Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012

British Journal of Sports Medicine

Volumn 47, Issue 5, 2013, Pages 250-258

  McCrory, Paul ^a   Meeuwisse, Willem H ^b,c   Aubry, Mark ^d,e,f   Cantu, Bob ^g   Dvořák, Jiří ^h,i,j   Echemendia, Ruben J ^k,l   Engebretsen, Lars ^m,n,o   Johnston, Karen ^p,q   Kutcher, Jeffrey S ^r   Raftery, Martin ^s   Sills, Allen ^t   Benson, Brian W ^c,u   Davis, Gavin A ^v   Ellenbogen, Richard G ^d,w   Guskiewicz, Kevin ^x   Herring, Stanley A ^y,z   Iverson, Grant L ^aa   Jordan, Barry D ^ab,ac,ad   Kissick, James ^f,ae,af,ag   McCrea, Michael ^ah   McIntosh, Andrew S ^ai,aj,ak   Maddocks, David ^al   Makdissi, Michael ^a,am   Purcell, Laura ^an   Putukian, Margot ^ao,ap   Schneider, Kathryn ^u   Tator, Charles H ^d,p,aq   Turner, Michael ^ar   more..

^a FLOREY INSTITUTE OF NEUROSCIENCE AND MENTAL HEALTH   (Australia)

^b UNIVERSITY OF CALGARY   (Canada)

^c UNIVERSITY OF CALGARY   (Canada)

^d International Ice Hockey Federation ^*  (Canada)

^e IOC Medical Commission Games Group   (Canada)

^f Ottawa Sport Medicine Centre   (Canada)

^g BOSTON UNIVERSITY MEDICAL CENTER   (United States)

^h UNIVERSITY OF ZURICH   (Switzerland)

ⁱ SCHULTHESS CLINIC   (Switzerland)

^j FIFA MEDICAL CENTRE OF EXCELLENCE   (Switzerland)

^k Psychological and Neurobehavioral Associates Inc   (United States)

^l UNIVERSITY OF MISSOURI KANSAS CITY   (United States)

^m OSLO UNIVERSITY HOSPITAL   (Norway)

ⁿ Oslo Sports Trauma Research Center   (Norway)

^o Academic Medical Center VU University Medical Center   (Switzerland)

^p UNIVERSITY OF TORONTO   (Canada)

^q Concussion Management Program Athletic Edge Sports Medicine ^*  (Canada)

^r UNIVERSITY OF MICHIGAN MEDICAL SCHOOL   (United States)

^s World Rugby House   (Ireland)

^t VANDERBILT UNIVERSITY MEDICAL CENTER   (United States)

^u UNIVERSITY OF CALGARY   (Canada)

^v CABRINI HOSPITAL   (Australia)

^w UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE   (United States)

^x The University of North Carolina at Chapel Hill   (United States)

^y UNIVERSITY OF WASHINGTON   (United States)

^z SEATTLE SEAHAWKS   (United States)

^aa UNIVERSITY OF BRITISH COLUMBIA   (Canada)

^ab WEILL CORNELL MEDICAL COLLEGE   (United States)

^ac BURKE REHABILITATION HOSPITAL   (United States)

^ad New York State Athletic Commission   (United States)

^ae UNIVERSITY OF OTTAWA   (Canada)

^af Canadian National Men's Sledge Hockey Team   (Canada)

^ag White Traumatic Brain Injury Committee   (Canada)

^ah MEDICAL COLLEGE OF WISCONSIN   (United States)

^ai MONASH UNIVERSITY   (Australia)

^aj UNIVERSITY OF NEW SOUTH WALES   (Australia)

^ak McIntosh Consultancy and Research Pty Ltd   (Australia)

^al Perry Maddocks Trollope Lawyers   (Australia)

^am UNIVERSITY OF MELBOURNE   (Australia)

^an MCMASTER UNIVERSITY   (Canada)

^ao PRINCETON UNIVERSITY   (United States)

^ap UNIVERSITY OF MEDICINE AND DENTISTRY OF NEW JERSEY   (United States)

^aq Krembil Neuroscience Centre   (Canada)

^ar BRITISH HORSERACING AUTHORITY   (United Kingdom)

more..

