Investigating concussion and repetitive mild Traumatic Brain Injury

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Aim

Sport concussion is a brief period of loss of consciousness, memory loss or feeling dazed or confused following trauma to the head. The aim of this study is to assess the relationship between brain imaging techniques (e.g. MRI scan), blood, saliva and urine biomarkers, and neurophysiological tests in assessing the duration and extent of the window of brain metabolic vulnerability following single and repetitive concussion that may support pitch-side and outpatient clinical decision making in order to objectively diagnose concussion, guide a safe return to play and identify the potential predictors of the long-term sequelae of concussion.

Background

Sport-related concussion management remains a diagnostic dilemma to clinicians in all strata of care, coaching staff and players alike. The lack of objective diagnostic and prognostic biomarkers and over-reliance on subjective clinical assessments carries a significant health risk of undiagnosed concussive episodes and early return to play before full recovery increasing the risk of sustaining additional concussion, and leading to long-term sequelae and/or unfavourable outcome. Therefore, a multidisciplinary approach is required to objectively diagnose sport-related concussion and guide a safe return to play following single and repetitive concussions to prevent further complications and long-term sequelae.

Method

RECOS is an observational, prospective, cohort study. A cohort of male or female contact sport athletes (16-65 years) will be recruited throughout the West Midlands region and through referrals from sports clubs anywhere in Great Britain. The participants will have a baseline pre-season screening (brain imaging, neuropsychological assessments, serum, urine and saliva sampling). If a screened player later suffers a concussion and/or multiple concussions then he/she will be assessed again with the same protocol within 48-72h in the Birmingham concussion clinic at QEHB, although attending directly or as soon as is practically possible will be advised. Should the injury be sufficiently serious that the attending staff believes immediate medical assistance or transfer to the nearest emergency department is required, then standard clinical procedures should be followed in these cases.

Research Team

Lay Summary

Currently, there is no validated clinical biomarker available to assess concussion, leading to an over-reliance on self-reporting of symptoms in the management of concussion.

At present, the mainstream assessment of concussion both in sports and in the primary/secondary healthcare setting involves the functional and symptomatic assessment of an individual using neurocognitive tests. These tests have significant limitations, particularly the lack of baseline/premorbid measurement in terms of sensitivity and specificity and the susceptibility to multiple confounding factors such as musculoskeletal injury and/or pre-morbid disability.

This study will help to identify tests that can support clinical decision making at the pitch-side and in the clinic in order to diagnose concussion, determine the severity of the injury, guide a safe return to play and predict the long-term effects. There are no significant risks to participants, as this is an observational study.

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