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Improving Care: The Latest ACC Update in Community Concussion Guidelines

Welcome to the first post of 2024. We hope you've had a great summer and have found time to be physically active in the sunshine. Did you know our clinic offers management of sport related concussion, in particular with guidance on management of concussion symptoms and the return to competition following competition.


Dr Mel Parnell has been involved in a consensus group to align concussion protocols across different sports at the community level. Previously, each sport provided guidelines for return to play post concussion, with differences between protocols creating confusion, particularly when athletes played across different codes. With ACC at the forefront, medical staff from several sporting disciplines came together to create community concussion guidelines. These new guidelines are published on the ACC website, are easy to follow and well worth the read: Concussion in sport (acc.co.nz).


There are three key principles athletes, parents, coaches and supporters on the sideline can use to know what to do in cases of suspected concussion. It can happen in any sport, and you don't need to be hit on the head or knocked out to be concussed.


  1. Recognise - there is a pocket concussion recognition tool to help identify signs of concussion. The signs and symptoms can be obvious or sometime quite subtle. You may notice:

    1. signs such as lying on the ground not moving, loss of balance, dazed or vacant look

    2. memory impairment if you ask them simple questions on where they are and what the score is

    3. they may report blurry vision, dizziness, confusion, headache or other symptoms

  2. Remove - the player should be removed immediately and not allowed to return - if in doubt, sit it out.

  3. Refer - they should attend a Doctor for an assessment and diagnosis of concussion. This could be a local A&E, local Dr/Medical Centre or the local hospital emergency department


Important things to consider:

  • early removal/assessment reduces recovery time

  • female athletes, children and adolescent athletes take longer to recover

  • if concussion is suspected, the athlete must not return to sport/activity on the same day


Red Flags (require urgent review)

  • significant neck pain

  • increasing confusion or irritability

  • repeated vomiting

  • weakness or tingling/burning in arms or legs

  • deteriorating after the injury - increased drowsiness, headache or vomiting

  • history of bleeding disorder/medications which may result in prolonged bleeding (eg: aspirin/Warfarin)

  • loss of consciousness or seizures

  • severe or increasing headache

  • unusual behaviour (different from normal)

  • double vision

  • anyone with inadequate supervision post injury

  • visible skull deformity


Recover

  • Typical management includes an element of physical and cognitive rest, usually between 24-48 hours, before a gradual progression of physical and cognitive activity.

  • This is best guided by a medical practitioner with experience in concussion management (eg: Doctor, physiotherapist, occupational therapist)

  • return to competitive sport must only occur after a graduated return to play program, and a return to education/work and social activities

  • Further evaluation by a Doctor should occur in those with prolonged symptoms (greater than 4 weeks)

Return to Sport (see table below)

  • This should be guided by a medical practitioner with experience in sport related concussion (eg: Doctor, physiotherapist, occupational therapist)

  • This should be progressed more slowly with children, adolescents and female athletes, and in the majority of cases will occur within 1 month of injury

  • clearance by a medical doctor is strongly recommended before returning to contact-based and sport specific training (stage 5), or full competition (stage 6)

  • Before returning to sport specific training (stage 5), the athlete should:

    • have returned to full capacity/usual work/education

    • be symptom free and completed up to/including Stage 4

    • be a minimum 14 days post injury

  • Before returning to competitive sport/play (stage 6), the athlete should

    • be symptoms free and completed 7 days at stage 5

    • be a minimum 21days post injury

    • have received medical clearance by a Doctor to return to competition


Dr Mel Parnell and Dr Alyse Cameron are skilled in the management of sport related concussion. Athletes will require a referral to be seen, and will be seen in our concussion clinic. Referral can be made by a medical practitioner/allied healthcare once an ACC45 has been lodged. There is no cost/surcharge for these appointments.









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