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Br J Sports Med 43:i76-i84 doi:10.1136/bjsm.2009.058248
  • Supplement

Consensus Statement on Concussion in Sport: the 3rd International Conference on Concussion in Sport held in Zurich, November 2008

  1. P McCrory1,
  2. W Meeuwisse2,
  3. K Johnston3,
  4. J Dvorak4,
  5. M Aubry5,
  6. M Molloy6,
  7. R Cantu7
  1. 1
    Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia
  2. 2
    Sport Medicine Centre, Faculty of Kinesiology, and Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3
    Sport Concussion Clinic, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
  4. 4
    FIFA Medical Assessment and Research Center and Schulthess Clinic, Zurich, Switzerland
  5. 5
    International Ice Hockey Federation and Hockey Canada, and Ottawa Sport Medicine Centre, Ottawa, Canada
  6. 6
    International Rugby Board, Dublin, Ireland
  7. 7
    Emerson Hospital, Concord, Massachusetts, USA
  1. Associate Professor P McCrory, Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Australia 3010; paulmccr{at}bigpond.net.au
  • Accepted 2 February 2009

This paper is a revision and update of the recommendations developed following the 1st (Vienna) and 2nd (Prague) International Symposia on Concussion in Sport.1 2 The Zurich Consensus statement is designed to build on the principles outlined in the original Vienna and Prague documents and to develop further conceptual understanding of this problem using a formal consensus-based approach. A detailed description of the consensus process is outlined at the end of this document. This document is developed for use by physicians, therapists, certified athletic trainers, health professionals, coaches and other people involved in the care of injured athletes, whether at the recreational, elite or professional level. While agreement exists pertaining to principal messages conveyed within this document, the authors acknowledge that the science of concussion is evolving and therefore management and return to play decisions remain in the realm of clinical judgement on an individualised basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document and/or the Sports Concussion Assessment Tool (SCAT2) card and neither is subject to any copyright restriction. The authors request, however that the document and/or the SCAT2 card be distributed in their full and complete format.

The following focus questions formed the foundation for the Zurich concussion consensus statement:

Acute simple concussion

  • Which symptom scale and which sideline assessment tool is best for diagnosis and/or follow up?

  • How extensive should the cognitive assessment be in elite athletes?

  • How extensive should clinical and neuropsychological (NP) testing be at non-elite level?

  • Who should do/interpret the cognitive assessment?

  • Is there a gender difference in concussion incidence and outcomes?

Return to play (RTP) issues

  • Is provocative exercise testing useful in guiding RTP?

  • What is the best RTP strategy for elite athletes?

  • What is the best RTP strategy for non-elite athletes?

  • Is protective equipment (eg, mouthguards and helmets) useful in reducing concussion incidence and/or severity? …

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