Controversial concussion guidelines published
The 'Prague' guidelines on concussion in sport have just been published in the March 2005 edition of the Clin J Sport Med (15(2):48-55), with the overall paper being a clear summary of current knowledge regarding concussion. The section of the consensus recommendations which has upset professional team physicians in Australia is as follows (with the major ruling underlined): "When a player shows ANY symptoms or signs of a concussion: 1. The player should not be allowed to return to play in the current game or practice. 2. The player should not be left alone; and regular monitoring for deterioration is essential over the initial few hours following injury. 3. The player should be medically evaluated following the injury. 4. Return to play must follow a medically supervised stepwise process. A player should never return to play while symptomatic. ‘‘When in doubt, sit them out!’’ The difficulty with this recommendation is that most AFL team doctors are already letting players back on to field during the same game on a regular basis, with very few (if any) recorded problems with the current approach. The situation is slightly different in the rugby codes. In the NRL, the team doctor is not allowed on the field unless called on by the referee, so that the decision is in the hands of the sports trainers (unless the player has lost consciousness). In rugby union, the ludicrous international recommendation that players should sit out for 3 weeks following a concussion means that players are conditioned to hide any concussive symptoms from their doctors for fear of being stood down. The approach of only returning when asymptomatic is probably the correct one, although there are cases where players have returned with symptoms and performed very well at professional level, without sequelae, which makes it very difficult to set guidelines. A recent example was Matt Orford of the Melbourne Storm, who apparently suffered amnesia regarding most of the round 1 game against the Knights, but still managed to be best player on the field in the Storm's win. Situations like the current one in rugby union, where real world practice is totally different to written guidelines, are dangerous and unhelpful. The current Prague guidelines, apart from the underlined sentence, are good. Football should not revert to the dark ages (or the current status in rugby union) where players are expected to lie about their symptoms in order to be able to stay on the field during a game. |
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