Author keywords

[No Author keywords available]

Indexed keywords

ACUTE DISEASE; ADOLESCENT; AGGRESSION; BRAIN CONCUSSION; CHILD; CLINICAL COMPETENCE; CLINICAL PROTOCOL; COGNITIVE DEFECT; COMPUTER ASSISTED DIAGNOSIS; CONFERENCE PAPER; CONSENSUS DEVELOPMENT; CONVALESCENCE; DEPRESSION; DIAGNOSTIC IMAGING; EMERGENCY TREATMENT; FEMALE; HEALTH CARE POLICY; HELMET; HUMAN; INJURY SCALE; MALE; METHODOLOGY; NEUROLOGIC EXAMINATION; NEUROPSYCHOLOGICAL TEST; REST; RISK ASSESSMENT; SEX DIFFERENCE; SPORT INJURY; SPORTS MEDICINE; STANDARD; SWITZERLAND; UNCONSCIOUSNESS; VIOLENCE;

ACUTE DISEASE; ADOLESCENT; AGGRESSION; ATHLETIC INJURIES; BRAIN CONCUSSION; CHILD; CLINICAL COMPETENCE; CLINICAL PROTOCOLS; COGNITION DISORDERS; DEPRESSIVE DISORDER; DIAGNOSIS, COMPUTER-ASSISTED; DIAGNOSTIC IMAGING; EMERGENCY TREATMENT; FEMALE; HEAD PROTECTIVE DEVICES; HEALTH POLICY; HUMANS; INJURY SEVERITY SCORE; MALE; NEUROLOGIC EXAMINATION; NEUROPSYCHOLOGICAL TESTS; RECOVERY OF FUNCTION; REST; RISK ASSESSMENT; SEX FACTORS; SPORTS MEDICINE; SWITZERLAND; UNCONSCIOUSNESS; VIOLENCE;

EID: 84875553245     PISSN: 03063674     EISSN: 14730480     Source Type: Journal    
DOI: 10.1136/bjsports-2013-092313     Document Type: Conference Paper

References (153)

