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New UK Concussion Guidelines: 'If in Doubt, Sit Them Out'

New UK-wide guidelines have been published that detail how concussion should be treated in grassroots sport .

No player with suspected concussion should return to competition, training, or take part in PE lessons within 24 hours of being injured, according to the guidance, which also details how to recognise and treat concussion.

The guidelines were developed by a panel of UK and international clinicians, and academics in neurology and sports medicine, and were based on guidance previously introduced in Scotland. Bearing the strapline, 'If in doubt, sit them out', it has been published by the Government and the Sport and Recreation Alliance as an aid to help players, coaches, parents, schools, national governing bodies, and administrators involved in non-elite sports to identify, manage, and prevent concussion.

Professor James Calder, who chaired the guideline drafting group, said: "For the first time we have UK-wide guidance that raises awareness of concussion in grassroots sport at all levels. It provides practical evidence-based advice for those who may have sustained a concussion and gives a step-by-step plan for their safe return to work, education, exercise, and full sport."

Removal from Play and Medical Assessment

The guidance states that any participant in sport suspected of sustaining a concussion should be immediately removed from play and assessed by an appropriate onsite healthcare professional or by contacting the NHS's 111 service within 24 hours of the injury occurring. In cases where there is concern about other loss of consciousness, amnesia, other 'red flag' symptoms, or other injuries, a player should receive urgent medical assessment either onsite, in a hospital emergency department, or by calling 999 for transit to hospital in an ambulance.

Players who experience a concussion are advised to rest for 24-48 hours and avoid intense exercise, challenging work, and sport. Anyone with a suspected concussion should not drive a motor vehicle, ride a bicycle, operate machinery, or drink alcohol within 24 hours, whilst commercial drivers should seek review by an appropriate healthcare professional before driving.

Anyone with symptoms that last longer than 28 days are advised to seek medical advice from their GP, which could require specialist referral and review.

Rehabilitation should be facilitated through a graduated programme, beginning with light physical activities, and with no return to sport competition before 21 days following injury, the guidance states.

Balancing Benefits of Sport With Risk

The Department for Culture, Media, and Sport said the document met the Government's commitment made in 2021 to introduce a national approach to prevent concussion and brain injury in sport.

Professor Chris Whitty, chief medical officer for England and chief medical adviser to the UK Government, said: "These guidelines help players, referees, schools, parents, and others balance the substantial health and social benefits and enjoyment from taking part in sport with minimising the rare but serious and potentially lifelong effects of concussion." 

Luke Griggs, chief executive of brain injury charity Headway, described the guidelines as an "important step" but warned they needed to be accompanied by a full public health campaign. He said: "Taking a pan-sport approach to concussion is sensible. Having one set of guidelines should reduce the inconsistent way in which concussion is managed, particularly within youth and grassroots sport.

"However, despite the increased awareness of brain injury in elite-level sport, there remains a great deal of work to be done to improve understanding at all levels of community sport." 

Publication of the guidelines followed research by scientists at the University of Cambridge that suggested that incomplete recovery from concussion was more common than previously thought. The study, published in the journal Brain, found acute thalamic hyperconnectivity in a cohort of patients with mild traumatic brain injuries, with 47% of the patients exhibiting incomplete recovery 6 months after their injury.

Funding for the study was provided by grants from the FP7 Health European Union, Medical Research Council, Gates Cambridge Trust, Academy of Medical Sciences/The Health Foundation Clinician Scientist Fellowship, NIHR Cambridge Biomedical Research Centre, Queens' College, Cambridge Stephen Erskine Fellowship, Canadian Institute for Advanced Research, British Oxygen Professorship of the Royal College of Anaesthetists, and NIHR Senior Investigator awards. DKM is in receipt of collaborative research grant funding with Lantmannen AB, GlaxoSmithKline Ltd., and Cortirio Ltd., and has received personal fees from Calico LLC, GlaxoSmithKline Ltd, Lantmannen AB, and Integra Neurosciences. All other authors report no competing interests.