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Comprehending concussion: evolving and expanding our clinical insight
  1. Michael Makdissi1,2,3,
  2. Jon Patricios4,5,6
  1. 1 The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne Brain Centre Austin Campus), University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
  3. 3 The Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Sports Concussion South Africa, Johannesburg, South Africa
  5. 5 The Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  6. 6 The Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Dr Michael Makdissi, Olympic Park Sports Medicine Centre, Olympic Bvd, AAMI Stadium, Melbourne, VIC 3002, Australia; makdissi{at}

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Concussion in sport has been defined as a “complex pathophysiological process affecting the brain, induced by biomechanical factors.”1 The condition is characterised by “a graded set of clinical symptoms that may or may not involve loss of consciousness.”1

Casting the net wide

The current consensus definition provides a broad clinicopathological description of concussion. It encompasses the wide range of clinical presentations that result from traumatic forces transmitted to the brain. In its most literal interpretation, any post-traumatic symptom or sign fits the definition of concussion.2 Consequently, the current definition has high sensitivity, but lacks specificity. This issue has been highlighted in recent papers.3

The purpose of ‘casting a large net’ is to capture all possible concussions and manage these injuries conservatively. This position is driven by the lack of reliable and specific diagnostic markers, and concerns related to potential complications associated with concussion. Compounding this, risk factors for complications remain unclear and currently there are few prognostic factors to accurately predict outcomes following concussion.4

Athletes do not like sitting out

From the athletes’ perspective, a significant downside to the broad definition of concussion is the major time …

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  • Contributors MM and JP contributed to the content, design and drafting of the paper. MM conceived the outline and themes of the paper, submitted the paper and acts as guarantor.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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