1. Aubry M, Cantu R, Dvorak J, et al. Summary and agreement statement of the 1st International Symposium on Concussion in Sport, Vienna 2001. Clin J Sport Med 2002;12:6-11.
2. McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med 2005;39:196-204.
3. McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport-the third international conference on concussion in sport held in Zurich, November 2008. Phys Sportsmed 2009;37:141-59.
4. Maddocks D, Dicker G. An objective measure of recovery from concussion in Australian rules footballers. Sport Health 1989;7(Suppl):6-7.
5. Maddocks DL, Dicker GD, Saling MM. The assessment of orientation following concussion in athletes. Clin J Sport Med 1995;5:32-5.
6. McCrea M. Standardized mental status assessment of sports concussion. Clin J Sport Med 2001;11:176-81.
7. McCrea M, Kelly J, Randolph C, et al. Standardised assessment of concussion (SAC): on site mental status evaluation of the athlete. J Head Trauma Rehab 1998;13:27-36.
8. McCrea M, Randolph C, Kelly J. The Standardized Assessment of Concussion (SAC): manual for administration, scoring and interpretation. 2nd edn. Waukesha, WI, 2000.
9. McCrea M, Kelly JP, Kluge J, et al. Standardized assessment of concussion in football players. Neurology 1997;48:586-8.
10. Chen J, Johnston K, Collie A, et al. A validation of the Post Concussion Symptom Scale in the assessment of complex concussion using cognitive testing and functional MRI. J Neurol Neurosurg Psych 2007;78:1231-8.
11. Chen J, Johnston K, Frey S, et al. Functional abnormalities in symptomatic concussed athletes: an fMRI study. Neuroimage 2004;22:68-82.
12. Chen JK, Johnston KM, Collie A, et al. (14) Association between symptom severity, CogSport tests results, and functional MRI activation in symptomatic concussed athletes. Clin J Sport Med 2004;14:379.
13. Chen JK, Johnston KM, Collie A, et al. Behavioural and functional imaging outcomes in symptomatic concussed athletes measured with cogsport and functional MRI. BJ Sport Med 2004;38:659.
14. Ptito A, Chen JK, Johnston KM. Contributions of functional magnetic resonance imaging (fMRI) to sport concussion evaluation. NeuroRehabilitation 2007;22:217-27.
15. Guskiewicz K. Postural stability assessment following concussion. Clin J Sport Med 2001;11:182-90.
16. Guskiewicz KM. Assessment of postural stability following sport-related concussion. Curr Sports Med Rep 2003;2:24-30.
17. Guskiewicz KM, Ross SE, Marshall SW. Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train 2001;36:263-73.
18. Cavanaugh JT, Guskiewicz KM, Giuliani C, et al. Detecting altered postural control after cerebral concussion in athletes with normal postural stability. Br J Sports Med 2005;39:805-11.
19. Cavanaugh JT, Guskiewicz KM, Giuliani C, et al. Recovery of postural control after cerebral concussion: new insights using approximate entropy. J Athl Train 2006;41:305-13.
20. Cavanaugh JT, Guskiewicz KM, Stergiou N. A nonlinear dynamic approach for evaluating postural control: new directions for the management of sport-related cerebral concussion. Sports Med (Auckland, NZ) 2005;35:935-50.
21. Fox ZG, Mihalik JP, Blackburn JT, et al. Return of postural control to baseline after anaerobic and aerobic exercise protocols. J Athl Train 2008;43:456-63.
22. Kristman VL, Tator CH, Kreiger N, et al. Does the apolipoprotein epsilon 4 allele predispose varsity athletes to concussion? A prospective cohort study. Clin J Sport Med 2008;18:322-8.
23. Terrell TR, Bostick RM, Abramson R, et al. APOE, APOE promoter, and Tau genotypes and risk for concussion in college athletes. Clin J Sport Med 2008;18:10-17.
24. Vagnozzi R, Tavazzi B, Signoretti S, et al. Temporal window of metabolic brain vulnerability to concussions: mitochondrial-related impairment-part I. Neurosurgery 2007;61:379-88; discussion 88-9.
25. Hang CH, Chen G, Shi JX, et al. Cortical expression of nuclear factor kappaB after human brain contusion. Brain Res 2006;1109:14-21.
26. Peng RY, Gao YB, Xiao XY, et al. [Study on the expressions of basic fibroblast growth factor and nervous growth factor genes in rat cerebral concussion]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2003;15:213-16.
27. Yunoki M, Kawauchi M, Ukita N, et al. Effects of lecithinized SOD on sequential change in SOD activity after cerebral contusion in rats. Acta Neurochir Suppl 1998;71:142-5.
28. Hinkle DA, Baldwin SA, Scheff SW, et al. GFAP and S100beta expression in the cortex and hippocampus in response to mild cortical contusion. J Neurotrauma 1997;14:729-38.
