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Sideline evaluation of concussion

Authors
Josh Bloom, MD, MPH
Jim G Blount, MD, CAQSM
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

Concussions are common, but complex traumatic brain injuries seen in athletes of all ages and skill levels in a wide variety of athletic settings. Given the variability of the clinical presentation associated with concussion, it is important that team physicians and other clinicians responsible for athletes perform a systematic and comprehensive sideline evaluation of each athlete with a suspected concussion.

This topic reviews the risk factors, clinical presentation, sideline evaluation, and initial management of adolescent and adult athletes with a concussion. More detailed discussions of mild traumatic brain injury and trauma assessment are provided separately. (See "Concussion and mild traumatic brain injury" and "Minor head trauma in infants and children: Evaluation" and "Postconcussion syndrome" and "Initial management of trauma in adults".)

DEFINITION

A concussion is a complex pathophysiological process affecting the brain that is caused by trauma. The biomechanical forces involved in the trauma (eg, acceleration, deceleration, shearing, rotation) can injure the brain via a direct blow to the head or a blow to the body that transmits force to the head (eg, whiplash). The ensuing brain disturbance is due to neurometabolic dysfunction, which manifests in a wide variety of symptoms and signs that may or may not include loss of consciousness [1]. No gross structural abnormalities are seen with neuroimaging. More detailed discussions of the definitions, pathophysiology, and epidemiology of concussion are provided separately. (See "Concussion and mild traumatic brain injury", section on 'Pathophysiology'.)

RISK FACTORS

Potential risk factors for increased susceptibility to concussion or prolonged recovery from concussion include the following:

Previous concussion – According to prospective studies involving thousands of athletes, a history of concussion substantially increases the risk of recurrence and prolonged recovery from subsequent injury [2-5]. Patients with unresolved symptoms from a prior injury appear to be at greatest risk; recurrent injury is most likely to occur within the first 10 days after the initial injury [2,6-12].

                     

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Literature review current through: Nov 2016. | This topic last updated: Tue May 05 00:00:00 GMT+00:00 2015.
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