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concussion management

Recovery from concussion. The ideal amount or duration of rest is supported only by limited data, but most guidelines suggest at least 24 to 48 hours.2,5,6,12,27,28 Extended cognitive and physical rest were once the cornerstone of initial management; however, this approach is impractical and may lead to prolonged symptoms and feelings of anxiety and isolation.5,12 A recent study demonstrated that five days of strict rest provided no benefit over 24 to 48 hours of rest and was associated with an increase in reported symptoms.29, No pharmacologic therapies are specifically available for concussion; therefore, medications for symptom management should be used as in patients without concussion.6,7,10,12,13 Nonsteroidal anti-inflammatory drugs are commonly avoided in the first 72 hours after a concussion because of a theoretical risk of bleeding7; however, this concern has not been substantiated. Signs of more severe injury include loss of consciousness for more than 30 minutes, posttraumatic amnesia for more than 24 hours, and positive neuroimaging findings (Table 37). Apps JN, Council on Sports Medicine and Fitness. 30. Wait times are an estimate that reflect the average time from arrival to being seen by a provider. et al. While manipulation of the neck still remains safer than taking an Advil or Tylenol we understand some individuals don’t like this form of treatment for a variety of reasons. Computed tomography scans are not necessary in the evaluation of minor head injuries. Centers for Disease Control and Prevention. Most people usually recover fully after a concussion. Meehan WP. 2005;294(12):1511–1518. Taylor CA, Updated February 16, 2015. https://www.cdc.gov/headsup/providers/index.html. "�*�b Policy, Cleveland Clinic is a non-profit academic medical center. Sports-related concussion is a traumatic brain injury induced by biomechanical forces. *—Maddocks questions include: (1) What venue are we at today? Concussion is treatable: Statements of agreement from the targeted evaluation and active management (TEAM) approaches to treating concussion meeting held in Pittsburgh, October 15-16, 2015. et al. Read more about how to prevent head injuries. 29. Contraindications to clearing the cervical spine include altered level of consciousness, intoxication, distracting injuries, midline tenderness, and focal neurologic deficits. Imaging is not indicated for the evaluation of uncomplicated concussion.2,4–7,10,12,13 Imaging is important in excluding moderate or severe traumatic brain injuries, skull fractures, and spinal injuries but contributes little to the management of concussion because it is a functional rather than structural injury.6,10 Computed tomography (CT) is the modality of choice.2,10 Although magnetic resonance imaging (MRI) may acutely identify cerebral contusions, MRI is more appropriate for evaluation of prolonged deficits.2 Plain radiography of the head has no role in the evaluation.7,10,14, The most commonly used imaging guidelines for patients 16 years and older with mild head injury include the Canadian CT Head Rule16 and the New Orleans Criteria.17 Both guidelines are sensitive, but the Canadian CT Head Rule has higher specificity.18–21 The Pediatric Emergency Care Applied Research Network (PECARN) pediatric head injury/trauma algorithm is validated for use in all children and adolescents through 18 years of age.5,14,22,23  The Canadian CT Head Rule and PECARN algorithm are provided in eTable B. 2013; doi: 10.1212/WNL.0b013e31828d57dd. 8. 2017;51(11):838–847. State law criteria for removing a player from activity. Updated February 16, 2015. Your brain has the consistency of gelatin. Sport-specific questions may be substituted. Adapted with permission from Scorza KA, Raleigh MF, O'Connor FG. Current concepts in concussion: evaluation and management. An ImPACT baseline test doesn’t reduce the chances of getting a concussion, but it can help assess injury in the event of a future concussion. It's important for athletes never to return to sports while they're still experiencing signs and symptoms of concussion. Note: See eTable A for a list of assessment tools used in the evaluation of suspected concussion. Get Permissions, Access the latest issue of American Family Physician. Limit any activities that worsen your symptoms. Most concussion research applies to those 13 years and older; few assessment tools have been validated in children younger than 13 years.5,6 Data suggest that teenagers are at greater risk of prolonged recovery.5,6,14 Other risk factors for persistent symptoms include prior concussion, premorbid concussion-like symptoms, psychological or neurologic disorders, learning disabilities, Hispanic ethnicity, and lower socioeconomic status.14 Those presenting with severe or numerous symptoms after concussion may also experience persistent symptoms.6,14 Children and adolescents with these risk factors should be monitored closely 14; however, given concern for potential consequences of injury to the developing brain, conservative management is recommended in all children and adolescents.4,5,7,13,28 Recommendations for return to activity or return to play are similar to those for adults; however, guidelines recommend waiting until the child or adolescent has successfully tolerated returning to school before resuming full activity or play.5,6, There is conflicting evidence regarding the long-term effects of multiple or repetitive concussions.6 It is established that those with previous concussions have increased vulnerability to recurrent injury and typically experience longer recovery periods.4–6,13 No specific guidelines exist regarding athletic disqualification or retirement because of recurrent concussions; however, more conservative management is recommended for those with recurrent concussions or increased sensitivity to impact.7, The use of protective gear for preventing concussions is supported by limited evidence. Dvořák J, Management of Concussion . (3) Who scored last this match? Stiell IG, 6. The Balance Error Scoring System is inexpensive, portable (requiring only a foam block), and easy to administer on the sideline of a sporting event. Cureus. Should the student's symptoms result in them spending more time in the space designated for rest and recovery than in class, the student should consider going home. Instead of stopping activities entirely, learn to recognize the triggers that bring on concussion symptoms. Taylor CA, Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS), such as naproxen (Aleve®) and ibuprofen (Advil®, Motrin®) should not be taken soon after a suspected concussion has occurred. PECARN pediatric head injury/trauma algorithm (online calculator: Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS. et al. Kuppermann N, Vasterling JJ, §—Considerations include physician experience, multiple symptoms rather than isolated findings, worsening symptoms or signs after observation, parental preference. Assessed June 20, 2018. Assessed June 20, 2018. Symptoms of traumatic brain injury (TBI). Consensus statement on concussion in sport—the 5th International Conference on Concussion in Sport held in Berlin, October 2016.

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