29. Holmin S, Schalling M, Hojeberg B, et al. Delayed cytokine expression in rat brain following experimental contusion. J Neurosurg 1997;86:493-504.
30. Sandberg Nordqvist AC, von Holst H, Holmin S, et al. Increase of insulin-like growth factor (IGF)-1, IGF binding protein-2 and-4 mRNAs following cerebral contusion. Brain Res Mol Brain Res 1996;38:285-93.
31. Fukuhara T, Nishio S, Ono Y, et al. Induction of Cu, Zn-superoxide dismutase after cortical contusion injury during hypothermia. Brain Res 1994;657:333-6.
32. Begaz T, Kyriacou DN, Segal J, et al. Serum biochemical markers for post-concussion syndrome in patients with mild traumatic brain injury. J Neurotrauma 2006;23:1201-10.
33. de Boussard CN, Lundin A, Karlstedt D, et al. S100 and cognitive impairment after mild traumatic brain injury. J Rehabil Med 2005;37:53-7.
34. Lima DP, Simao Filho C, Abib Sde C, et al. Quality of life and neuropsychological changes in mild head trauma. Late analysis and correlation with S100B protein and cranial CT scan performed at hospital admission. Injury 2008;39:604-11.
35. Ma M, Lindsell CJ, Rosenberry CM, et al. Serum cleaved tau does not predict postconcussion syndrome after mild traumatic brain injury. Am J Emerg Med 2008;26:763-8.
36. Stalnacke BM, Tegner Y, Sojka P. Playing ice hockey and basketball increases serum levels of S-100B in elite players: a pilot study. Clin J Sport Med 2003;13:292-302.
37. Stalnacke BM, Tegner Y, Sojka P. Playing soccer increases serum concentrations of the biochemical markers of brain damage S-100B and neuron-specific enolase in elite players: a pilot study. Brain Inj 2004;18:899-909.
38. Townend W, Ingebrigtsen T. Head injury outcome prediction: a role for protein S-100B? Injury 2006;37:1098-108.
39. Boutin D, Lassonde M, Robert M, et al. Neurophysiological assessment prior to and following sports-related concussion during childhood: a case study. Neurocase 2008;14:239-48.
40. De Beaumont L, Brisson B, Lassonde M, et al. Long-term electrophysiological changes in athletes with a history of multiple concussions. Brain Inj 2007;21:631-44.
41. De Beaumont L, Lassonde M, Leclerc S, et al. Long-term and cumulative effects of sports concussion on motor cortex inhibition. Neurosurgery 2007;61:329-36; discussion 36-7.
42. Gaetz M, Weinberg H. Electrophysiological indices of persistent post-concussion symptoms. Brain Inj 2000;14:815-32.
43. Gosselin N, Theriault M, Leclerc S, et al. Neurophysiological anomalies in symptomatic and asymptomatic concussed athletes. Neurosurgery 2006;58:1151-61; discussion-61.
44. Lavoie ME, Dupuis F, Johnston KM, et al. Visual p300 effects beyond symptoms in concussed college athletes. J Clin Exp Neuropsychol 2004;26:55-73.
45. Rousseff RT, Tzvetanov P, Atanassova PA, et al. Correlation between cognitive P300 changes and the grade of closed head injury. Electromyogr Clin Neurophysiol 2006;46:275-7.
46. Collie A, Darby D, Maruff P. Computerised cognitive assessment of athletes with sports related head injury. Br J Sports Med 2001;35:297-302.
47. Collie A, Maruff P. Computerised neuropsychological testing. Br J Sports Med 2003;37:2-3.
48. Collie A, Maruff P, McStephen M, et al. Psychometric issues associated with computerised neuropsychological assessment of concussed athletes. Br J Sports Med 2003;37:556-9.
49. Collins MW, Grindel SH, Lovell MR, et al. Relationship between concussion and neuropsychological performance in college football players [see comments]. JAMA 1999;282:964-70.
50. Lovell MR. The relevance of neuropsychologic testing for sports-related head injuries. Curr Sports Med Rep 2002;1:7-11.
51. Lovell MR, Collins MW. Neuropsychological assessment of the college football player. J Head Trauma Rehabil 1998;13:9-26.
52. Bleiberg J, Cernich AN, Cameron K, et al Duration of cognitive impairment after sports concussion. Neurosurgery 2004;54:1073-8; discussion 8-80.
53. Bleiberg J, Warden D. Duration of cognitive impairment after sports concussion. Neurosurgery 2005;56:E1166.
54. Broglio SP, Macciocchi SN, Ferrara MS. Neurocognitive performance of concussed athletes when symptom free. J Athl Train 2007;42:504-8.
55. Broglio SP, Macciocchi SN, Ferrara MS. Sensitivity of the concussion assessment battery. Neurosurgery 2007;60:1050-7; discussion 7-8.
56. Gioia G, Janusz J, Gilstein K, et al. Neueopsychological management of consussion in children and adolescents: effects of age and gender on ImPact (abstract). Br J Sp Med 2004;38:657.
