Early instrumental diagnostics on playground of head trauma in sporting events: the role of biomarkers to improve sports medical protocols in recognition and treatment of brain concussion

BACKGROUND: Introduction of diagnostic tests for cerebral concussion detection in head trauma must constitute a milestone in sporting events in order to immediately address the management and therapeutic process of the injured athlete, as well as the return-to-play in safety. METHODS: During activity in Contact Sports (i.e. Rugby, Boxing, American Football, Football, Ice Hockey) or in individual Sports (Motor Sports, Cycling, Alpine Skiing, Bobsleigh, Skeleton) where there is a high risk of head trauma and consequent cerebral concussion, currently in Italy there is no other diagnostic method on playground than direct observation of the traumatic event by the Team Doctor and the subsequent objective examination of the athlete combined with anamnestic data. RESULTS: The most obvious symptom of concussion is loss of consciousness, although most injured athletes experience other symptoms and signs such as headache, nausea and vomiting, dizziness, postural balance disturbances, confusion with lightheadedness or numbness, retrograde amnesia or anterograde, diplopia and photophobia. Sometimes the symptoms are absent or trivial and the injury is underestimated with possible subsequent immediate and deferred serious consequences as Second Impact Syndrome. CONCLUSIONS: Introduction of biomarkers test of head trauma and consequent concussion is an American reality for the National Football League in the 2023-2024 championship. Estimates of the incidence of sport related concussion in the United States vary from underestimates by 200,000 cases up to a conceivable number of 3,800,000. When occurs a fatal outcome the fatal concussion was mainly subsequent to a previous undiagnosed event (SIS): data from the Centers for Disease Control and Prevention. In Italy there are no certain data on this matter. An approximate estimate, calculated on data from Emilia Romagna, assumes around 120,000 cases per year in line with the American data compared to the Italian population. To complete validated concussion protocols, it is necessary to introduce reliable biomarkers in order to manage the athlete’s injury and to obtain a diagnostic and therapeutic gold standard, as well for return-to-play of the athlete.