple organisations. He has served or serves on the following committees/boards for which he receive(d) honorarium: 1. Independent Data Monitoring Committee (IDMC), Care for Post-Concussive Symptoms EffecCveness (CARE4PCS-2) Trial, National Institute for Child Health and Human Development. 2. Observational Study Monitoring Board (OSMB), Approaches and Decisions in Acute Pediatric TBI (ADAPT) Trial, National Institute of Neurological Disorders and Stroke National Research Advisory Council, National Pediatric Rehabilitation Resource Center, Center for Pediatric Rehabilitation: Growing Research, Education, and Sharing Science (C-PROGRESS), Virginia Tech University., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Sport-related concussions (SRCs) affect millions of adolescents and young adults annually in the USA; however, current SRC consensus statements provide limited guidance on academic support for students within higher education., Objective: To generate consensus on appropriate academic recommendations for clinicians, students, and academic stakeholders to support university students during their recovery., Methods: Panelists participated in three stages of a modified Delphi procedure: the first stage included a series of open-ended questions after reviewing a literature review on post-SRC return-to-learn (RTL) in higher education; the second stage asked panelists to anonymously rate the recommendations developed through the first Delphi stage using a 9-point scale; and the final stage offered panelists the opportunity to change their responses and/or provide feedback based on the group's overall ratings., Results: Twenty-two panelists including clinicians, concussion researchers, and academic stakeholders (54.5% female) from 15 institutions and/or healthcare systems participated in a modified Delphi procedure. A total of 42 statements were developed after round one. Following the next two rounds, 27 statements achieved consensus amongst the panel resulting in the four-stage Post-Concussion Collegiate RTL Protocol., Conclusion: There are several unique challenges when assisting university students back to the classroom after SRC. Explicit guidelines on when to seek additional medical care (e.g., if they are experiencing worsening or persistent symptoms) and how to approach their instructor(s) regarding academic support may help the student self-advocate. Findings from the present study address barriers and provide a framework for universities to facilitate a multidisciplinary approach amongst medical and academic stakeholders., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Abstract: Athletes are vulnerable to sexual violence. Perpetrators of sexual violence may be a trusted coach, a member of the health care team, or a peer. The consequences of sexual violence are wide ranging, resulting in immediate and long-term physical and mental health outcomes that require recognition and comprehensive, multidisciplinary care. Sports medicine providers need to have specific knowledge and skill to care for athletes who experience sexual violence. Several sports organizations (e.g., International Olympic Committee, United States Olympic and Paralympic Committee, the National Collegiate Athletic Association, and the National Athletic Trainers' Association) have developed policies and procedures to prevent sexual violence and help sports medicine specialists provide care and services for athletes affected by sexual violence. Nevertheless, there remains a need for clinical guidelines, screening tools, and education, as well as clinical best practices to address sexual violence in sports medicine., (Copyright © 2021 by the American College of Sports Medicine.)

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the Task Force used an iterative process and expert consensus to finalise the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a position statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

Objective: To review the literature guiding all aspects of the use of injectable corticosteroids for painful musculoskeletal conditions, with a focus on the treatment of athletes., Data Sources: An extensive search of the literature was completed including search terms of corticosteroid, steroid, athlete, and injection, among others. Additional articles were used after being identified from previously reviewed articles., Main Results: Injections of corticosteroids for a variety of painful conditions of the extremities and the axial spine have been described. Numerous minor and major complications have been reported, including those with a high degree of morbidity. There is a dearth of published research on the use of corticosteroid injections in athletes, with most of the research on this topic focused on older, nonathlete populations. Generally, these injections are well tolerated and can provide short-term pain improvement with little or no long-term benefits., Conclusions: Corticosteroid injections should be used cautiously in athletes and only after a full consideration of the pharmacology, pathogenesis of disease, potential benefits, complications, factors specific to the athlete, and rules of athletic governing bodies. Corticosteroid injections are just one component of a comprehensive rehabilitation plan available to the physician providing care to athletes.

Selected Issues in Sport-Related Concussion (SRC|Mild Traumatic Brain Injury) for the Team Physician: A Consensus Statement is title 22 in a series of annual consensus documents written for the practicing team physician. This document provides an overview of selected medical issues important to team physicians who are responsible for athletes with sports-related concussion (SRC). This statement was developed by the Team Physician Consensus Conference (TPCC), an annual project-based alliance of six major professional associations. The goal of this TPCC statement is to assist the team physician in providing optimal medical care for the athlete with SRC. [ABSTRACT FROM AUTHOR]

Abstract: Selected Issues in Sport-Related Concussion (SRC | Mild Traumatic Brain Injury) for the Team Physician: A Consensus Statement is title 22 in a series of annual consensus articles written for the practicing team physician. This document provides an overview of select medical issues important to team physicians who are responsible for athletes with sports-related concussion (SRC). This statement was developed by the Team Physician Consensus Conference (TPCC), an annual project-based alliance of six major professional associations. The goal of this TPCC statement is to assist the team physician in providing optimal medical care for the athlete with SRC. [ABSTRACT FROM AUTHOR]

Introduction: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. Methods: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2- day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. Results: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved. Conclusions: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence. [ABSTRACT FROM AUTHOR]

Sport-related spine injury can be devastating and have longlasting effects on athletes and their families. Providing evidencebased care for patients with spine injury is essential for optimizing postinjury outcomes. When caring for an injured athlete in American tackle football, clinicians must make decisions that involve unique challenges related to protective equipment (eg, helmet and shoulder pads). The Spine Injury in Sport Group (SISG) met in Atlanta, Georgia, March 2-3, 2019, and involved 25 health care professionals with expertise in emergency medicine, sports medicine, neurologic surgery, orthopaedic surgery, neurology, physiatry, athletic training, and research to review the current literature and discuss evidencebased medicine, best practices, and care options available for the prehospital treatment of athletes with suspected cervical spine injuries.1,2 That meeting and the subsequent Mills et al publication delineate the quality and quantity of published evidence regarding many aspects of prehospital care for the athlete with a suspected cervical spine injury. This paper offers a practical treatment guide based on the experience of those who attended the Atlanta meeting as well as the evidence presented in the Mills et al article. Ongoing research will help to further advance clinical treatment recommendations. [ABSTRACT FROM AUTHOR]

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the task force used an iterative process and expert consensus to finalize the position statement. The objective of this position statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport. [ABSTRACT FROM AUTHOR]

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 health care 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. The American Medical Society for Sports Medicine formed a writing group to review the existing literature on SRC, update its previous position statement,1 and 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- and long-term risks of SRC and repetitive head impact exposure, SRC prevention strategies, and potential future directions for SRC research. The American Medical Society for Sports Medicine is committed to best clinical practices, evidence-based research, and educational initiatives that positively impact the health and safety of athletes. [ABSTRACT FROM AUTHOR]