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

McCrory, Paul<sup>1</sup>; Meeuwisse, Willem H.<sup>2,3</sup>; Aubry, Mark<sup>4,5,6</sup>; Cantu, Bob<sup>7,8</sup>; Dvořák, Jiří<sup>9,10,11</sup>; Echemendia, Ruben J.<sup>12,13</sup>; Engebretsen, Lars<sup>14,15,16</sup>; Johnston, Karen<sup>17,18</sup>; Kutcher, Jeffrey S.<sup>19</sup>; Raftery, Martin<sup>20</sup>; Sills, Allen<sup>21</sup>; Benson, Brian W<sup>22,23,24</sup>; Davis, Gavin A.<sup>25</sup>; Ellenbogen, Richard G.<sup>26,27</sup>; Guskiewicz, Kevin<sup>28</sup>; Herring, Stanley A.<sup>29,30</sup>; Iverson, Grant L<sup>31</sup>; Jordan, Barry D<sup>32,33,34</sup>; Kissick, James<sup>6,35,36,37</sup>; McCrea, Michael<sup>38</sup>; McIntosh, Andrew S.<sup>39,40,41</sup>; Maddocks, David<sup>42</sup>; Makdissi, Michael<sup>43,44</sup>; Purcell, Laura<sup>45,46</sup>; Putukian, Margot<sup>47,48</sup>; Schneider, Kathryn<sup>49</sup>; Tator, Charles H<sup>50,51,52,53</sup>; Turner, Michael<sup>54</sup>

¹The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia

²Faculty of Kinesiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada

³Faculty of Medicine, Sport Injury Prevention Research Centre, Calgary, Alberta, Canada

⁴International Ice Hockey Federation, Switzerland

⁵IOC Medical Commission Games Group, Ottawa, Ontario, Canada

⁶Ottawa Sport Medicine Centre, Ottawa, Ontario, Canada

⁷Department of Neurosurgery, Boston University Medical Center, Boston, Massachusetts, USA

⁸Center for the Study of Traumatic Encephalopathy, Boston University Medical Center, Boston, Massachusetts, USA

⁹Department of Neurology, University of Zurich, Zurich, Switzerland

¹⁰Schulthess Clinic Zurich, Zurich, Switzerland

¹¹F-MARC (FIFA Medical Assessment and Research Center), Zurich, Switzerland

¹²Psychological and Neurobehavioral Associates, Inc., State College, Pennsylvania, USA

¹³University of Missouri–Kansas City, Kansas City, Missouri, USA

¹⁴Department of Orthopaedic Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Norway

¹⁵Oslo Sports Trauma Research Center, Norway

¹⁶International Olympic Committee (IOC), Lausanne, Switzerland

¹⁷Division of Neurosurgery, University of Toronto, Toronto, Canada

¹⁸Concussion Management Program Athletic Edge Sports Medicine, Toronto, Canada

¹⁹Michigan NeuroSport, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA

²⁰International Rugby Board, Dublin, Ireland

²¹Department of Neurosurgery, Orthopaedic Surgery and Rehabilitation, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA

²²Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada

²³Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada

²⁴Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada

²⁵Department of Neurosurgery, Austin and Cabrini Hospitals & The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia

²⁶Theodore S. Roberts Endowed Chair Department of Neurological Surgery University of Washington Seattle, WA, USA

²⁷NFL Head, Neck and Spine Medical Committee

²⁸Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA

²⁹Clinical Professor Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, USA

³⁰Seattle Sports Concussion Program, Team Physician Seattle Seahawks and Seattle Mariners, Seattle, Washington, USA

³¹Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada

³²Weill Medical College of Cornell University, New York, New York, USA

³³Burke Rehabilitation Hospital, White Plains, New York, USA

³⁴New York State Athletic Commission. New York, New York, USA

³⁵Department of Family Medicine, University of Ottawa, Ottawa, Canada

³⁶Canadian National Men's Sledge Hockey Team, Canada

³⁷National Football League Players Association (NFLPA) Mackey-White Traumatic Brain Injury Committee

³⁸Brain Injury Research, Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Wisconsin, USA

³⁹Australian Centre for Research into Injury in Sports and its Prevention, Monash Injury Research Institute, Monash University, Australia

⁴⁰Transport and Road Safety Research, Faculty of Science, the University of New South Wales, Australia

⁴¹McIntosh Consultancy and Research Pty Ltd. Sydney, Australia

⁴²Perry Maddocks Trollope Lawyers, Melbourne, Australia

⁴³The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Campus, Melbourne, Australia

⁴⁴Centre For Health Exercise and Sports Medicine, Melbourne Physiotherapy Department, University of Melbourne, Melbourne, Australia

