Concussion

Background

Concussion (mild TBI) is defined as GCS 14-15 with associated signs or symptoms after a blunt force or acceleration-deceleration head injury
Types
- Simple concussion
  - Gradual resolution of symptoms within 7-10d
- Complex concussion
  - Persisting symptoms or cognitive impairment
  - Symptoms with exertion

Any alteration in the mental state at the time of event or subsequent to the event
- Symptoms may be delayed by days-weeks
Most consistent abnormality is subtle impairments in cognitive function
- Attention, concentration, memory, processing speed, reaction time
Physical signs/symptoms
- Headache, dizziness, insomnia, fatigue, uneven gait, nausea/vomiting, blurred vision, seizure
Behavioral changes
- Irritability, depression, anxiety, sleep disturbances, problems related to school/work

Simple
- Limitations on playing and training while symptomatic
- Follow up with primary care provider
Complex
- Refer to sports medicine or concussion specialist

Upon discharge from the ER all patients with a diagnosis of concussion should receive educational materials on activities to avoid and symptoms to anticipate during recovery as those who received it have better long-term outcomesials^[1]
Recommend strict rest for 1-2 days with gradual introduction back to regular activity^[2]
Physical activity at any level (light aerobic, moderate, full) within first 7 days compared with no activity associated with lower rates of persistent symptoms at 28 days (29% vs. 40%)^[3]
- Multicohort study - 2400 children, aged 5-18, in the emergency department
- Still recommend strict rest for first 24-48 hours

↑ Ronsford J, et al. Impact of early intervention on outcome after mild traumatic head in adults. 2002
↑ Thomas DG, Apps JN, Hoffmann RG, et al. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015; 2(135):213-223.
↑ Grool AM et al. Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. JAMA. 2016;316(23):2504-2514.