ZURICH – The 4th International Consensus Conference on Concussion in Sport was held here on November 1-2. The participants agreed on a number of points in their striving to decrease the number of concussions as well as ensuring correct treatment, primarily in team sports.

The conference is held every four years and is run by the IIHF, FIFA, the International Olympic Committee, the International Rugby Board and the International Federation for Equestrian Sports. The 4th conference was held at the House of FIFA in Zürich.

The previous conference was held in 2008, and resulted in the development of the Sport Concussion Assessment Tool (SCAT2), a standardized method of evaluating athletes aged 10 years and older for concussions. It has been adopted across the sporting world, by top leagues such as the National Hockey League, the National Football League, and in IIHF and FIFA tournaments.

IIHF President René Fasel addressed the conference on Friday, on its second day.

“We as federations have to continue working with the doctors,” said René Fasel. “And it’s imperative that all doctors work together and in some cases the medical people have to put their egos aside. But we need you because the work to prevent concussions must continue and when they occur, to treat them properly.”

“I cannot thank you enough for the job you are doing,” said Fasel. “From the sports side we must work with enforcing rules, work to increase the awareness of fair play and respect and, especially in ice hockey, do something about the equipment which today is like armour. There is no doubt that this unforgiving gear contributes to injuries and concussions.”

Other highlights from the conference and the consensus which was reached:

• No return to play on same day
• Discussions about SCAT3 (refinement of SCAT2) to exclude neck injury
• Discussions about a revision of the pocket SCAT for non- health care personnel to recognise concussion
• Discussions about a possible Child SCAT
• Treatment of Concussion
  • Relative rest (not bed rest)
  • Proactive approach in treatment that could involve low level activity and therapy before symptoms have completely disappeared 
• Multimodal management of patients after one month
  • Low level activity
  • Psychology
  • Physiotherapy (neck, brain, vestibular)
  • Neuropsychological consult
• Baseline Testing not necessary to evaluate patients’ post-concussion but SCAT could serve as an educational tool.
• Computerised Neuropsychological testing is not necessary in most athletes who have a concussion but can be used in those whose concussion persists.
• Pediatric Athlete
  
  • Concussions can last longer
  • Return to learn before return to sport
  • Return to learn a progressive stepwise process
• Risk Reduction strategies
  • No evidence that helmets protect against concussion
  • No evidence that mouth guards prevent concussion
  • Evidence that full facemasks may decrease the time of recovery from concussion
  • Neck strengthening may help reduce concussions
  • Rule enforcement and no tolerance on head checking
  • Strict penalties for head checking
  • Body checking in pee wee hockey has led to increased concussions
• Chronic Traumatic Encephalopathy (CTE) is a neurodegenerative disease that has been found in five hockey players and some NFL football players from brain biopsies taken after their death. No proof that there is a causal effect from concussion. More research is needed on the subject.
• Translation of knowledge with new tools (App) and media
• Legislation in 40 states in the U.S. and One province (Ontario) in Canada on concussions.

Other stories from the event:
"Keeping a straight head" with Mark Aubry (IIHF.com)
"Making the game safer" with Ken Dryden (IIHF.com)
"Sport experts meet at FIFA to discuss concussion" (FIFA.com)