What HIRTS athletes? Establishing a unified public policy understanding of Head Impact-Related Trauma in Sport.

Globally, concussions in sport now attract far greater concern than several decades ago. Yet, no international scientific consensus exists for defining 'concussion,' or for determining how many brain injuries caused by a contact sport constitute a sufficient public health threat to warrant improving policies. How can policymakers help coaches, players, and parents work with public health authorities and clinicians to identify concussions, and prevent and treat head injuries? Doing so will require language that helps distinguish among the multitude of conditions related to Head Impact-Related Trauma in Sport (HIRTS), including sport-related concussion, post-concussion syndrome, second impact syndrome, and neurodegenerative diseases such as chronic traumatic encephalopathy. We propose a 'HIRTS framework' to advance public policy pertaining to head impacts and their effects. Given the scientific ambiguities regarding the definition, diagnosis, and markers of concussion and resulting complications, we encourage international policymakers, clinicians, and public health officials to adopt the following working definitions and concomitant policy recommendations to safeguard athletes' health and optimize tracking efforts, public education, funding, and government services.