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Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016
  1. Paul McCrory1,
  2. Willem Meeuwisse2,
  3. Jiří Dvorak3,4,
  4. Mark Aubry5,
  5. Julian Bailes6,
  6. Steven Broglio7,
  7. Robert C Cantu8,
  8. David Cassidy9,
  9. Ruben J Echemendia10,11,
  10. Rudy J Castellani12,
  11. Gavin A Davis13,14,
  12. Richard Ellenbogen15,
  13. Carolyn Emery16,
  14. Lars Engebretsen17,
  15. Nina Feddermann-Demont18,19,
  16. Christopher C Giza20,21,
  17. Kevin M Guskiewicz22,
  18. Stanley Herring23,
  19. Grant L Iverson24,
  20. Karen M Johnston25,
  21. James Kissick26,
  22. Jeffrey Kutcher27,
  23. John J Leddy28,
  24. David Maddocks29,
  25. Michael Makdissi30,31,
  26. Geoff T Manley32,
  27. Michael McCrea33,
  28. William P Meehan34,35,
  29. Sinji Nagahiro36,
  30. Jon Patricios37,38,
  31. Margot Putukian39,
  32. Kathryn J Schneider40,
  33. Allen Sills41,42,
  34. Charles H Tator43,44,
  35. Michael Turner45,
  36. Pieter E Vos46
  1. 1 The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
  2. 2 Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
  3. 3 Swiss Concussion Center, Zurich, Switzerland
  4. 4 Spine Unit, Schulthess Clinic, Zurich, Switzerland
  5. 5 International Ice Hockey Federation, Zurich, Switzerland
  6. 6 Department of Neurosurgery, North Shore University Health System, Evanston, Illinois, USA
  7. 7 Department of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
  8. 8 Centre for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts, USA
  9. 9 Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Canada
  10. 10 Department of Psychology, University of Missouri - Kansas City, State College, Pennsylvania, USA
  11. 11 Psychological and Neurobehavioral Associates, Inc
  12. 12 Department of Pathology, University of Maryland, Baltimore, Baltimore, Maryland, USA
  13. 13 Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
  14. 14 Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  15. 15 Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
  16. 16 Department of Kinesiology, University of Calgary, Calgary, Canada
  17. 17 Department of Orthosurgery, Oslo University Hospital, Oslo, Norway
  18. 18 Department of Neurology, University Hospital Zurich, Zurich, Switzerland
  19. 19 Schulthess Clinic, Zurich, Switzerland
  20. 20 Department of Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
  21. 21 Department of Pediatrics / Pediatric Neurology, Mattel Children’s Hospital UCLA, Los Angeles, California, USA
  22. 22 Sports Medicine Research laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  23. 23 Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
  24. 24 Physical Medicine and Rehabilitation, Harvard Medical School; & Red Sox Foundation and Massachusetts General Hospital Home Base Program, Boston, Massachusetts, USA
  25. 25 Department of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
  26. 26 Kanata, Ontario, Canada
  27. 27 The Sports Neurology Clinic, Brighton, Michigan, USA
  28. 28 Department of Orthopaedics, SUNY Buffalo, Buffalo, New York, USA
  29. 29 Centre for Health Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
  30. 30 Melbourne Brain Centre, Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
  31. 31 Olympic Park Sports Medicine Centre, Melbourne, Australia
  32. 32 Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
  33. 33 Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  34. 34 Sports Medicine, Children’s Hospital Boston, Boston, Massachusetts, USA
  35. 35 Department of Emergency Medicine, Children’s Hospital Boston, Boston, Massachusetts, USA
  36. 36 Tokushima Daigaku Byoin, Tokushima, Japan
  37. 37 Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Johannesburg, South Africa
  38. 38 Department of Emergency Medicine. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  39. 39 Department of Athletic Medicine, Princeton University, Princeton, USA
  40. 40 Faculty of Kinesiology, University of Calgary, Calgary, Canada
  41. 41 Department of Neurological Surgery, Vanderbilt University Medical Center, Franklin, Tennessee, USA
  42. 42 Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Franklin, Tennessee, USA
  43. 43 Division of Neurosurgery, Toronto Western Hospital and University of Toronto, Toronto, Canada
  44. 44 Canadian Sports Concussion Project, Toronto, Canada
  45. 45 International Concussion and Head Injury Research Foundation (ICHIRF), London, UK
  46. 46 Department of Neurology, Slingeland Ziekenhuis, Doetinchem, The Netherlands
  1. Correspondence to Dr Paul McCrory, The Florey Institute of Neuroscience and Mental Health, Heidelberg 3084, Victoria, Australia; paulmccrory{at}icloud.com

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Preamble

The 2017 Concussion in Sport Group (CISG) consensus statement is designed to build on the principles outlined in the previous statements1–4 and to develop further conceptual understanding of sport-related concussion (SRC) using an expert consensus-based approach. This document is developed for physicians and healthcare providers who are involved in athlete care, whether at a recreational, elite or professional level. While agreement exists on the principal messages conveyed by this document, the authors acknowledge that the science of SRC is evolving and therefore individual management and return-to-play decisions remain in the realm of clinical judgement.

This consensus document reflects the current state of knowledge and will need to be modified as new knowledge develops. It provides an overview of issues that may be of importance to healthcare providers involved in the management of SRC. This paper should be read in conjunction with the systematic reviews and methodology paper that accompany it. First and foremost, this document is intended to guide clinical practice; however, the authors feel that it can also help form the agenda for future research relevant to SRC by identifying knowledge gaps.

A series of specific clinical questions were developed as part of the consensus process for the Berlin 2016 meeting. Each consensus question was the subject of a specific formal systematic review, which is published concurrently with this summary statement. Readers are directed to these background papers in conjunction with this summary statement as they provide the context for the issues and include the scope of published research, search strategy and citations reviewed for each question. This 2017 consensus statement also summarises each topic and recommendations in the context of all five CISG meetings (that is, 2001, 2004, 2008, 2012 as well as 2016). Approximately 60 000 published articles were screened by the expert panels for the Berlin …

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