Concussion Health Article

Diagnosis

It is very important for those attending a person with a concussion to pay close attention to the person's symptoms and progression immediately after the accident. The duration of unconsciousness and degree of confusion are very important indicators of the severity of the injury and help guide the diagnostic process and subsequent treatment decisions.

A trained health professional may make an immediate assessment based on the severity of the symptoms; a neurological exam of the pupils, coordination and sensation; and brief tests of orientation, memory, and concentration. Persons with very mild concussions may not need to be hospitalized or have expensive diagnostic tests. Questionable or more severe cases may require a computed tomography scan (CT) or magnetic resonance imaging (MRI) scan to look for brain injury.

Treatment

The symptoms of concussion usually clear quickly and without lasting effect, if no further injury is sustained during the healing process. Guidelines for returning to sports activities are based on the severity of a concussion.

A grade 1 concussion (no loss of consciousness, transient confusion, and other symptoms that resolve within 15 minutes) can usually be treated with rest and continued observation alone. The person may return to sports activities the same day, but only after examination by a trained professional, and after all symptoms have completely resolved. If the person sustains a second concussion of any severity that same day, contact sports should be discontinued and not resumed until there have been no symptoms, during both rest and activity, for one week.

A person with a grade 2 concussion (no loss of consciousness, transient confusion, and other symptoms that require more than 15 minutes to resolve) must discontinue sports activity for the day, should be evaluated by a trained professional, and should be observed closely throughout the day to make sure that all symptoms have completely cleared. Worsening of symptoms, or continuation of any symptoms beyond one week, indicates the need for a CT or MRI scan. Return to contact sports should only occur after one week with no symptoms, both at rest and during activity, and following examination by a physician. Following a second grade 2 concussion, the person should remain symptom-free for two weeks before resuming contact sports.

A person with a grade 3 concussion (involving any loss of consciousness, no matter how brief) should be examined by a medical professional either on the scene or in an emergency room. More severe symptoms may warrant a CT or MRI scan, along with a thorough neurological and physical exam. The person should be hospitalized if any abnormalities are found or if confusion persists. Prolonged unconsciousness and worsening symptoms require urgent neurosurgical evaluation or transfer to a trauma center. Following discharge from professional care, a person should be closely monitored for neurological symptoms that may arise or worsen. If headaches or other symptoms worsen or last longer than one week, a CT or MRI scan should be performed. Contact sports should be avoided for one week following unconsciousness of only seconds, and for two weeks following unconsciousness of a minute or more. A person receiving a second grade 3 concussion should avoid contact sports for at least a month after all symptoms have cleared, and then resume them only with the approval of a physician. If signs of brain swelling or bleeding are seen on a CT or MRI scan, an athlete should not return to the sport for the rest of the season at the earliest, if not indefinitely.

For someone who has sustained a concussion of any severity, it is critically important to avoid the possibility of another blow to the head until well after all symptoms have cleared to prevent second-impact syndrome. The guidelines above are designed to minimize the risk of this syndrome.

Prognosis

A concussion usually leaves no lasting neurological problems. Nonetheless, symptoms of post-concussion syndrome may last for weeks or even months.

Studies of concussion in contact sports have shown that the risk of sustaining a second concussion is even greater than for the first, if the person continues to engage in the sport.

Health care team roles

A doctor, nurse, athletic trainer, or emergency medical technician may provide an initial evaluation at the time of the concussion. These health care team members can usually evaluate a grade 1 or 2 concussion. A neurologist, neurosurgeon, or trauma specialist should evaluate a concussion in a hospital. A neurologist or neurosurgeon should provide follow-up for grade 3 concussions. A nurse may provide post-concussion supportive care. Radiologists may obtain and interpret CT or MRI scans.