Global relevance

International summary, agreement and consensus statements on concussion in sport have evolved over the past 23 years and guided current clinical practice. The last International Consensus Statement on Concussion in Sport was published in 2017,1 along with 12 systematic reviews and the 3 assessment tools. Importantly, true global translation to clinical practice requires these works to be culturally adapted to inform regionally appropriate guidelines for concussion care across the world.2 In fact, there are 14 translations of the SCAT5 available.3

The 6th International Conference on Concussion in Sport was supported by the International Olympic Committee, Fédération Internationale de Football Association, International Ice Hockey Federation, Fédération Equestre Internationale, World Rugby and the Fédération Internationale de l’Automobile. We are grateful for the support of this important scientific process and optimistic that the global networks that these sporting bodies have will further promote better athlete care as they develop and disseminate sport-specific guidelines.

New resources

The outcomes of the Amsterdam Consensus process are intended for athletes of all levels (from grass roots to professional), and across all ages, including children, adolescents and adults. The concept of 11 ‘R’s’ from the 2017 Berlin conference created an easy-to-follow framework that again has been followed in the consensus statement to summarise key messages. The scientific committee used an updated, rigorous methodological process to conduct the systematic reviews and guide the consensus process, which is described in detail in the methodology paper. (see page 712)

While resources and access to care may vary at different levels of sport and geographic locations, similar principles related to the management of athletes to optimise health and safety can be applied across the spectrum. We highlight primary prevention (i.e., preventing SRCs before they occur) as paramount. (see page 749) Recognition of concussion and immediate removal from play continues to be a key message applicable to all settings. The development of an updated Concussion Recognition Tool-6, (see page 689) a Sport Concussion Assessment Tool-6 (SCAT6), (see page 619) and Child SCAT6 (see page 636) have been informed by a systematic review on acute detection of SRC (see page 722) . A new Sport Concussion Office Assessment Tool (SCOAT6) (see page 651) and Child SCOAT6 (see page 672) are designed to guide the subacute (>3 days from injury) assessment of SRC. These assessment tools are all freely available to enable broad access for all stakeholders involved in the care of athletes at risk of or who have sustained an SRC.

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Progress but more to do

Appropriate early management of concussion, including the use of exercise (see page 762) , implementation of updated gradual return to learn and return to sport strategies (see page 798) , rehabilitation when symptoms persist (see page 771) and referral to appropriate healthcare professionals using an interdisciplinary team approach (see page 780) are recommended and highlighted by comprehensive systematic reviews in these two concussion-dedicated BJSM editions. In some cases, recommendations may differ across ages, sex, sport or level of play. It is also important to consider differential access to healthcare professionals and the availability of local resources. Another new feature to this Amsterdam consensus is a systematic review dedicated to informing retirement recommendations (see page 822) . The systematic review on potential long-term effects of concussion comprehensively details the science related to this much-publicised topic and includes a narrative section dedicated to chronic traumatic encephalopathy. (see page 810)

For the first time, the Concussion in Para Sport Group and athletes with disabilities were represented on the Amsterdam Scientific Committee and Expert Panel. It is a start that needs to gain momentum and research—facilitating adaptation of recommendations to the specific needs of all athletes across all sports. Additional considerations for the paediatric athlete and ethical considerations are reviewed in more detail in this consensus statement. Recommendations for future research and priorities were voted on by the audience at the International Conference and summarised in the statement. There is also a section on targeted areas for future research, including the need to diversify research from around the globe. We invite you to review these recommendations and contribute to answering critically important research questions that will enable further improvements in concussion prevention, assessment and management.

Take it all in

We encourage you to read not only the consensus statement, but also the accompanying methodology paper, systematic reviews, tools and editorials to have a comprehensive understanding of the outputs of this consensus process. The recommendations from Amsterdam are meant to be adapted to a variety of health contexts. While these recommendations will evolve as new evidence becomes available, our goal remains to define the optimal care of all athletes with suspected or diagnosed SRC.

Playing your part

We would like to extend our thanks to the over 100 researchers and clinicians from around the world who have spent countless hours and days working on this process, as well as the international sport federations for their educational grant and conference organisation support—it truly has been a team effort! We hope that you adapt these recommendations to your environment and use the freely available tools to positively impact concussion care in athletes.