57. McCrory P, Collie A, Anderson V, et al. Can we manage sport related concussion in children the same as in adults? Br J Sports Med 2004;38:516-19.
58. Johnston K, Bloom G, Ramsay J, et al. Current concepts in concussion rehabilitation. Curr Sports Med Rep 2004;3:316-23.
59. Guskiewicz KM, McCrea M, Marshall SW, et al. Cumulative effects associated with recurrent concussion in collegiate football players. JAMA 2003;290:2549-55.
60. Lovell M, Collins M, Bradley J. Return to play following sports-related concussion. Clin Sports Med 2004;23:421-41, ix.
61. Collins M, Field M, Lovell M, et al. Relationship between postconcussion headache and neuropsychological test performance in high school athletes. Am J Sports Med 2003;31:168-73.
62. Collins M, Grindel S, Lovell M, et al. Relationship between concussion and neuropsychological performance in college football players. J Am Med Assoc 1999;282:964-70.
63. Collins MW, Lovell MR, Iverson GL, et al. Cumulative effects of concussion in high school athletes. Neurosurgery 2002;51:1175-9; discussion 80-1.
64. McCrea M, Guskiewicz KM, Marshall SW, et al. Acute effects and recovery time following concussion in collegiate football players. JAMA 2003;290:2556-63.
65. McCrea M, Hammeke T, Olsen G, etal. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med 2004;14:13-17.
66. Bloom G, Horton A, McCrory P, et al. Sport psychology and concussion: new impacts to explore. Br J Sports Med 2004;38:519-21.
67. Weiss MR, Gill DL. What goes around comes around: re-emerging themes in sport and exercise psychology. Res Q Exerc Sport 2005;76:S71-87.
68. McCrory P. Should we treat concussion pharmacologically? The need for evidence based pharmacological treatment for the concussed athlete. Br J Sports Med 2002;36:3-5.
69. McCrory P. Preparticipation assessment for head injury. Clin J Sport Med 2004;14:139-44.
70. Johnston KM, Lassonde M, Ptito A. A contemporary neurosurgical approach to sport-related head injury: the McGill concussion protocol. J Am Coll Surg 2001;192:515-24.
71. Delaney J, Lacroix V, Leclerc S, et al. Concussions during the 1997 Canadian Football League Season. Clin J Sport Med 2000;10:9-14.
72. Delaney J, Lacroix V, Leclerc S, et al. Concussions among university football and soccer players. Clin J Sport Med 2002;12:331-8.
73. Gessel LM, Fields SK, Collins CL, et al. Concussions among United States high school and collegiate athletes. J Athl Train 2007;42:495-503.
74. Dvorak J, Junge A, Fuller C, et al. Medical issues in women's football. Br J Sports Med 2007;41(Suppl 1):i1.
75. Dvorak J, McCrory P, Kirkendall DT. Head injuries in the female football player: incidence, mechanisms, risk factors and management. Br J Sports Med 2007;41 (Suppl 1):i44-6.
76. Jennett B, Bond M. Assessment of outcome after severe brain damage: a practical scale. Lancet 1975;1:480-4.
77. Leninger B, Gramling S, Farrell A, et al. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neurol Neurosurg Psych 1990;53:293-6.
78. Lovell M, Iverson G, Collins M, et al. Does loss of consciousness predict neuropsychological decrements after concussion. Clin J Sp Med 1999;9:193-9.
79. McCrea M, Kelly J, Randolph C, et al. Immediate neurocognitive effects of concussion. Neurosurgery 2002;50:1032-42.
80. Cantu RC. Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. J Athl Train 2001;36:244-8.
81. Lovell MR, Collins MW, Iverson GL, et al. Recovery from mild concussion in high school atheltes. J Neurosurg 2003;98:296-301.
82. McCrory PR, Ariens T, Berkovic SF. The nature and duration of acute concussive symptoms in Australian football. Clin J Sport Med 2000;10:235-8.
83. Yarnell P, Lynch S. The 'ding': amnestic state in football trauma. Neurology 1973;23:196-7.
84. Yarnell PR, Lynch S. Retrograde memory immediately after concussion. Lancet 1970;1:863-4.
85. McCrory PR, Berkovic SF. Video analysis of acute motor and convulsive manifestations in sport-related concussion. Neurology 2000;54:1488-91.
86. McCrory PR, Bladin PF, Berkovic SF. Retrospective study of concussive convulsions in elite Australian rules and rugby league footballers: phenomenology, aetiology, and outcome. BMJ 1997;314:171-4.
87. Fleminger S. Long-term psychiatric disorders after traumatic brain injury. Eur J Anaesthesiol Suppl 2008;42:123-30.
88. Chen JK, Johnston KM, Petrides M, et al. Neural substrates of symptoms of depression following concussion in male athletes with persisting postconcussion symptoms. Arch Gen Psychiatry 2008;65:81-9.
