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Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012
  1. Paul McCrory1,
  2. Willem H Meeuwisse2,3,
  3. Mark Aubry4,5,6,
  4. Bob Cantu7,8,
  5. Jiří Dvořák9,10,11,
  6. Ruben J Echemendia12,13,
  7. Lars Engebretsen14,15,16,
  8. Karen Johnston17,18,
  9. Jeffrey S Kutcher19,
  10. Martin Raftery20,
  11. Allen Sills21,
  12. Brian W Benson22,23,24,
  13. Gavin A Davis25,
  14. Richard G Ellenbogen26,27,
  15. Kevin Guskiewicz28,
  16. Stanley A Herring29,30,
  17. Grant L Iverson31,
  18. Barry D Jordan32,33,34,
  19. James Kissick6,35,36,37,
  20. Michael McCrea38,
  21. Andrew S McIntosh39,40,41,
  22. David Maddocks42,
  23. Michael Makdissi43,44,
  24. Laura Purcell45,46,
  25. Margot Putukian47,48,
  26. Kathryn Schneider49,
  27. Charles H Tator50,51,52,53,
  28. Michael Turner54
  1. 1The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
  2. 2Faculty of Kinesiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  3. 3Faculty of Medicine, Sport Injury Prevention Research Centre, Calgary, Alberta, Canada
  4. 4International Ice Hockey Federation, Switzerland
  5. 5IOC Medical Commission Games Group, Ottawa, Ontario, Canada
  6. 6Ottawa Sport Medicine Centre, Ottawa, Ontario, Canada
  7. 7Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA
  8. 8Center for the Study of Traumatic Encephalopathy, Boston University Medical Center, Boston, Massachusetts, USA
  9. 9Department of Neurology, University of Zurich, Zurich, Switzerland
  10. 10Schulthess Clinic Zurich, Zurich, Switzerland
  11. 11F-MARC (FIFA Medical Assessment and Research Center), Zurich, Switzerland
  12. 12Psychological and Neurobehavioral Associates, Inc., State College, Pennsylvania, USA
  13. 13University of Missouri–Kansas City, Kansas City, Missouri, USA
  14. 14Department of Orthopaedic Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Norway
  15. 15Oslo Sports Trauma Research Center, Norway
  16. 16International Olympic Committee (IOC), Lausanne, Switzerland
  17. 17Division of Neurosurgery, University of Toronto, Toronto, Canada
  18. 18Concussion Management Program Athletic Edge Sports Medicine, Toronto, Canada
  19. 19Michigan NeuroSport, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
  20. 20International Rugby Board, Dublin, Ireland
  21. 21Department of Neurosurgery, Orthopaedic Surgery and Rehabilitation, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  22. 22Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
  23. 23Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
  24. 24Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  25. 25Department of Neurosurgery, Austin and Cabrini Hospitals & The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
  26. 26Theodore S. Roberts Endowed Chair Department of Neurological Surgery University of Washington Seattle, WA, USA
  27. 27NFL Head, Neck and Spine Medical Committee
  28. 28Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
  29. 29Clinical Professor Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, USA
  30. 30Seattle Sports Concussion Program, Team Physician Seattle Seahawks and Seattle Mariners, Seattle, Washington, USA
  31. 31Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
  32. 32Weill Medical College of Cornell University, New York, New York, USA
  33. 33Burke Rehabilitation Hospital, White Plains, New York, USA
  34. 34New York State Athletic Commission. New York, New York, USA
  35. 35Department of Family Medicine, University of Ottawa, Ottawa, Canada
  36. 36Canadian National Men's Sledge Hockey Team, Canada
  37. 37National Football League Players Association (NFLPA) Mackey-White Traumatic Brain Injury Committee
  38. 38Brain Injury Research, Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Wisconsin, USA
  39. 39Australian Centre for Research into Injury in Sports and its Prevention, Monash Injury Research Institute, Monash University, Australia
  40. 40Transport and Road Safety Research, Faculty of Science, the University of New South Wales, Australia
  41. 41McIntosh Consultancy and Research Pty Ltd. Sydney, Australia
  42. 42Perry Maddocks Trollope Lawyers, Melbourne, Australia
  43. 43The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Campus, Melbourne, Australia
  44. 44Centre For Health Exercise and Sports Medicine, Melbourne Physiotherapy Department, University of Melbourne, Melbourne, Australia
  45. 45Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  46. 46David Braley Sport Medicine and Rehabilitation Centre, McMaster University, Hamilton, Ontario, Canada
  47. 47Princeton University, New Jersey, USA
  48. 48Robert Wood Johnson, University of Medicine and Dentistry of New Jersey (UMDNJ), USA
  49. 49Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  50. 50Toronto Western Hospital and University of Toronto, Canada
  51. 51Krembil Neuroscience Centre, Toronto, Canada
  52. 52ThinkFirst Canada
  53. 53Parachute, Canada
  54. 54British Horseracing Authority, London, UK
  1. Correspondence to: Dr Paul McCrory, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3084, Australia; paulmccr{at}

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This paper is a revision and update of the recommendations developed following the 1st (Vienna 2001), 2nd (Prague 2004) and 3rd (Zurich 2008) International Consensus Conferences on Concussion in Sport and is based on the deliberations at the 4th International Conference on Concussion in Sport held in Zurich, November 2012.1–3

The new 2012 Zurich Consensus statement is designed to build on the principles outlined in the previous 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 under the Background section. This document is developed primarily for use by physicians and healthcare professionals who are 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 (RTP) decisions remain in the realm of clinical judgement on an individualised basis. Readers are encouraged to copy and distribute freely the Zurich Consensus document, the Concussion Recognition Tool (CRT), the Sports Concussion Assessment Tool V.3 (SCAT3) and/or the Child SCAT3 card and none are subject to any restrictions, provided they are not altered in any way or converted to a digital format. The authors request that the document and/or the accompanying tools be distributed in their full and complete format.

This consensus paper is broken into a number of sections

  1. A summary of concussion and its management, with updates from the previous meetings;

  2. Background information about the consensus meeting process;

  3. A summary of the specific consensus questions discussed at this meeting;

  4. The Consensus paper should be read in conjunction with the SCAT3 assessment tool, the Child SCAT3 and the CRT …

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