What is the immediate management for a patient with a concussion?

From the Guidelines

The immediate management for a patient with a concussion involves removal from activity and evaluation by a healthcare professional, with a focus on physical and cognitive rest for 24-48 hours, followed by a gradual return to normal activities as symptoms allow. This approach is supported by the most recent guidelines, including the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The patient should be monitored for worsening symptoms such as severe headache, repeated vomiting, seizures, increasing confusion, or unusual behavior, which would necessitate emergency medical attention.

Key considerations in the management of concussion include:

• Removal from activity: A person with signs and symptoms of a concussion should be immediately removed from activity and not allowed to return until evaluated by a healthcare professional 1.
• Physical and cognitive rest: This involves avoiding activities that exacerbate symptoms, including physical exertion and cognitive tasks like schoolwork or reading 1.
• Gradual return to activity: After the initial rest period, patients should gradually resume normal activities while staying below the threshold that worsens symptoms, following a stepwise protocol for return to sports 1.
• Medication use: Acetaminophen can be used for headache pain, but NSAIDs like ibuprofen should be avoided in the acute phase due to bleeding risk, and medication use should be considered on a case-by-case basis, with the goal of stopping medication before return to play 1.
• Education on post-concussive symptoms: Patients should be educated on symptoms to watch for and when to seek further medical attention, with a focus on identifying symptoms that may indicate a need for specialist referral 1.

Overall, the goal of concussion management is to prioritize the patient's safety and promote recovery, while minimizing the risk of further injury or complications.

From the Research

Immediate Management for Concussion

The immediate management for a patient with a concussion involves several key components:

• Immediate removal from activity to prevent further injury and allow the brain to rest 2
• Cognitive and physical rest immediately after injury, as delayed rest may prolong recovery time 3
• A gradual increase in activity may aid in returning to normal daily activity sooner than those who avoid both physical and cognitive activity during the acute stage of a traumatic brain injury 4

Rest and Recovery

Research suggests that:

• Complete rest exceeding 3 days is probably not helpful, and gradual resumption of preinjury activities should begin as soon as tolerated 5
• Supervised exercise may benefit patients with persistent symptoms 5
• Immediate cognitive and physical rest is almost universally recommended in the concussion literature, and patients who start rest immediately after injury are more likely to recover within 30 days 3

Symptom Management

For acute postconcussive headaches:

• Routine analgesia administration, such as ibuprofen and acetaminophen, may be effective in reducing headache days, episodes, and intensity 6
• Patients on ibuprofen and acetaminophen were more likely to return to school 1 week postinjury compared to the standard care group 6