On the 27th and 28th of October, representatives of FIFA joined many of the world’s foremost experts on sport concussions at the Fifth International Consensus Conference on Concussion in Sport (ICCCS), an event designed to share evidence about the serious issue and come to a scientific consensus based that information. The idea of a “consensus conference” – where the world’s top medical professionals gather to present new research and review and discuss established practice – has been determined as the best approach to combatting the growing issue of head trauma.
Leading the process was a Scientific and Organizing Committee that included IIHF Chief Medical Officer Dr. Mark Aubry and FIFA Chief Medical Officer Dr. Jiri Dvorak, who were joined at the Berlin conference by over 400 medical professionals and scientists, including representatives from the International Olympic Committee, World Rugby and the International Federation for Equestrian Sports (FEI).
“We learn from each other the specificity of the different sports, which is a big advantage,” said Dvorak. “Just in the four sports of ice hockey, football, equestrian, and rugby, we are representing probably 1 billion professional and amateur athletes around the globe. So it’s important that we are exchanging views, and not just talking about concussions but prevention to reduce the general rate of all injuries.
“Where the scientific evidence was provided, the rules have been changed: in ice hockey they addressed hits to the head, in football it was the elbow to head, in rugby the different scrums were adapted and in equestrian the use of helmets and spine protection was implemented. But we can’t stop … we have to continue because there are other issues to address.”
A coming together In Berlin last week, attendees were shown a variety of research about concussions. The subjects ranged from the definition of what a concussion is, to presentations that gave an assessment of the latest technologies and biomarkers (indications in the patient of the degree of a concussion and the efficacy of its treatment) that could aid side-line medical staff to diagnose a concussion near the field of play.
The presenters were all experts in their respective fields, and the material produced for review came out of a tremendous amount of work by their research teams, who went over vast amounts of scientific papers to get the latest and most important scientific data. In all, about 18 months of preparation goes into an ICCCS. The conference participants, who are also specialists in the field, give feedback on the reviews so that a consensus is developed between the experts. The process is scientific, complete, and transparent, and results in a document -- the “Consensus Statement on Concussion in Sport”-- that will be clinically applicable.
In total about 59,000 articles were examined in preparation for the ICCCS, 750 of which were included in the detailed evaluations presented in Berlin. “On average for a single presentation there were about 10 experts involved,” said Jiri Dvorak. “They had to screen on average 5,000 articles and study each in detail, so that would be about 500 hours per pre-defined question. This research is presented in addition with the expertise and knowledge of the presenters themselves.”
The Consensus Statement on Concussion in Sport from the 5th ICCCS in Berlin will be published in early 2017 and will appear in various medical journals such as the British Journal of Sports Medicine.
A work in progress Since its inception in 2001, the conference has become the main forum for concussion awareness and prevention. It led to the publication of the first Sport Concussion Assessment Tool (SCAT) in 2005, which is in use by many sports leagues and federations today. The Consensus and the SCAT has formed the foundation by which the majority of sporting organisations have developed protocols with respect to concussions. The SCAT ranks as one of the most significant efforts by the sports medicine field to address concussion treatment and prevention.
The most recent conferences (the last occurring in 2012 at the Home of FIFA in Zurich) have developed and adjusted the SCAT, currently in its 3rd version (SCAT3), in order to fit better the treatment and prevention needs of both pro athletes and children (Child SCAT3). A pocket concussion recognition tool (Pocket CRT) has also been developed for parents, coaches and others to help with concussion detection.