When should an athlete retire or discontinue participating in contact or collision sports following sport-related concussion? A systematic review

• Published in: British journal of sports medicine 2023-06, Vol.57 (12), p.822-830
• Main Authors: Makdissi, Michael, Critchley, Meghan L, Cantu, Robert C, Caron, Jeffrey G, Davis, Gavin A, Echemendia, Ruben J, Fremont, Pierre, Hayden, K Alix, Herring, Stanley A, Hinds, Sidney R, Jordan, Barry, Kemp, Simon, McNamee, Michael, Maddocks, David, Nagahiro, Shinji, Patricios, Jon, Putukian, Margot, Turner, Michael, Sick, Stacy, Schneider, Kathryn J
• Format: Article
• Language: English
• Subjects: Adolescent; Athletes; Australian football; Brain Concussion; Brain Injuries; Brain research; Child; Concussion; Decision making; Head injuries; Health sciences; Humans; Keywords; Librarians; Participation; Retirement; Sport; Sports; Subject heading schemes; Systematic review; Trauma; Traumatic brain injury
• ISSN: 0306-3674; 1473-0480
• DOI: 10.1136/bjsports-2023-106815

ObjectiveTo systematically review the scientific literature regarding factors to consider when providing advice or guidance to athletes about retirement from contact or collision sport following sport-related concussion (SRC), and to define contraindications to children/adolescent athletes entering or continuing with contact or collision sports after SRC.Data sourcesMedline, Embase, SPORTSDiscus, APA PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials were searched systematically.Study eligibility criteriaStudies were included if they were (1) original research, (2) reported on SRC as the primary source of injury, (3) evaluated the history, clinical assessment and/or investigation of findings that may preclude participation in sport and (4) evaluated mood disturbance and/or neurocognitive deficits, evidence of structural brain injury or risk factors for increased risk of subsequent SRC or prolonged recovery.ResultsOf 4355 articles identified, 93 met the inclusion criteria. None of the included articles directly examined retirement and/or discontinuation from contact or collision sport. Included studies examined factors associated with increased risk of recurrent SRC or prolonged recovery following SRC. In general, these were low-quality cohort studies with heterogeneous results and moderate risk of bias. Higher number and/or severity of symptoms at presentation, sleep disturbance and symptom reproduction with Vestibular Ocular Motor Screen testing were associated with prolonged recovery and history of previous concussion was associated with a risk of further SRC.ConclusionNo evidence was identified to support the inclusion of any patient-specific, injury-specific or other factors (eg, imaging findings) as absolute indications for retirement or discontinued participation in contact or collision sport following SRC.PROSPERO registration numberCRD42022155121.