Objective To analyse the potential ways to reunite the mTBI and concussion constructs in order to harmonise screening, diagnosis and management.
Design Narrative review.
Setting In Quebec, the initial management of concussions sustained in a sport or school-based setting falls under the authority of the Ministry of education and sports whereas the Ministry of health governs the clinical management of mTBI. The recent work of a task force on concussions in Quebec has emphasised the need to achieve a unified understanding and operationalization of the two constructs so that persons affected receive consistent information and care.
Main results Sport and school-based concussion management is generally based on the Concussion In Sport Group definition whereas the Quebec health care system relies on the 5 diagnostic criteria proposed by the WHO task force in 2004. Although the 5 classification criteria of mTBI include normal values, the actual definition requires the presence of one or more abnormal criteria. In a public health care system, such a definition structures access to limited public resources. However unfavourable evolution can occur in the absence of phenomena such as LOC or PTA. Yet these cases represent a potentially serious health condition if proper identification and management is not initiated.
Conclusion So far, sport, education and health care stakeholders in Quebec have agreed that the constructs of concussion and TBI must be revisited and better integrated. This process raises challenges and opportunities in terms of operationalization and management. Studies on prognostic indicators should guide this analysis.
Conclusion Competing interests Pierre Frémont is chair of the Canadian Concussion Collaborative.
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