What are the key questions to ask in the assessment of a concussion (mild traumatic brain injury)?

From the Guidelines

When assessing a potential concussion, it is crucial to ask key questions to identify symptoms quickly, as concussions are traumatic brain injuries that may not be immediately obvious, and delayed diagnosis can lead to worsened outcomes and prolonged recovery 1. To evaluate a potential concussion, consider asking the following questions:

• "Did you hit your head or experience a jolt to the body?"
• "Did you lose consciousness, even briefly?"
• "Do you have a headache, dizziness, nausea, or vision problems?"
• "Are you feeling confused or having trouble concentrating?"
• "Do you remember what happened before and after the injury?" Additionally, inquire about symptoms like sensitivity to light or noise, balance problems, feeling foggy, or sleep disturbances. For children, ask if they appear dazed, confused, or are behaving differently than usual, as their symptoms may manifest differently than adults 1. These questions are essential in guiding whether immediate medical attention is needed, as concussions can have long-term serious or even fatal consequences if not properly managed 1. It is vital to prioritize the patient's safety and stop all physical activity immediately if a concussion is suspected, and have them evaluated by a healthcare professional to prevent worsening the injury and prolonging recovery 1.

From the Research

Concussion Quick Questions to Ask

When evaluating a concussion, several key questions can be asked to assess the severity of the injury and guide management. Some of these questions include:

• What are the patient's symptoms, such as headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues? 2
• What is the patient's medical history, including any previous concussions? 3
• What are the results of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) or other standardized clinical tools? 4, 3
• What is the patient's symptom profile, including the presence of migraine, cognition, sleep, and neuropsychiatric symptoms? 3
• What are the patient's plans for return to activity, including return to learn/play recommendations? 5

Assessment and Management

The assessment and management of concussion involve several key components, including:

• Rapid removal from play or activity 5
• Symptomatic treatment, including medication and other therapies 2, 6
• Use of standardized clinical tools, such as the ImPACT test 4, 3
• Return to learn/play recommendations, including gradual return to activity 5
• Consideration of potential long-term consequences, including recurrent concussions and prolonged recovery 5

Prognostic Metrics

Several prognostic metrics can be used to anticipate recovery time and symptom regression, including:

• The Severity Index (SI), which is a summation of the number of standard deviations from baseline at the 80% CI for each of the 5 composite scores reported by ImPACT 3
• The results of the ImPACT test, including the presence of symptoms in all 4 symptom clusters (Migraine, Cognition, Sleep, and Neuropsychiatric) 3