What are the guidelines for managing a concussion (mild traumatic brain injury)?

From the Guidelines

Concussion management requires immediate removal from activity and medical evaluation, as stated in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When managing a concussion, it is essential to prioritize the patient's safety and well-being. The first step is to remove the person from play or activity immediately and seek medical evaluation.

Key Recommendations

• Remove the person from activity immediately if suspected concussion
• Seek medical evaluation before returning to activity
• Activate EMS if severe head injury symptoms are present, such as loss of consciousness, worsening headache, vomiting, altered mental status, seizures, visual changes, swelling, or deformities of the scalp 1
• Provide physical and cognitive rest for the first 24-48 hours
• Use acetaminophen (Tylenol) for headache pain, if necessary, at 325-650mg every 4-6 hours, not exceeding 3000mg daily
• Avoid NSAIDs like ibuprofen initially due to bleeding risk
• Gradually return to normal activities, progressing through stages only when symptoms don't worsen
• Monitor for red flags requiring immediate medical attention, including worsening headache, repeated vomiting, seizures, increasing confusion, or one pupil larger than the other The recovery process typically takes 7-10 days for adults and longer for children and adolescents 1.

Nonpharmacological Treatment

Nonpharmacological treatments, such as active management and interdisciplinary rehabilitation, may be beneficial for persistent postconcussion symptoms 1. It is crucial to prioritize the patient's quality of life and minimize the risk of prolonged symptoms or second impact syndrome. By following these guidelines and recommendations, healthcare professionals can provide optimal care for patients with concussions.

From the Research

Concussion Guidelines

• Concussion is a disturbance in brain function caused by direct or indirect force to the head, resulting from shear stress to brain tissue caused by rotational or angular forces 2
• Initial evaluation involves eliminating cervical spine injury and serious traumatic brain injury, with headache being the most common symptom of concussion 2
• Assessment tools, such as symptom checklists, neuropsychological tests, postural stability tests, and sideline assessment tools, aid in diagnosis and monitoring recovery 2, 3

Management of Concussion

• Cognitive and physical rest are the cornerstones of initial management, with a focus on managing symptoms and return to play 2
• There are no specific treatments for concussion, and rigid classification systems have been abandoned in favor of an individualized approach 2
• A graded return-to-play protocol can be implemented once a patient has recovered in all affected domains, with children, adolescents, and those with a history of concussions potentially requiring a longer recovery period 2, 4

Treatment of Symptoms

• Routine analgesia administration, such as ibuprofen and acetaminophen, may be effective for managing postconcussive headaches in youth 5
• Symptomatic treatment, including management of headaches, dizziness, sleep disturbance, psychiatric symptoms, and cognitive issues, is an important aspect of concussion management 6

Return to Play and Learn

• Return to learn/play recommendations are essential for primary care providers, with a focus on ensuring safe return to activity after acute concussion 3, 4
• Patients with concussion should be removed from play, provided with symptomatic treatment, and given return to learn/play recommendations to prevent recurrent concussions and prolonged recovery 4