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Concussion Care Pathway

Date of last update: September, 2024

3. Health History

 

Taking a patient's history is about forging a therapeutic relationship. Actively and empathetically listening to the patient's story offers insights into their condition and its optimal approach to management.

 

Clinicians should exercise judgment during history-taking. Adopting cultural awareness and principles of trauma-informed care could help minimize potential barriers. This might involve reframing questions from "what's wrong with you" to "what happened". This might also involve explaining the rationale behind sensitive questions or tests.

 

While history-taking needs to be thorough, it does not need to be linear. Certain topics like prior episodes of headache or neck pain, past care experiences, and recovery expectations are crucial but can be addressed at different times during the patient encounter.

 

When re-evaluating existing patients, especially those with new complaints, a thorough clinical examination is as imperative as with new patients. Explore the new issue's onset, duration, and associated factors, and gauge its impact on pre-existing conditions and treatments.

Plausible Mechanism of Injury:

  • Clinicians should identify a plausible mechanism of injury resulting from an external force. The force could come from a direct blow to the head (either the head impacting an object or an object impacting the head), an indirect blow to the body transmitting force to the brain, or an acceleration/deceleration mechanism.

  • Common causes include slips or falls when walking, participation in sports, household chores/physical activity, work-related incidents, motor vehicle collisions, or forces generated from a blast.

  • Not all head trauma results in concussion. Diagnosis requires both a plausible mechanism of injury and the presence of specific signs or symptoms.

Meaningful Outcomes:

  • Regularly incorporating outcome measures before treatment and regularly throughout the management process ensures that care remains patient-centered and evidence-driven. This allows for adapting the management plan to achieve the best possible results. Selected outcome measures should align with the patient’s goals and expectations.

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