Consensus Statement on Concussion in Sport

The 4th International Conference on Concussion in Sport Held in Zurich, November 2012

Paul McCrory, MBBS, PhD; Willem Meeuwisse, MD, PhD; Mark Aubry, MD; Bob Cantu, MD; Jiri Dvorak, MD; Ruben J. Echemendia, PhD; Lars Engebretsen, MD, PhD; Karen Johnston, MD, PhD; Jeffrey S. Kutcher, MD; Martin Raftery, MBBS; Allen Sills, MD; Brian W. Benson, MD, PhD; Gavin A. Davis, MBBS; Richard G. Ellenbogen, MD; Kevin M. Guskiewicz, PhD, ATC; Stanley A. Herring, MD; Grant Iverson, PhD; Barry D. Jordan, MD, MPH; James Kissick MD, CCFP, Dip Sport Med; Michael McCrea, PhD, ABPP; Andrew S McIntosh, MBiomedE, PhD; David L. Maddocks, LLB, PhD; Michael Makdissi, MBBS, PhD; Laura Purcell, MD, FRCPC; Margot Putukian, MD; Michael Turner MBBS; Kathryn Schneider, PT, PhD; Charles H. Tator, MD, PHD


Clin J Sport Med. 2013;23(2):89-117. 

In This Article

Section 2: Statement on Background to the Consensus Process

In November 2001, the 1st International Conference on Concussion in Sport was held in Vienna, Austria. This meeting was organised by the IIHF in partnership with FIFA and the Medical Commission of the IOC. As part of the resulting mandate for the future, the need for leadership and future updates was identified. The 2nd International Conference on Concussion in Sport was organised by the same group with the additional involvement of the IRB and was held in Prague, the Czech Republic, in November 2004. The original aims of the symposia were to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, rugby, football (soccer) as well as other sports. To this end, a range of experts were invited to both meetings to address specific issues of epidemiology, basic and clinical science, injury grading systems, cognitive assessment, new research methods, protective equipment, management, prevention and long-term outcome.[1,2]

The 3rd International Conference on Concussion in Sport was held in Zurich, Switzerland on 29/30 October 2008 and was designed as a formal consensus meeting following the organisational guidelines set forth by the US National Institutes of Health. (Details of the consensus methodology can be obtained at: The basic principles governing the conduct of a consensus development conference are summarised below:

  1. A broad-based non-government, non-advocacy panel was assembled to give balanced, objective and knowledgeable attention to the topic. Panel members excluded anyone with scientific or commercial conflicts of interest and included researchers in clinical medicine, sports medicine, neuroscience, neuroimaging, athletic training and sports science.

  2. These experts presented data in a public session, followed by inquiry and discussion. The panel then met in an executive session to prepare the consensus statement.

  3. A number of specific questions were prepared and posed in advance to define the scope and guide the direction of the conference. The principal task of the panel was to elucidate responses to these questions. These questions are outlined below.

  4. A systematic literature review was prepared and circulated in advance for use by the panel in addressing the conference questions.

  5. The consensus statement is intended to serve as the scientific record of the conference.

  6. The consensus statement will be widely disseminated to achieve maximum impact on both current healthcare practice and future medical research.

The panel chairperson (WM) did not identify with any advocacy position. The chairperson was responsible for directing the consensus session and guiding the panel's deliberations. Panellists were drawn from clinical practice, academics and research in the field of sports-related concussion. They do not represent organisations per se, but were selected for their expertise, experience and understanding of this field.

The 4th International Conference on Concussion in Sport was held in Zurich, Switzerland on 1–3 November 2012 and followed the same outline as for the third meeting. All speakers, consensus panel members and abstract authors were required to sign an ICMJE Form for Disclosure of Potential Conflicts of Interest. Detailed information related to each author's affiliations and conflicts of interests will be made publicly available on the CISG website and published with the BJSM supplement.

Medical Legal Considerations

This consensus document reflects the current state of knowledge and will need to be modified according to the development of new knowledge. It provides an overview of issues that may be of importance to healthcare providers involved in the management of sports-related concussion. It is not intended as a standard of care, and should not be interpreted as such. This document is only a guide, and is of a general nature, consistent with the reasonable practice of a healthcare professional. Individual treatment will depend on the facts and circumstances specific to each individual case.

It is intended that this document will be formally reviewed and updated prior to 1 December 2016.