Neuroimaging in professional combat sports: consensus statement from the association of ringside physicians

Figures & data

Table 1. Neuroimaging requirements for combat sports licensure in different Commissions around the world.

Commission	Imaging Requirements for Combat Sports Licensure
UNITED STATES OF AMERICA
ALABAMA ATHLETIC COMMISSION	None
ARIZONA BOXING & MMA COMMISSION	MRI if 40+ ‘if reccomended’ by the examining physician
CALIFORNIA STATE ATHLETIC COMMISSION	MRI every 5 years for all, also need MRA if 40+
COLORADO STATE BOXING COMMISSION	None
CONNECTICUT DEPT. OF EMERGENCY SERVICES & PUBLIC PROTECTION – BOXING AND MMA REGULATION	‘May include’ MRI/CT
FLORIDA STATE BOXING COMMISSION	MRI every year if 40+
GEORGIA ATHLETIC AND ENTERTAINMENT COMMISSION	None
IDAHO STATE ATHLETIC COMMISSION	None
ILLONOIS STATE ATHLETIC COMMISSION	MRI/CT for all every 5 years
INDIANA GAMING COMMISSION	None
KANSAS ATHLETIC COMMISSION	None
KENTUCKY BOXING & WRESTLING COMMISSION	None
LOUISIANA BOXING & WRESTLING COMMISSION	MRA if 40+
COMBATIVE SPORTS AUTHORITY OF MAINE	None
MARYLAND STATE ATHLETIC COMMISSION	None
MASSACHUSETTS STATE ATHLETIC COMMISSION	MRI/CT for all every 5 years
MICHIGAN UNARMED COMBAT COMMISSION	None
MINNESOTA OFFICE OF COMBATIVE SPORTS	None
MISSISSIPPI ATHLETIC COMMISSION	None
MISSOURI OFFICE OF ATHLETICS	None
NEBRASKA ATHLETIC COMMISSION	None
NEVADA ATHLETIC COMMISSION	MRI every 5 years for all, also need MRA once
NEW HAMPSHIRE BOXING/WRESTLING COMMISSION	None
NEW JERSEY ATHLETIC CONTROL BOARD	MRI/CT for all, also need MRA if 40+
NEW YORK STATE ATHLETIC COMMISSION	MRI every 3 years for all, also need MRA if 40+
NORTH CAROLINA BOXING AUTHORITY	MRI if 40+ or ‘high risk’
OHIO ATHLETIC COMMISSION	MRI if 35+ or ‘high risk’
OKLAHOMA STATE ATHLETIC COMMISSION	MRI if 40+ or ‘high risk’
OREGON STATE ATHLETIC COMMISSION	None
PENNSYLVANIA ATHLETIC COMMISSION	None
RHODE ISLAND LICENSING AND REGULATION	MRI/CT every 3 years for all, also need MRA if 40+
SOUTH CAROLINA ATHLETIC COMMISSION	None
SOUTH DAKOTA ATHLETIC COMMISSION	None
TENNESSEE ATHLETIC COMMISSION	None
TEXAS COMBATIVE SPORTS PROGRAM	None
PETE SUAZO UTAH ATHLETIC COMMISSION	None
VERMONT BOXING COMMISSION	None
VIRGINIA BOXING AND WRESTLING	CT if lost last bout via TKO/KO
WASHINGTON STATE DEPARTMENT OF LICENSING	MRI if 37+ or if combat sports athlete has had 6 or more losses in a row
WEST VIRGINIA ATHLETIC COMMISSION	MRI & MRA if 40+
WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES	MRI/MRA if 40+
WYOMING STATE BOARD OF MIXED MARTIAL ARTS	None
CANADA
EDMONTON COMBATIVE SPORTS COMMISSION (ALBERTA)	Baseline MRI/CT for all, MRI every year if 40+
LETHBRIDGE COMBATIVE SPORTS COMMISSION (ALBERTA)	MRI if 40+
BRITISH COLUMBIA ATHLETIC COMMISSION	None
MINISTRY OF TOURISM, CULTURE & SPORT	None
MANITOBA COMBATIVE SPORTS COMMISSION	None
NEW BRUNSWICK COMBAT SPORTS COMMISSION	MRI if 40+
NOVA SCOTIA BOXING AUTHORITY	None
OFFICE OF THE ONTARIO ATHLETICS COMMISSIONER	MRI/CT every 2 years for all
QUEBEC BOXING COMMISSION	CT scan
ATHLETICS COMMISSION OF SASKATCHEWAN	None
SOUTH AMERICA
BRAZILIAN MMA ATHLETIC COMMISSION (CABMMA)	MRI every 3 years for all, also MRA every 3 years for all
EUROPE
BRITISH BOXING BOARD OF CONTROL	MRI or MRA every year for all
BRITISH & IRISH BOXING AUTHORITY	MRI or MRA every year for all
BOXING UNION OF IRELAND	MRI every year for all, also need MRA once if younger than 40, MRA every year if 40+
SUOMEN AMMATTINYRKKEILYLIITTO (FINNISH PROFESSIONAL BOXING FEDERATION)	MRI every year for all
SUOMEN VAPAAOTTELUIITTO (FINNISH MIXED MARTIAL ARTS FEDERATION)	MRI every 2 years for all, also need MRA once in beginning of career
FFBOXE FéDERATION FRANçAISE DE BOXE (FRANCE)	MRI or MRA if requested by the federation ringside physician
FEDERAZIONE PUGILISTICA ITALIANA (ITALY)	MRI or MRA every year for all
MALTA BOXING COMMISSION	MRI or MRA every year for all
SWISSBOXING	MRI or MRA every year for all

***Although listed as none, some commissions state that additional medical test may be necessary based on the past or present medical condition

Table 2. Signs and symptoms concerning for acute traumatic brain injury.

‘Red Flag’ Signs and Symptoms of Serious Brain Injury

Glasgow Coma Scale (GCS) <15

Suspected open, depressed or basal skull fracture

Cerebrospinal fluid (CSF) coming out of nose or ears

Post-traumatic seizure

Focal neurological deficit

>1 episode of vomiting since the head injury

Pupillary abnormality

Progressive increase of headache, nausea/vomiting, light/ noise sensitivity and vision problems

Deterioration of mental status/overall condition