Concussion (Uncomplicated)

Patient with h/o concussion presents s/p direct head injury. Reports headache, nausea, dizziness/balance disturbances, sleep disturbances, disorientation, difficulty concentrating, anxiety/irritability following injury and during past 72 hours. No LOC, amnesia, vomiting, convulsions. Oriented to date/time. No c-spine tenderness. Balance deficits noted; neurologic exam otherwise intact. Immediate word memory for 5 words over three trials. Able to recite numbers and months in reverse.

• Perform MRI if symptoms continue for > 10 days or any of the following develop:

  • LOC/decreased responsiveness

  • Vomiting

  • Seizure

  • Focal neurologic deficit

  • Decline in current condition

• Remove from play with 6-day graded return pending resolution of symptoms

• Pt counseled about risk of chronic traumatic encephalopathy with repeat concussions

Notes

• Pediatric Emergency Care Applied Research Network (PECARN) Rules

  • Rule out clinically important traumatic brain injuries (100% sensitive)

  • Pending risk factors, may allow clinician to forgo CT (see calculator)

  • Outperform CHALICE and CATCH decision aids