From the Guidelines
There is no clear evidence to support the existence of a 2nd degree concussion as a distinct medical diagnosis, as modern concussion management focuses on individual symptom assessment and personalized recovery plans rather than rigid classification. The concept of grading concussions, including a 2nd degree concussion, is somewhat outdated, as it does not account for the unique characteristics and symptoms of each individual's concussion 1. According to the most recent study, the focus has shifted towards identifying biomarkers for mild traumatic brain injury (mTBI) to aid in diagnosis and inform treatment guidelines 1.
Key Points to Consider
- Concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces, and may result in a graded set of clinical syndromes that may or may not involve loss of consciousness 1.
- The clinical symptoms of concussion largely reflect a functional disturbance rather than structural injury, and resolution of the clinical and cognitive symptoms typically follows a sequential course 1.
- Modern concussion management emphasizes individual symptom assessment and personalized recovery plans, rather than relying on a rigid classification system 1.
- The use of clinical decision tools and factors can help identify patients requiring follow-up care for postconcussive syndrome or delayed sequelae after ED discharge 1.
Treatment and Management
Treatment for concussion typically involves physical and cognitive rest for 24-48 hours, followed by a gradual return to normal activities as symptoms improve. Acetaminophen may be used for headache pain, but NSAIDs like ibuprofen should be avoided initially due to bleeding risk. Medical attention is necessary for proper diagnosis and management, especially if symptoms worsen or persist beyond 1-2 weeks. It is essential to prioritize individualized care and monitoring, rather than relying on a specific grading system, to ensure the best possible outcomes for patients with concussion.
From the Research
Definition and Classification of Concussions
- Concussions are defined as a traumatically induced transient disturbance of brain function, involving a complex pathophysiological process 2.
- Concussions are a subset of mild traumatic brain injury (MTBI), which is generally self-limited and at the less-severe end of the brain injury spectrum 2.
Degrees of Concussions
- The provided studies do not explicitly mention a "2nd degree concussion" 2, 3, 4, 5, 6.
- However, concussions can be classified based on their severity, with most being considered mild 2.
Management and Treatment of Concussions
- Concussion management should be individualized, based on predominant signs and symptoms, and can include subsymptom threshold aerobic exercise, cervical physical therapy, vestibulo-ocular rehabilitation, behavioral and cognitive psychotherapy, and some symptom-specific pharmacological therapies 3.
- Treatment for concussion and persistent postconcussive symptoms (PPCS) should be based on a comprehensive evaluation, including a history, physical examination, and additional tests as clinically indicated 3.
Return to Play (RTP) Protocols
- RTP after concussion should occur only with medical clearance from a licensed healthcare provider trained in the evaluation and management of concussions 2.
- A RTP progression involves a gradual, step-wise increase in physical demands, sports-specific activities, and the risk for contact, with symptoms being resolved before returning to exercise 2.