On-field and pitch-side assessment of sports concussion in collision sports: An expert consensus statement using the modified Delphi Technique.

Purpose The purpose of this study was to perform a Delphi consensus for on-field and pitch-side assessment of sports related concussion (SRC). Methods Open-ended questions in rounds 1 and 2 were answered. The results of the first two rounds were used to develop a Likert style questionnaire for round 3. If agreement at round 3 was <80% for an item, if panel members were outside consensus or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%. Results Loss of consciousness (LOC) or suspected LOC, motor incoordination/ataxia, balance disturbance, confusion/disorientation, memory disturbance/amnesia, blurred vision/light sensitivity, irritability, slurred speech, slow reaction time, lying motionless, dizziness, headaches/pressure in the head, falling to the ground with no protective action, slow to get up after a hit, dazed look and posturing/seizures were clinical signs of SRC and indicate removal from play. Video assessment is helpful but should not replace clinical judgement. LOC/unresponsiveness, signs of cervical spine injury, suspicion of other fractures (skull/maxillo-facial), seizures, Glasgow Coma Scale (GCS) <14 and abnormal neurological examination are indications for hospitalization. Return to play (RTP) should only be considered when no clinical signs of SRC are present. Every suspected concussion should be referred to an experienced physician. Conclusion Consensus was achieved for 85% of the clinical signs indicating concussion. On-field and pitch-side assessment should include the observation of the mechanism, a clinical examination and cervical spine assessment. Of the 19 signs and red flags requiring removal from play, consensus was reached for 74%. Normal clinical examination and HIA with no signs of concussion allow RTP. Video assessment should be mandatory for professional games but should not replace clinical decision making. SCAT, VOMS, HIA and Maddocks questions are useful tools. Guidelines are helpful for non-health professionals.