A baseline computerized cognitive assessment was completed by 483 military cadets before their initial school year. Fourteen cadets concussed during physical education boxing were retested <1 hour after injury and again on return to full activity 4 days later. Compared with baseline testing, postinjury performance on simple reaction time and continuous performance tests was significantly slowed, even after cadets experienced resolution of physical symptoms and were cleared to resume full activity. These findings may be relevant to current concussion management guidelines.

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Introduction: Sports concussion remains a challenging condition to manage despite changes

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Objective1. To gain an understanding of Singapore Emergency Physicians (EPs) knowledge and practice habits when assessing concussions in the Emergency Department (ED).2. To determine what knowledge exists regarding current international concussion management and return-to-play guidelinesDesignA 21 item anonymous internet survey was developed and disseminated to EPs in Singapore. A limited time period for completion was given. Because of anonymity, non-responders could not be specifically targeted. Participation was voluntary and no incentives were offered.Results26 responses which included 9 Associate Consultants or above, 4 Registrars, 14 junior doctors. 63% were Singapore trained.88.9% were aware of the concussion diagnosis but only 50% could document the salient points required to diagnose concussion.The highest percentage (33.3%) reported seeing cases of concussion monthly, 18.5% fortnightly, 29.6% weekly and 14.8% daily. 33.3% of EPs were aware of Internationally Recognised guidelines but only 11% use them.70.4% refer concussions for follow up (47.4% to Neurosurgery and 21.1% to Sports Medicine). Only 14.8% of EPs have had specific training in sports concussion management.Conclusions1. It is likely that concussion is under diagnosed; many EPs only report seeing cases monthly and are unaware of the salient features to diagnose concussion.2. International guidelines regarding return-to-play and standardised assessment have not reached the majority of EPs.3. A small proportion of concussion cases are referred to Sports Clinics for follow up.4. Further training in sports concussion management in Singapore EDs is needed.5. Further studies in this area are required.Competing interestsJoanne Probert – Trainer for World Rugby.