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Concussion Care Pathway

Date of last update: May, 2024

Diagnosis

Clinical Cornerstone:

  • The majority of traumatic brain injuries are considered “mild”. Nearly one in two people will experience a mild traumatic brain injury in their lifetime. Concussion is considered a concussion.

  • Diagnosing a concussion requires a patient-centered approach that integrates physical and psychological aspects of the patient’s symptoms.

  • Diagnosis may be complicated by comorbid conditions that mimic concussion symptoms (e.g. anxiety, migraine, etc.). Clinical reasoning is needed to increase confidence in a diagnosis of concussion, and to decrease confidence that more serious conditions, more serious TBI, or conditions with similar symptoms are present. A comprehensive diagnostic strategy integrates clinical findings with patient narratives and risk factor evaluations for a fulsome understanding of the patient's condition.

Concussion

  • One or more conditions need to be met for the diagnosis of concussion once a plausible mechanism of injury has been established and suspicion for other causes of the patient’s symptoms has decreased

    • one or more clinical signs; altered mental status, loss of consciousness (<30 minutes), amnesia (<24 hours), neurological signs (seizure, coordination, etc.).

    • two or more new or worsened clinical symptoms; subjective alteration of mental status (feeling dazed or confused), physical symptoms (headache, nausea, dizzy or sensitive to light/sound), cognitive symptoms (feeling run down, fatigue or foggy/processing-speed), emotional symptoms (lability, impulsivity).

    • unambiguous imaging evidence of neurotrauma.

  • Other common symptoms include:

    • sleep disturbance

    • visual disturbance

    • hearing difficulties, tinnitus

    • difficulties with memory/retrograde amnesia/anterograde amnesia

    • difficulties with focus/concentration

    • difficulties with judgement/executive-function

    • depression or anxiety

    • loss or decreased levels of consciousness <30 minutes

Documentation: Record all findings in the patient record.

Conduct patient assessment

Red flags or Orange flags present

Red flags or Orange flags present

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Refer to appropriate emergency or healthcare provider

No

Yes

Acute mTBI

  • Structured patient education

  • Self Care

  • Return to work / school

  • Return to driving

  • Return to sport / activity

Persistent mTBI

  • Monitoring and Reassessment

  • Tailored clinical management of symptoms:

    • Headache
    • Neck Pain
    • Sleep Disturbance
    • Fatigue
    • Emotional / Behavioural
    • Cognitive Disorders
    • Vestibular Disorders

Differential Diagnosis

Diagnosis

 

Diagnosis

Follow-up

Follow-up

(Align with patient goals, Criteria for discharge)

Major symptom/sign change

Goals not achieved

Discharge

No

Yes

Re-evaluate

Adjust treatment and management plan or refer

References or links to primary sources

  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. CDC Heads Up [Internet]. CDC February 2022. Available from: https://www.cdc.gov/headsup/index.html.

  • David L. MacIntosh Sports Medicine Clinic, University of Toronto. Post-Concussion Return to Activity Guidelines. EMPWR Our Toolkit [Internet]. EMPWR Foundation 2019. Available from: https://empwr.ca/our-toolkit.

 

Contact information for further inquiries or feedback

carolina.cancelliere@ontariotechu.ca

Disclaimer:

These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.

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