- Definition: Trauma-induced alteration in mental status with or without loss of consciousness
- Concussions occur as a result of neurometabolic destruction at the cellular rather than structural level, which is why our current modalities of imaging are negative.
- Concussive symptoms are divided into 4 categories: Cognitive, physical, emotional, sleep-related
- Patients who are at increased risk of prolonged concussive symptoms include those with severe initial symptoms, teenagers, females, and those with previous concussions
- Beware secondary impact syndrome which occurs when a patient re-injures their brain before full recovery from previous injury
- As far as ED management, history is key along with a thorough physical exam including a neuro exam. Do not forget to check for gait instability, which is the most specific indicator of concussion
- From your neuro exam, use PECARN to determine if a CT scan is indicated to determine structural injury
- Discharge instructions are key. The Big 5 include:
- Cognitive rest first 24-48 hours after injury
- More benefit in uninterrupted sleep
- Graded return to sport protocol
- Symptom free without meds before full return to play
- Set Expectations