The Latest in Concussion Management: A Conversation with Dr Gill Cowen

The Good GP

In this episode, host Dr Catherine Bourke is joined by Dr Gill Cowen, a multi-talented expert with roles including a senior lectureship at Curtin Medical School and a clinical research fellow at the Curtin Health Innovation Research Institute, to discuss advancements in concussion management.

Defining concussion and elaborating on the latest Australian Sports Commission concussion guidelines released in February 2024. They covered various aspects of concussion, including preventive measures in sports, the importance of strict adherence to game rules, and the role of mouthguards and helmets. Dr Cowen clarifies that loss of consciousness is not required for a concussion diagnosis and outlines the serious conditions that GPs must not overlook.

Gaining insights into available diagnostic tools such as the post-concussion symptom score, SCAT 6, and the Vestibular Ocular Motor Screening Tool (VOMS). Dr Cowen also updates on current recommendations for post-concussion management, moving away from complete rest and instead advocating for relative rest and limited screen time in the initial 48 hours. They also discussed return-to-play protocols, particularly the revised 14-day symptom-free period before re-engaging in contact sports and a minimum 21-day interval for returning to play.

They emphasise a conservative approach to repeated concussions within a season and acknowledge ongoing research on chronic traumatic encephalopathy (CTE) and its association with repetitive head trauma. Dr Cowen highlights that, in the current absence of predictive tools, a cautious management approach should be employed.

References:

• Concussion guidelines: https://www.connectivity.org.au/clinical-guidance/health-guidelines/
• Concussion Fact Sheets: https://www.connectivity.org.au/guidance-for-clinicians/fact-sheets/
• Free short concussion courses: https://www.connectivity.org.au/courses/
• State Head Injury Unit Concussion Program: https://www.nmhs.health.wa.gov.au/Hospitals-and-Services/Public-Health/Head-Injury/Concussion
• mTBI Healthpathway: https://wa.communityhealthpathways.org/246668.htm
• Vestibular oculomotor screening (VOMS): https://www.youtube.com/watch?v=CJF6kJcFGqE
• Sport-related concussion: https://sma.org.au/resources/concussion/

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