Article Text

Download PDFPDF
Various clinical practice guidelines for sports-related concussion are of sufficient methodological quality by AGREE II: a systematic review
  1. Steven R Dayton1,
  2. Hayden Baker2,
  3. Ujash Sheth3,
  4. Vehniah K Tjong3,
  5. Michael Terry3
  1. 1Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Department of Orthopaedic Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
  3. 3Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  1. Correspondence to Steven R Dayton, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; steven.dayton{at}


Importance Clinical practice guidelines (CPGs) relating to concussion management are published by various healthcare specialties, including but not limited to orthopaedic surgery, family medicine, neurology and athletic trainers. A systematic analysis can help identify high quality CPGs for clinical use by sports medicine physicians.

Objective The purpose of this study is to systematically identify and appraise relevant CPGs related to sports-related concussion in adult patients.

Evidence review Predetermined selection criteria were used by two reviewers who independently identified published CPGs before 1 November 2018. CPGs were excluded if they focused only on paediatric patients or their scope was greater than concussion in the setting of sports. The remaining guidelines were analysed by five independent reviewers with different levels of training using the Appraisal of Guidelines for Research and Evaluation II tool. Guidelines were deficient if they earned scores less than 50%. The Spearman correlation coefficient was used to assess interobserver agreement between the evaluators. Scores were compared by publishing institution and healthcare discipline using Kruskal-Wallis tests.

Findings Seven CPGs met the inclusion criteria. Guidelines came from neurologists, athletic therapists/trainers and interdisciplinary sports medicine bodies. Interobserver agreement was strong and mean scores between surgical trainees (124.5) and board-certified surgeons (125.9) were not statistically different. Guideline quality was variable but not deficient (>50%), except regarding ‘editorial independence’. No statistical difference was found between guidelines from different publishing institutions. Additionally, no statistical difference was found between guidelines published by different healthcare professionals.

Conclusions and relevance Overall, CPG quality was variable but not deficient, except for the domain of editorial independence. Bias due to poor editorial independence is a concern, particularly in CPGs published by non-physicians. Given the similarity in content and methodological quality, consideration should be given to condense evidence into a single CPG to be used by all healthcare professionals in the management of sports concussion.

Level of evidence 1, Systematic Review.

  • concussion
  • practice management
  • sport specific injuries
  • team physician
View Full Text

Statistics from


  • Contributors SRD and HB authored the manuscript. All authors analysed the quality of the guidelines using the AGREE II tool. US and VKT came up with the conceptualised the project. US, VKT and MT edited the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.