Neha Raukar, MD and Anand Swaminathan, MD
- Concussion is a complex pathophysiologic process induced by traumatic biomechanical forces caused either by a direct blow to the head, face, or neck with an impulsive force translated to the brain.
- This results in the rapid onset of short-lived neurologic impairment that spontaneously resolves and is due to functional disturbance rather than a structural injury.
- Only 10% of concussions involve a loss of consciousness.
- Immediate Symptoms
- Visual disturbances
- Balance disturbances
- Increased emotionality
- Increased or decreased sleep
- Concussion is a clinical diagnosis without a diagnostic test available at this time. It can be difficult to make a full assessment in the acute setting and we can’t always make the diagnosis immediately, as symptoms may only manifest later on with exertion or concentration.
- We cannot predict the duration or severity of concussion symptoms based on presentation.
- We should not “clear for return to activity” based on initial assessment.
- Risk factors for prolonged symptoms:
- Age (kids are at higher risk)
- History of prior concussions
- Sex (women tend to have longer recovery)
- Comorbidities (migraines, ADHD, sleep disorders, anxiety, or depression)
- Emergency Evaluation (at sporting event or in ED)
- Primary Question: Does the patient have an intracranial hemorrhage or cervical spine injury?
- Next, perform a concussion assessment:
- Sports Concussion Assessment Tool-5 (SCAT-5) is a validated tool:
- Assessment tools are comprehensive and may be better utilized in follow up.
- Imaging is used to rule in/rule out intracranial hemorrhage or cervical spine injury in cases where there is clinical concern.
- It has no utility in the diagnosis of concussion (ie, normal imaging does not rule out concussion).
- Protect the brain from future injury (ie, hold from sports activities).
- Provide an environment for the brain to heal.
- Stress will evoke and prolong symptoms.
- Activity should be guided/restricted by patient’s symptoms.
- Follow up
- Start with a primary care physician or pediatrician.
- Ideally, a neurologist or concussion specialist should be involved.
- Long-term sequelae are still unclear and a subject of ongoing research.
EM:RAP 2016 Special Report: Concussion
ROP 2019 October Abstract 6: Early Subthreshold Aerobic Exercise for Sport-Related Concussion
EM:RAP 2019 June Pediatric Pearls: Pediatric Mild Traumatic Brain Injury
CorePendium: Traumatic Brain Injury (major and minor)
tom f. - March 17, 2021 12:24 PM
super cool pod.