From WikEM
Jump to: navigation, search


  • 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
  • Behavioral changes
    • Irritability, depression, anxiety, sleep disturbances, problems related to school/work

Differential Diagnosis

Intracranial Hemorrhage


  • Based on history and clinical evaluation


  • 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


  • At 3 mo after injury <30% are symptomatic
  • At 1 yr after injury 15% are symptomatic

See Also


  1. Ronsford J, et al. Impact of early intervention on outcome after mild traumatic head in adults. 2002
  2. 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.
  3. 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.