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Towards an operational definition of sports concussion: identifying a limitation in the 2012 Zurich consensus statement and suggesting solutions
  1. Kenneth Lincoln Quarrie,
  2. Ian Robert Murphy
  1. High Performance Unit, New Zealand Rugby, Wellington, New Zealand
  1. Correspondence to Dr Kenneth Lincoln Quarrie, High Performance Unit, New Zealand Rugby, 100 Molesworth Street, Wellington 6140, New Zealand; ken.quarrie{at}nzrugby.co.nz

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Introduction

A fundamental precept in managing injury risks1 and preventing injuries2 ,3 is that the size of the injury issue needs to be well established. The size, or importance, of the particular injury issue depends on factors such as the injury incidence (how many injuries occur per participant per unit of exposure) and severity (eg, typical degree and duration of impairment; costs associated with the injury).3 The most common means of measuring the size of an injury issue is via an injury surveillance system, by which all injuries meeting some predetermined criteria are counted.

Theoretical and operational definitions of injury

To understand the size of an injury issue, the injury being counted needs to be well defined. Theoretical definitions of injury specify what injuries ‘are’4; operational definitions of injury specify which injuries become cases, that is, how injuries can, or will, be counted in a given context.5–7

Although controversies remain about exactly what does and does not fall within a good theoretical definition of an injury,4 most definitions include some reference to an abnormal transfer of energy, and the resulting outcome(s). Theoretical definitions of injury are helpful in providing a conceptual framework by which to consider injuries, however, they leave open the question of operationalising the definition for the purposes of injury surveillance, and subsequent risk management and injury prevention initiatives. It is for this reason that various sports medicine groups have produced ‘injury definitions’ guidelines specifying which events meet the criteria for inclusion in injury counts.6 ,8

The Zürich definition of concussion

The Zürich Consensus Statement on Concussion (hereafter referred to as the Zürich Guidelines) provides a relatively clear theoretical definition of concussion.9 The concept of a transfer of injury resulting in some physical change is reflected in the Zürich Guidelines. To paraphrase, the Zürich Guidelines specify that concussion is …

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