Objective To define the characteristics, investigation, diagnosis and management of elite athletes attending a complex concussion service.

Design Retrospective analysis of case notes.

Setting Secondary care single centre.

Participants All patients (n=38, aged 16-35, 79% male) seen between April 2015 and April 2016.

Outcomes Patient characteristics (sport, position played in rugby, previous concussion history), referral reason, investigations, diagnosis, interventions.

Main results Most referrals came from Rugby (74% Rugby, 16% soccer, 8% other). Back row (57%) and centre (25%) were the commonest rugby positions seen. The average number of previous concussions of this cohort was 2.5 (95% CI±0.85). Referral reasons included chronic symptoms following concussion (53%), delayed GRTP (21% of which 28% were due to reduced performance on computerised neuropsychological testing), multiple concussions (18%) and severe injury (8%). 95% of patients had brain MRI imaging (with SWI sequences) and 4 patients (10%) had abnormalities (cortical cavernoma, brainstem cavernoma, diffuse axonal injury, obstructive hydrocephalus). 30% of patients required additional vestibular and/or neuropsychological assessment in addition to screening. Post-traumatic migraine was the commonest single diagnosis (36%) followed by isolated vestibular dysfunction (16%). 30% had multiple diagnoses (usually migraine, vestibular dysfunction and mood disorder). 8% did not have concussion. Intervention with medical management for migraine was initiated in 40%, vestibular rehabilitation in 20% and psychological intervention in 15%.

Conclusions A proportion of elite athletes with sports related concussion in the UK have complex needs. These require expert MDT assessment and management. The limited provision of such services needs to be addressed.

Competing interests None.