⁴⁵Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada

⁴⁶David Braley Sport Medicine and Rehabilitation Centre, McMaster University, Hamilton, Ontario, Canada

⁴⁷Princeton University, New Jersey, USA

⁴⁸Robert Wood Johnson, University of Medicine and Dentistry of New Jersey (UMDNJ), USA

⁴⁹Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada

⁵⁰Toronto Western Hospital and University of Toronto, Canada

⁵¹Krembil Neuroscience Centre, Toronto, Canada

⁵²ThinkFirst Canada

⁵³Parachute, Canada

⁵⁴British Horseracing Authority, London, UK

Year

Entry

2003

McCrea M, Guskiewicz KM, Marshall SW, Barr W, Randolph C, Cantu RC, Onate JA, Yang J, Kelly JP. Acute effects and recovery time following concussion in collegiate football players: the NCAA concussion study. JAMA. November 19, 2003;290(19):2556-2563.

2004

McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med. January 2004;14(1):13-17.

2000

McIntosh AS, McCrory P, Comerford J. The dynamics of concussive head impacts in rugby and Australian rules football. Med Sci Sports Exer. December 2000;32(12):1980-1984.

2004

Andersen TE, Ârnason Â, Engebretsen L, Bahr R. Mechanisms of head injuries in elite football. Br J Sports Med. December 2004;38(6):690-696.

2007

Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Harding HP Jr, Mattihews A, Mihalik JR, Cantu RC. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exer. June 2007;39(6):903-909.

2005

Omalu BI, DeKosky ST, Minster RL, Kamboh MI, Hamilton RL, Wecht CH. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery. July 2005;57(1):128-134.

2002

Delaney JS, Lacroix VJ, Leclerc S, Johnston KM. Concussions among university football and soccer players. Clin J Sport Med. November 2002;2(6):331-338.

1997

McCrea M, Kelly JP, Kluge J, Ackley B, Randolph C. Standardized assessment of concussion in football players. Neurology. March 1997;48(3):586-588.

2003

Pellman EJ. Background on the National Football League's research on concussion in professional football. Neurosurgery. October 2003;53(4):797-798.

2001

Cantu RC. Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. J Athl Train. July–September 2001;36(3):244-248.

2007

De Beaumont L, Lassonde M, Leclerc S, Théoret H. Long-term and cumulative effects of sports concussion on motor cortex inhibition. Neurosurgery. August 2007;61(2):329-337.

2009

McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, Santini VE, Lee H-S, Kubilus CA, Stern RA. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol & Exp Neurol. July 2009;68(7):709-735.

2003

Guskiewicz KM, McCrea M, Marshall SW, Cantu RC, Randolph C, Barr W, Onate JA, Kelly JP. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA concussion study. JAMA. November 19, 2003;290(19):2549-2555.

2002

Collins MW, Lovell MR, Iverson GL, Cantu RC, Maroon JC, Field M. Cumulative effects of concussion in high school athletes. Neurosurgery. November 2002;51(5):1175-1179.

2000

Guskiewicz KM, Weaver NL, Padua DA, Garrett WE Jr. Epidemiology of concussion in collegiate and high school football players. Am J Sports Med. September 2000;28(5):643-650.

2005

Guskiewicz KM, Marshall SW, Bailes J, McCrea M, Cantu RC, Randolph C, Jordan BD. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. October 2005;57(4):719-724.

2007

Gessel LM, Fields SK, Collins CL, Dick RW, Comstock RD. Concussions among United States high school and collegiate athletes. J Athl Train. October–December 2007;42(4):495-503.

2006

Viano DC, Pellman EJ, Withnall C, Shewchenko N. Concussion in professional football: performance of newer helmets in reconstructed game impacts: part 13. Neurosurgery. September 2006;59(3):591-606.

2007

Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. April–June 2007;42(2):311-319.

Year

Entry

2014

Oeur RA, Zanetti K, Hoshizaki TB. Angular acceleration responses of American football, lacrosse and ice hockey helmets subject to low‐energy impacts. In: Proceedings of the 2014 International IRCOBI Conference on the Biomechanics of Injury. September 10-12, 2014; Berlin, Germany.81-92.

2017

Koncan DA, Zemek R, Gilchrist MD, Hoshizaki TB. Helmet construction influences brain strain patterns for events causing concussion in youth ice hockey. In: Proceedings of the 2017 International IRCOBI Conference on the Biomechanics of Injury. September 13-15, 2017; Antwerp, Belgium.201-210.