89. Bryant RA. Disentangling mild traumatic brain injury and stress reactions. N Engl J Med 2008;358:525-7.
90. Vanderploeg RD, Curtiss G, Luis CA, et al. Long-term morbidities following self-reported mild traumatic brain injury. J Clin Exp Neuropsychol 2007;29:585-98.
91. Guskiewicz KM, Marshall SW, Bailes J, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc 2007;39:903-9.
92. Kashluba S, Casey JE, Paniak C. Evaluating the utility of ICD-10 diagnostic criteria for postconcussion syndrome following mild traumatic brain injury. J Int Neuropsychol Soc 2006;12:111-18.
93. Iverson GL. Misdiagnosis of the persistent postconcussion syndrome in patients with depression. Arch Clin Neuropsychol 2006;21:303-10.
94. Chamelian L, Feinstein A. The effect of major depression on subjective and objective cognitive deficits in mild to moderate traumatic brain injury. J Neuropsychiatry Clin Neurosci 2006;18:33-8.
95. Mooney G, Speed J, Sheppard S. Factors related to recovery after mild traumatic brain injury. Brain Inj 2005;19:975-87.
96. Broshek DK, Freeman Jr. Psychiatric and neuropsychological issues in sport medicine. Clin Sports Med 2005;24:663-79, x.
97. Pellman EJ. Background on the National Football League's research on concussion in professional football. Neurosurgery 2003;53:797-8.
98. Purcell L, Carson J. Sport-related concussion in pediatric athletes. Clin Pediatr (Phila) 2008;47:106-13.
99. Lee LK. Controversies in the sequelae of pediatric mild traumatic brain injury. Pediatr Emerg Care 2007;23:580-3; quiz 4-6.
100. Schnadower D, Vazquez H, Lee J, et al. Controversies in the evaluation and management of minor blunt head trauma in children. Curr Opin Pediatr 2007;19:258-64.
101. Wozniak JR, Krach L, Ward E, et al. Neurocognitive and neuroimaging correlates of pediatric traumatic brain injury: a diffusion tensor imaging (DTI) study. Arch Clin Neuropsychol 2007;22:555-68.
102. Hayden MG, Jandial R, Duenas HA, et al. Pediatric concussions in sports; a simple and rapid assessment tool for concussive injury in children and adults. Childs Nerv Syst 2007;23:431-5.
103. Lee MA. Adolescent concussions-management recommendations: a practical approach. Conn Med 2006;70:377-80.
104. Kirkwood MW, Yeates KO, Wilson PE. Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics 2006;117:1359-71.
105. Guskiewicz KM, Marshall SW, Bailes J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery 2005;57:719-26; discussion-26.
106. Nandoe RD, Scheltens P, Eikelenboom P. Head trauma and Alzheimer's disease. J Alzheimers Dis 2002;4:303-8.
107. Stern MB. Head trauma as a risk factor for Parkinson's disease. Mov Disord 1991;6:95-7.
108. Omalu BI, DeKosky ST, Hamilton RL, et al. Chronic traumatic encephalopathy in a national football league player: part II. Neurosurgery 2006;59:1086-92; discussion 92-3.
109. Omalu BI, DeKosky ST, Minster RL, et al. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery 2005;57:128-34; discussion-34.
110. McKee AC, Cantu RC, Nowinski CJ, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol 2009;68:709-35.
111. McKee AC, Gavett BE, Stern RA, et al. TDP-43 Proteinopathy and Motor Neuron Disease in Chronic Traumatic Encephalopathy. J Neuropathol Exp Neurol 2010;69:918-29.
112. McKee AC, Stein TD, Nowinski CJ, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain 2013;136:43-64.
113. McCrory P. Sports concussion and the risk of chronic neurological impairment. Clin J Sport Med 2011;21:6-12.
114. McCrory P. Future advances and areas of future focus in the treatment of sport-related concussion. Clin Sports Med 2011;30:201-8, xi-ii.
115. Hagel BE, Pless IB, Goulet C, et al. Effectiveness of helmets in skiers and snowboarders: case-control and case crossover study. BMJ (Clin Res ed) 2005;330:281.
116. McCrory P. The role of helmets in skiing and snowboarding. Br J Sports Med 2002;36:314.
117. Mueller BA, Cummings P, Rivara FP, et al. Injuries of the head, face, and neck in relation to ski helmet use. Epidemiology 2008;19:270-6.
118. Sulheim S, Holme I, Ekeland A, et al. Helmet use and risk of head injuries in alpine skiers and snowboarders. JAMA 2006;295:919-24.
119. Delaney JS, Al-Kashmiri A, Drummond R, et al. The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players. Br J Sports Med 2008;42:110-15; discussion 5.
120. Viano DC, Pellman EJ, Withnall C, et al. Concussion in professional football: performance of newer helmets in reconstructed game impacts-part 13. Neurosurgery 2006;59:591-606; discussion 591-606.
