Once every four years, the world’s leading experts on concussion management and understanding gather to review new evidence-based research that covers all aspects of concussions, and to reach agreement in developing a consensus statement on concussion in sports.

Since the inaugural conference in 2001, the consensus meeting has become the main forum for concussion awareness and prevention. The consensus has been the foundation used by many sports organizations to develop protocols with respect to concussions.

Two members of US Lacrosse’s Sports Science and Safety CommitteeDr. Margot Putukian and Dr. Ruben Echemendia - were among the experts invited to participate at the fifth consensus conference, held in Berlin in October. The two attendees presented updates from Berlin at last week’s US Lacrosse Sports Medicine Symposium.

“The outcomes from the conference are not yet public. They will be published in March,” Putukian told the audience. “What we are able to share currently is more related to the process.”

The ultimate goal for the experts at the consensus conference is to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in all sports. Participants review all aspects of concussion, including definition, management, investigations, treatment, return-to-play protocol, prevention and knowledge transfer. They then produce a document that can be used by physicians and healthcare professionals involved in the care of injured athletes at all levels of play.

A systematic review of research studies began months in advance of the meeting in Berlin. Scientific abstracts that provide the latest evidence are also accepted as presentations during the conference.

“This is probably one of the most grueling experiences I have been through because of how rigorous we are in the review of the literature,” said Echemendia, a neuropsychologist who serves as a concussion consultant for the National Hockey League, Major League Soccer and the US Soccer Federation, among others.

Putukian, who is director of athletic medicine at Princeton University and a concussion advisor to the National Football League, USA Football and the NCAA, noted that 12 specific questions are prepared and posed in advance to define the scope and guide the direction of the conference.

Research findings and data are presented during public sessions, which include open discussions. The 35-person expert panel then meets in closed sessions to prepare the consensus statement and to develop responses to the focused questions.

Some of the questions addressed by the experts included:

• What is the definition of concussion?
• What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion?
• What domains of clinical function should be assessed post-injury?
• What advanced or novel tests can assist in the assessment and evaluation of concussion?
• What is the time course of physiological recovery after sports concussion?
• What differences are there in concussion management in children as compared to adults?
• What strategies can be used to effectively reduce the risk of concussion in sport?

“This was a very captivating meeting that included very active audience participation during the open sessions,” Putukian said.

Echemendia noted that the importance of the international conference and the need for expert-driven consensus is due, in some measure, to the quantity of misinformation about concussion that floods the marketplace.

“There’s a lot of snake-oil out there and you need to be very careful of the claims that are being made by some people,” Echemendia said. “Part of our job in lacrosse is to make sure the snake oil doesn’t get in.”

The new consensus statement, which will supersede the 2012 consensus, is expected to be initially published online in March, with printed versions available in May. Putukian, Echemendia and the other attendees are on strict orders not to discuss the content of the meeting or engage in media discussions until that time.

“Ultimately, I don’t think there will be a lot of surprises in the information that is published,” Putukian said.

Concussion Awareness

As part of its commitment to educating the lacrosse community about injury prevention and safety, US Lacrosse provides free online resources about concussion awareness.

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