2016

Black AM, Macpherson AK, Hagel BE, Romiti MA, Palacios-Derflingher L, Kang J, Meeuwisse WH, Emery CA. Policy change eliminating body checking in non-elite ice hockey leads to a threefold reduction in injury and concussion risk in 11- and 12-year-old players. Br J Sports Med. January 2016;50(1):55-61.

2018

Sollmann N, Echlin PS, Schultz V, Viher PV, Lyall AE, Tripodis Y, Kaufmann D, Hartl E, Kinzel P, Forwell LA, Johnson AM, Skopelja EN, Lepage C, Bouix S, Pasternak O, Lin AP, Shenton ME, Koerte IK. Sex differences in white matter alterations following repetitive subconcussive head impacts in collegiate ice hockey players. NeuroImage Clin. 2018;17:642-649.

2021

Sharkey J. Bridging the Gap in Clinical Translation: Optimising an Ovine Model of Traumatic Brain Injury [PhD thesis]. University of Adelaide; June 2021.

2020

Humm JR. Design of Novel Experiments and Analyses for Head and Spine Trauma Biomechanics [PhD thesis]. Marquette University; December 2020.

2016

Schussler E. Assessment, Feedback and Head Accelerations in Youth American Football [PhD thesis]. The Ohio State University; 2016.

2017

Aggelou AE. Concussion as a Risk Factor for Lower Extremity Musculoskeletal Injury in Collegiate Athletes [PhD thesis]. University of Pittsburgh; 2017.

2016

Virani S. The Effect of Shoulder Pad Design on Head Impact Severity During Shoulder Checks in Ice Hockey [Master's thesis]. Simon Fraser University; Spring 2016.

2018

Tierney G. A Biomechanical Assessment of Direct and Inertial Head Loading in Rugby Union [PhD thesis]. Dublin, Ireland: Trinity College Dublin; 2018.

2013

Brown HJ. Development and Validation of an Objective Balance Error Scoring System [Master's thesis]. Vancouver, BC: University of British Columbia; September 2013.

2020

Pryhoda MK. A Longitudinal Examination of Biomechanical Balance and Quantitative Multidomain Assessments During Recovery Following Sport-Related Concussion [PhD thesis]. University of Colorado Denver; June 2020.

2021

Wahlquist VE. Purposeful Soccer Heading Exposure and Clinical Outcomes in Youth Soccer Players [PhD thesis]. University of Delaware; 2021.

2016

Bolton Hall AN. Histological and Behavioral Consequences of Repeated Mild Traumatic Brain Injury in Mice [PhD thesis]. University of Kentucky; 2016.

2014

Patton DA. The Biomechanical Determinants of Sports-Related Concussion: Finite Element Simulations of Unhelmeted Head Impacts to Evaluate Kinematic and Tissue-Level Predictors of Injury and Investigate the Design Implications for Soft-Shell Headgear [PhD thesis]. University of New South Wales; March 2014.

2016

Riley PA. Baseline Comparability to Accelerometry Data and Changes in Standing Balance Over the Course of an Athletic Season Using a Postural Sway Assessment Tool [Master's thesis]. University of Ontario Institute of Technology; January 2016.

2022

Lowther S. Effect of Rule Changes Occurring Between 2003 and 2016 on Head Impact Frequency and Brain Strain Magnitude in North American Professional Ice Hockey [Master's thesis]. University of Ottawa; 2022.

2017

Sanchez EJ. Evaluation of the Efficacy of Head and Brain Injury Risk Functions [Master's thesis]. Charlottesville, VA: University of Virginia; December 2017.

2013

Young TJ. Head Impact Biomechanics and Helmet Performance in Youth Football [Master's thesis]. Virginia Polytechnic Institute and State University; December 9, 2013.

2015

Cobb BR. Laboratory and Field Studies in Sports-Related Brain Injury [PhD thesis]. Virginia Polytechnic Institute and State University; March 25, 2015.

2021

Kieffer EE. Sex-Specific Head Impact Exposure in Rugby: Measurement Considerations and Relationships to Clinical Outcomes [PhD thesis]. Virginia Polytechnic Institute and State University; March 18, 2021.

2014

Campbell K. Quantifying and Comparing the Head Impact Biomechanics of Different Player Positions for Canadian University Football [Master's thesis]. University of Western Ontario; 2014.

2016

Brooks JS. The Use of P3b as an Indicator of Neurophysiologic Change from Subconcussive Impacts in Football Players [Master's thesis]. University of Western Ontario; 2016.

2021

Liu X. Developing Multi-Species Brain-Strain-Based Scaling Law Using Finite Element Analysis [Master's thesis]. University of Western Ontario; 2021.