Identifying concussion: when guidelines collide with real-world implementation—is a formal medical diagnosis necessary in every case once a proper protocol is implemented?

Several countries, such as Canada, are in the process of defining strategies to address the public health problem of sport-related concussions. One of the challenges is to develop strategies that can apply at the earlier levels where the timely availability of qualified healthcare resources is limited. Here, I respectfully challenge the notion that every athlete with suspected concussion should have a medical consultation to confirm the diagnosis. Specifically, I question the added value of the systematic requirement for a medical diagnosis in a sport or school-based environment, when a suspected case of concussion without any ‘red flag’ (as per the concussion recognition tool)1 is identified and a proper concussion management protocol is initiated. The Zurich consensus states that, following the identification of a suspected case of concussion, ‘The final determination regarding concussion diagnosis and/or fitness to play is a medical decision based on clinical judgement’.2 Also, the concussion recognition tool recommends that: ‘… in all cases of suspected concussion, the player is referred to a medical professional for diagnosis and guidance…’.1 However, the …