Role of video review for sport-related concussion identification: a systematic review

OBJECTIVE: To determine the frequency and diagnostic utility of visible signs identified through video review for sport-related concussion detection and to evaluate the role of injury mechanism in predicting concussions. DESIGN: Systematic review. DATA SOURCES: MEDLINE, SPORTDiscus, Web of Science and Cochrane Library from 2001 to June 2024. ELIGIBILITY CRITERIA: Original, peer-reviewed studies focusing on sport-related concussion, where video review identified visible signs or the mechanism of injury relevant to clinical decision-making. Studies were included irrespective of study design but had to be published in English and use a clinical diagnosis or consensus definition of sport-related concussion as a reference standard. RESULTS: Out of 1001 records screened, 29 studies involving 3281 sport-related concussions were included for quantitative synthesis. Only eight studies had a low risk of bias. All studies used clinical diagnosis as a reference standard; 26 were conducted in professional competitions, with two studies including female athletes. The most frequently observed visible sign was 'slow to get up' (37.6%), followed by 'motor incoordination' (26.7%). Sensitivity of visible signs was generally low (<50%), while specificity was high (>90%) across most studies. Four studies across three sports examined mechanism of injury characteristics, identifying common themes, such as high speed of impact, potentially associated with sport-related concussion occurrence. Inter-rater and intrarater reliability varied, with indications of higher reliability among expert raters. CONCLUSIONS: Expert video review can reliably identify visible signs of sport-related concussion. However, due to their low frequency and limited diagnostic sensitivity, the diagnosis of sport-related concussion should be supported by a multimodal assessment.