What is the best approach to diagnose and manage a concussion in a General Practice (GP) setting?

From the Guidelines

The best quick concussion score for a GP setting is the Concussion Recognition Tool (CRT5) or the Sport Concussion Assessment Tool (SCAT5), as they are standardized tools that aid in diagnosis and management of concussions. When evaluating a patient with a suspected concussion, it is essential to conduct a thorough history and neurological examination, focusing on symptoms like headache, dizziness, confusion, memory problems, and balance issues 1. The use of standardized tools such as the SCAT5 or CRT5 can help guide the assessment and management of concussions in a GP setting.

Key Considerations

• Neuroimaging like CT or MRI is generally not necessary unless there are concerns about more serious brain injury, such as persistent symptoms, focal neurological deficits, or worsening clinical status 1.
• For management, prescribe physical and cognitive rest for 24-48 hours, followed by a gradual return to normal activities as tolerated.
• Advise patients to avoid activities with risk of head injury until symptoms resolve.
• Symptomatic treatment includes acetaminophen for headaches (500-1000mg every 6 hours as needed, not exceeding 4000mg daily), while NSAIDs should be avoided initially due to bleeding risk.
• Sleep hygiene measures and stress management techniques are beneficial.
• Patient education is crucial - explain that most concussions resolve within 7-10 days, though some may take longer.
• Provide clear return-to-work/school guidelines with gradual reintroduction of cognitive demands.
• Follow-up within 1-2 weeks is recommended, with referral to specialists if symptoms persist beyond 2-4 weeks.

Return to Play Protocol

The return to play protocol after a concussion follows a stepwise process, which includes:

• No activity, complete rest
• Light aerobic exercise
• Sport-specific training
• Non-contact training drills
• Full contact training after medical clearance
• Game play 1.

This approach balances prompt assessment with appropriate management while avoiding unnecessary investigations or medications. The use of standardized tools such as the SCAT5 or CRT5, in conjunction with a thorough history and neurological examination, is the best approach to diagnose and manage a concussion in a GP setting.

From the Research

Quick Concussion Score for GP Setting

• The best approach to diagnose and manage a concussion in a General Practice (GP) setting is to use a combination of clinical tools and guidelines, such as the Concussion Recognition Tool 5th Edition (CRT5) 2 and the Sports Concussion Assessment Tool (SCAT-3) 3.
• The CRT5 is designed to assist non-medically trained individuals to recognize the signs and symptoms of possible sport-related concussion and provides guidance for removing an athlete from play/sport and to seek medical attention 2.
• The SCAT-3 is a standardized clinical tool that has been developed and validated for assessment of acute concussion across injury settings, including civilian, sport, and military settings 4.
• The use of over-the-counter (OTC) analgesics, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), has been shown to be associated with improved concussion symptoms and recovery, and earlier use of these medications has been associated with quicker recovery times 3.

Clinical Tools and Guidelines

• The Concussion Recognition Tool 5th Edition (CRT5) is a useful tool for recognizing the signs and symptoms of possible sport-related concussion 2.
• The Sports Concussion Assessment Tool (SCAT-3) is a standardized clinical tool that can be used to assess acute concussion across injury settings 4.
• The Abbreviated Westmead Post-traumatic Amnesia Scale (A-WPTAS) and the Pocket Concussion Recognition Tool (Pocket CRT) are also useful tools for evaluating concussion in amateur sports players 5.

Management of Concussion

• The management of concussion should include a combination of rest, rehabilitation, and education, as outlined in the guidelines for the evaluation and management of concussion 6.
• The use of OTC analgesics, such as acetaminophen and NSAIDs, can be beneficial in reducing symptoms and improving recovery, but should be used under the guidance of a healthcare professional 3.