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Fifty shades of grey: concussion complexities and constructive conclusions
  1. Jonathan Patricios1,2,3,
  2. Michael Makdissi4,5
  1. 1Sports Concussion South Africa, Johannesburg, South Africa
  2. 2Faculty of Health Sciences, The Section of Sports Medicine, University of Pretoria, Pretoria, South Africa
  3. 3Faculty of Health Sciences, The Department of Emergency Medicine, University of the Witwatersrand, Johannesburg, South Africa
  4. 4The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, University of Melbourne, Melbourne, Victoria, Australia
  5. 5The Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
  1. Correspondence to Dr Jonathan Patricios, Sports Concussion South Africa, PO Box 1267, Parklands, Johannesburg 2121, South Africa; jpat{at}

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Concussion remains prominent in the medical and scientific literature but its assessment and management remain somewhat ‘grey’ and ill defined. The key issues related to concussion are widely discussed in the public arena. While these discussions should contribute to an improved understanding of concussion in the broader community, confusing messages are being driven by different agendas.

Questions being asked

Quarrie and Murphy1 question the relevance of current concussion consensus definitions, particularly as they translate to the real world. The authors make pragmatic recommendations. Specifically, they suggest that the increasing incidence of concussion may be partly due to the expanded ‘theoretical’ definition, and that changes in the manner in which the SCAT3 is implemented and interpreted may more accurately diagnose the condition.

Similarly, a number of recent articles have highlighted the fact that the ‘theoretical definition’ of concussion, as outlined in the current Zurich statement, lacks sensitivity and specificity. Furthermore, basic concepts of concussion management, such as a period of absolute rest and graded return to play, lack a strong evidence base.2 ,3 Increasingly, concussion in sport appears to have become ‘a grey area about grey matter’, with an increasingly wide net cast to capture more cases, the management of which remains subject to varied opinion and some conjecture.

Concussion is not unique

‘Shades of grey’ are not unique …

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