How to identify someone with concussion

Recognising concussion can be extremely difficult.  So much so that much has been written in medical journals about it.  Even in high profile top level sports concussion is sometimes not recognized.  There was much discussion in the newspapers about a Welsh rugby player being allowed to carry on in a match a couple of years ago, and similar discussions have been had surrounding footballers.

Ultimately, concussion will be a medical diagnosis, so getting someone who might be concussed seen by a doctor should be made a priority.  Probably the most important thing is to be suspicious – almost taking the attitude that after a smack on the head someone is concussed until they have demonstrated they aren’t!  If you don’t think of it, you will probably miss it.  You should also be aware that concussion is more common in young people (under 18s).

There is a new screening tool which was published in the British Journal of Sports Medicine in 2013 (McCrory et. al, Consensus Statement on Concussion in Sport. Br J Sports Med 47 (5), 2013 ) – it’s called the pocket concussion recognition tool (or pocket CRT) and is endorsed by FEI among other organisations.  The full CRT can be freely downloaded from the internet.  These are the principles it covers.

Visible Clues

  • Someone is conscious or unresponsive
  • The rider who doesn’t get up or is slow to get up
  • Being unsteady on feet, problems with balance or co-ordination or falling over
  • Holding the head
  • Dazed, blank or vacant look
  • Confusion / lack of awareness of event

Signs & symptoms

The presence of any of these may indicate concussion

Loss of consciousness Fatigued Blurred vision
Seizure or fitting Nervous/ anxious Light sensitivity
Blanace problems 'Not feeling right' Memory loss
Being/ feeling sick Difficulty remembering  Feeling 'in a fog'
Drowsiness Headache Neck pain
More emotional Confusion Sensitivity to noise
Irritability Feeling 'slow' Difficulty concentrating
Sadness 'Pressure in the head'  







Memory Function

Ask some questions about where they are & what they have done – for example:

  • What venue is this?
  • What is the name of the horse & who owns it?
  • Which fence did you fall off at?
  • Which class are you doing?
  • What was the last competition you went to?
  • Failure to answer any of these correctly may indicate concussion.  

Red Flags

There are some particular symptoms which must be taken seriously, and if any of these are present then medical attention is required:

Neck Pain Decreasing consciousness
Increasing confusion or irritability Severe or worsening headache
Repeated vomiting Unusual behaviour change
Fitting Double vision
Weakness/ tingling/ buring in arms or legs  





You may well have looked at these signs & symptoms and thought they are very vague - or that is how you feel right now (hopefully not having just fallen off the horse!).  That is one of the reasons why the diagnosis is so difficult.

There is a much more complicated concussion screen that the doctor may do called a SCAT3 (Sports Concussion Assessment Tool 3).  It takes about 20 minutes to do a full SCAT3, but even this is based on similar things to the pocket CRT.  Where it starts to become really useful is if someone has already done a SCAT3 at an earlier date - that makes comparison or the results before & after injury possible which is much more useful.  Perhaps one day having a baseline SCAT3 assessment (or similar) will be a requirement for competitions?

So – remember the principle that you need to be suspicious if you are going to spot mild cases of concussion.  If someone is concussed they really do need proper attention – they should be assessed medically, and should not be left alone until that has been done.  Someone who is concussed must not drive – they are putting themselves, their passengers & other road users at risk (and insurers may decline to cover any incident occurring in such circumstances).