Sideline evaluation of concussion
- Josh Bloom, MD, MPH
Josh Bloom, MD, MPH
- Clinical Instructor, Department of Family Medicine
- University of North Carolina at Chapel Hill
- Jim G Blount, MD, CAQSM
Jim G Blount, MD, CAQSM
- Adjunct Clinical Professor, Departments of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
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 the care of 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".)
A concussion is a complex, trauma-induced pathophysiological process affecting the brain. The biomechanical forces involved in the trauma (eg, acceleration, deceleration, rotation) can injure the brain via a direct blow to the head, face, or neck, or via 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 [1,2]. No gross structural abnormalities are seen with conventional neuroimaging.
It is important to note that while a concussion typically manifests with rapid onset of short-lived neurologic dysfunction, in some cases, development of signs and symptoms of concussion can be delayed minutes to hours . Detailed discussions of the definitions, pathophysiology, and epidemiology of concussion are provided separately. (See "Concussion and mild traumatic brain injury", section on 'Pathophysiology'.)
ACUTE CONCUSSION EVALUATION
Evaluation and diagnosis of concussion remains a clinical exercise. At this point, there is no compelling evidence supporting one specific test, tool, biomarker, imaging study, or protocol to definitively diagnose or exclude a concussion. In the absence of such evidence, use of a consensus-derived, multimodal concussion assessment tool, such as the Sport Concussion Assessment Tool 5th Edition (SCAT5), is recommended as the framework for a sideline concussion evaluation .
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- ACUTE CONCUSSION EVALUATION
- RISK FACTORS
- CLINICAL PRESENTATION
- Mechanism of injury
- - Location and magnitude of impact
- - High risk mechanisms
- Immediate clinical response after trauma
- Symptoms of concussion
- PERFORMANCE OF THE PHYSICAL EXAMINATION
- INDICATIONS FOR EMERGENCY DEPARTMENT EVALUATION
- DIFFERENTIAL DIAGNOSIS: CONCUSSION MIMICS
- Initial patient evaluation
- Concussion assessment
- Assessment instruments
- Additional tools for assessment
- Initial treatment
- - Remove from play; no return to play
- - Relative rest
- - Management of somatic symptoms
- - Observation after injury and during sleep
- SUMMARY AND RECOMMENDATIONS