From the Guidelines
Concussions require immediate removal from activity and evaluation by a healthcare professional, with red flags including loss of consciousness, severe or worsening headache, repeated vomiting, seizures, and worsening symptoms, as emphasized by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The management of a suspected concussion involves several key strategies to ensure the individual's safety and promote recovery. Red flags that warrant immediate medical attention include:
- Loss of consciousness
- Severe or worsening headache
- Repeated vomiting
- Seizures
- Increasing confusion
- Slurred speech
- Weakness or numbness in limbs
- Unusual behavior changes
- Worsening symptoms For management, the individual should be removed from activity immediately and evaluated by a healthcare professional, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Initial treatment involves physical and cognitive rest for 24-48 hours, followed by a gradual return to normal activities as symptoms improve. Some key considerations for management include:
- Acetaminophen (Tylenol) may be used for headache pain, but NSAIDs like ibuprofen should be avoided initially due to bleeding risk, as noted in the American Academy of Pediatrics clinical report 1.
- Sleep should be monitored but not disrupted with hourly wake-ups.
- Recovery typically requires avoiding screens, bright lights, loud noises, and mental exertion initially.
- Return to sports or physical activities should follow a stepwise protocol, beginning with light aerobic exercise and progressing only when symptoms don't worsen, as outlined in the summary and agreement statement of the first international conference on concussion in sport 1. These measures are important because a concussion involves a temporary disruption of brain function, and proper management helps prevent complications and secondary injury during the vulnerable recovery period, as highlighted by the 2024 American Heart Association and American Red Cross guidelines for first aid 1.
From the Research
Concussion Red Flags
The following are red flags for a suspected concussion:
- Loss of consciousness or frank neurological signs 2
- Mental confusion, memory and balance disturbance 2
- Headache, nausea, dizziness and balance problems, blurred vision or other visual disturbance, confusion, memory loss and 'fatigue' 2
- Symptoms such as tiredness, irritability, nervousness or anxiety, sleep disturbance and sensitivity to light or noise 2
- A history of concussion is associated with a higher risk of sustaining another concussion 3
- A greater number, severity and duration of symptoms after a concussion are predictors of a prolonged recovery 3
Management Strategies
Management strategies for a suspected concussion include:
- Removing the athlete from play and evaluating them thoroughly 3, 2
- Gradual return to learn and play 4
- Relative rest for the first 24-48 hours following acute concussion, but prolonged cognitive and physical rest can be detrimental 4
- Return to sport should only occur once the patient is symptom-free 3, 4
- Treatment options may include sub-symptom threshold aerobic exercise, cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, cognitive behavioral therapy, pharmacological management, or a combination of treatments 5
- Neuropsychological (NP) tests may be used as part of a comprehensive concussion management strategy, but should not be used in isolation 3