How to manage a suspected concussion?

From the Guidelines

A person with a suspected concussion should be immediately removed from activity and not allowed to return until evaluated by a healthcare professional.

Management of Suspected Concussion

• Remove from activity: A person with signs and symptoms of a concussion should be immediately removed from activity (play/sports) and not allowed to return to activity until evaluated by a healthcare professional 1.
• Assess for severe head injury: For a person with signs or symptoms of severe head injury (such as loss of consciousness, worsening headache, vomiting, altered mental status, seizures, visual changes, swelling, or deformities of the scalp), EMS should be activated 1.

Return to Activity

• Gradual return: Health care professionals should counsel patients to return to full activity when they return to premorbid performance if they have remained symptom-free at rest and with increasing levels of physical exertion 1.
• Symptom-based return: The return to activity should be based on the presence and severity of symptoms, with a gradual increase in physical exertion to avoid exacerbating symptoms 1.

Important Considerations

• Risk of reinjury: The postinjury period is a posited temporal window of vulnerability for reinjury because the reinjury threshold is lower during recovery and the symptom burden may be greater 1.
• Importance of healthcare evaluation: A broad consensus of health care organizations recommends removing the person with a concussion from sports and other activities posing a risk of reinjury until the injured person has fully recovered, as determined in consultation with a healthcare professional 1.

From the Research

Managing a Suspected Concussion

To manage a suspected concussion, the following steps can be taken:

• Remove the individual from risk if a concussion is suspected 2
• Provide education and reassurance once diagnosis is made 2
• Implement a graded return-to-play protocol with close supervision and observation for return of symptoms 2
• Tailor management to the individual, and if symptoms are prolonged, further diagnostic evaluation may be necessary 2

Assessment and Diagnosis

Assessment and diagnosis of concussion can be aided by:

• Standardized clinical tools 3
• A thorough history and physical examination 2
• Neurocognitive testing in the subacute period 2
• A multimodal, clinical profile-based approach to assessment and targeted treatment 4
• A physical examination toolbox that includes evaluation of cranial nerves, manual muscle testing, and deep tendon reflexes, among other elements 5

Rehabilitation and Recovery

Rehabilitation and recovery from concussion can involve:

• A brief period of rest, followed by a gradual reintroduction of activities 6
• A graduated return-to-sport protocol 6
• Exercise, vestibular, and cognitive rehabilitation programs for patients with prolonged recovery 6
• Targeted rehabilitation strategies focused on specific symptom clusters and deficits 4