Concussion Evaluation & Management
Expected symptoms​: confusion, amnesia (before/after), headache, dizziness, vertigo, n/v,
lack of awareness of surroundings (can develop over hours to days)
-
Alarm signs: ​focal neurologic deficits, vision loss, hemiparesis, limb weakness,
stroke syndrome symptoms, worsening headache, worsening confusion, worsening
lethargy ​**ALWAYS REVIEW THESE WITH PATIENTS when you conclude your
visit!
- Alarm physical exam findings: ​battle sign (bleeding behind ear), bruising
around the eyes (intraorbital bruising), hemotympanum, seizure, 2+ episodes
of vomiting
Symptom assessment
Sport Concussion Assessment Tool​ SCAT5 (symptom checklist page 3)
Standard Assessment of Concussion
Imaging assessment
Canadian Head CT rules​ (on MDCalc)
New Orleans Criteria​ (on MDCalc)
Composite findings for all imaging assessments
Imaging indicated for:
- Age >65, Glasgow Coma Scale <15 after 2 hours of injury, signs of skull fracture (above),
two or more episodes of vomiting, amnesia longer than 30 minutes before injury,
dangerous mechanism (fall from >3 feet or >5 stairs)
- Neurologic deficits, seizure, anticoagulant use or bleeding disorder, return assessment
of head injury
- NOC criteria adds visual trauma above the clavicle and intoxication, persistent
anterograde amnesia
- NEXUS II adds abnormal behavior
PEDIATRIC ASSESSMENT over age 5 ​(consult for under age 5)
- Can use ​Child-SCAT 5​ for symptom assessment and ​PECARN ​imaging assessment
tool
Management
Mental and physical rest, at LEAST 5 days for kids returning to sports. Only activities that
don’t worsen symptoms, gradual increase from mental rest, light walking up through
strenuous activity, 24 hours at a time. More info at CDC return to play steps ​here​.
**Always review alarm signs of worsening symptoms to go to the ER above**