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What is the lowest threshold to make a diagnosis of concussion?
  1. Paul McCrory1,
  2. Willem H Meeuwisse2,3,
  3. Ruben J Echemendia4,
  4. Grant L Iverson5,
  5. Jiří Dvořák6,
  6. Jeffrey S Kutcher7
  1. 1The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
  2. 2Faculty of Kinesiology, Sport Injury Prevention Research Centre, Calgary, Alberta, Canada
  3. 3Faculty of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
  4. 4Department of Psychology, Psychological and Neurobehavioral Associates, Inc., University of Missouri—Kansas City, State College, Pennsylvania, USA
  5. 5Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
  6. 6Fédération Internationale de Football Association, Schulthess Clinic Zurich, Zurich, Switzerland
  7. 7Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Paul McCrory, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3084, Australia; paulmccrory{at}


Objective The purpose of this review is to examine the evidence for determining the lowest threshold for diagnosing a sport-related concussion.

Data Sources MEDLINE, CINAHL, EMBASE, Mosby's Index, PsycEXTRA, PsycINFO and Scopus. Key words included sports concussion, concussion assessment, diagnosis, concussion symptoms, onfield assessment and sports-related traumatic brain injury.

Results The majority of concussions in sport occur without loss of consciousness or frank neurological signs. Some of the hallmark signs of acute concussion include mental confusion, memory and balance disturbance. Over the course of the first 24 h, the most common symptoms include headache, nausea, dizziness and balance problems, blurred vision or other visual disturbance, confusion, memory loss and ‘fatigue’. Symptoms such as tiredness, irritability, nervousness or anxiety, sleep disturbance and sensitivity to light or noise may be noticed in the days after injury. The pathophysiology of sports concussion remains poorly understood. There appears to be a period of vulnerability following concussion in which an overlapping injury might cause magnified pathophysiology.

Conclusions Sport-related concussions can be difficult to diagnose. Concussion produces an evolving constellation of somatic, cognitive and neurobehavioral symptoms that are typically most severe during the earliest acute postinjury period (ie, within the first 24–48 h) and diminish over a matter of several days to weeks in the majority of athletes. Athletes suspected of concussion should be removed from play and evaluated thoroughly.

  • Concussion

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