121. Finch C, Braham R, McIntosh A, et al. Should football players wear custom fitted mouthguards? Results from a group randomised controlled trial. Inj Prev 2005;11:242-6.
122. McIntosh A, McCrory P. The dynamics of concussive head impacts in rugby and Australian rules football. Med Sci Sports Exerc 2000;32:1980-5.
123. McIntosh A, McCrory P. Impact energy attenuation performance of football headgear. Br J Sports Med 2000;34:337-42.
124. McIntosh A, McCrory P. Effectiveness of headgear in a pilot study of under 15 rugby union football. Br J Sports Med 2001;35:167-70.
125. McIntosh A, McCrory P, Finch C, et al. Rugby Headgear Study. Sydney: School of Safety Science, The University of New South Wales, May 2005.
126. Finch C, Newstead S, Cameron M, et al. Head injury reductions in Victoria two years after the introduction of mandatory bicycle helmet use. Melbourne: Monash University Accident Research Centre, 1993 July, Report No.: 51.
127. Curnow WJ. Bicycle helmets and public health in Australia. Health Promot J Austr 2008;19:10-15.
128. Hewson PJ. Cycle helmets and road casualties in the UK. Traffic Inj Prev 2005;6:127-34.
129. Davidson JA. Epidemiology and outcome of bicycle injuries presenting to an emergency department in the United Kingdom. Eur J Emerg Med 2005;12:24-9.
130. Hansen KS, Engesaeter LB, Viste A. Protective effect of different types of bicycle helmets. Traffic Inj Prev 2003;4:285-90.
131. Andersen T, Arnason A, Engebretsen L, et al. Mechanism of head injuries in elite football. Br J Sports Med 2004;38:690-6.
132. Hagel B, Meewisse W. Editorial: risk compensation: a "side effect" of sport injury prevention? Clin J Sp Med 2004;14:193-6.
133. Finch C, Mcintosh AS, McCrory P, et al. A pilot study of the attitudes of Australian Rules footballers towards protective headgear. J Sci Med Sport 2003;6:505-11.
134. Finch CF, McIntosh AS, McCrory P. What do under 15-year-old schoolboy rugby union players think about protective headgear? BrJ Sports Med 2001;35:89-94.
135. Finch C, Mcintosh AS, McCrory P. What is the evidence base for the use of protective headgear and mouthguards in Australian football. Sport Health 2000;18:35-8.
136. Reece RM, Sege R. Childhood head injuries: accidental or inflicted? Arch Pediatr Adolesc Med 2000;154:11-15.
137. Shaw NH. Bodychecking in hockey. CMAJ 2004;170:15-16; author reply 6, 8.
138. Denke NJ. Brain injury in sports. J Emerg Nurs 2008;34:363-4.
139. Gianotti S, Hume PA. Concussion sideline management intervention for rugby union leads to reduced concussion claims. NeuroRehabilitation 2007;22:181-9.
140. Guilmette TJ, Malia LA, McQuiggan MD. Concussion understanding and management among New England high school football coaches. Brain Inj 2007;21:1039-47.
141. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 2007;42:311-19
142. Valovich McLeod TC, Schwartz C, Bay RC. Sport-related concussion misunderstandings among youth coaches. Clin J Sport Med 2007;17:140-2.
143. Sye G, Sullivan SJ, McCrory P. High school rugby players' understanding of concussion and return to play guidelines. Br J Sports Med 2006;40:1003-5.
144. Theye F, Mueller KA. "Heads up": concussions in high school sports. Clin Med Res 2004;2:165-71.
145. Kashluba S, Paniak C, Blake T, et al. A longitudinal, controlled study of patient complaints following treated mild traumatic brain injury. Arch Clin Neuropsychol 2004;19:805-16.
146. Gabbe B, Finch CF, Wajswelner H, et al. Does community-level Australian football support injury prevention research? J Sci Med Sport 2003;6:231-6.
147. Kaut KP, DePompei R, Kerr J, et al. Reports of head injury and symptom knowledge among college athletes: implications for assessment and educational intervention. Clin J Sport Med 2003;13:213-21.
148. Davidhizar R, Cramer C. The best thing about the hospitalization was that the nurses kept me well informed" issues and strategies of client education. Accid Emerg Nurs 2002;10:149-54.
149. McCrory P. What advice should we give to athletes postconcussion? Br J Sports Med 2002;36:316-18.
150. Bazarian JJ, Veenema T, Brayer AF, et al. Knowledge of concussion guidelines among practitioners caring for children. Clin Pediatr (Phila) 2001;40:207-12.
151. Guskiewicz KM, Weaver NL, Padua DA Jr, et al. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med 2000;28:643-50.
152. McCrea M, Guskiewicz KM, Marshall SW, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA 2003;290:2556-63.
153. Macciocchi SN, Barth JT, Alves W, et al. Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery 1996;39:510-14.