Concussions

A concussion is a traumatic brain injury induced by biomechanical forces. It is caused either by a direct blow to the head, face, neck, or elsewhere in the body with an impulsive force transmitted to the head. Concussions typically result in the rapid onset of transient impairment of neurological function that resolves spontaneously. In some cases, signs and symptoms of a concussion evolve over a number of minutes to hours. The acute signs and symptoms largely reflect a functional disturbance, rather than a structural injury. Often, there is no loss of consciousness.

Concussion should be suspected in the presence of any one or more of the following:

Physical Symptoms
  • Headache
  • Nausea
  • vomiting
  • confusion
  • dizziness
  • balance problems
  • visual problems
  • fatigue
  • light sensitivity
  • noise sensitivity
Cognitive Changes
  • Fogginess of thought
  • difficulty with concentration
  • difficulty with memory
  • forgetfulness
  • repeating questions
  • answering questions slowly
Emotional Changes
  • Irritability
  • sadness
  • anxiety
  • emotional lability
Sleep Changes
  • Drowsiness
  • sleeping more than usual
  • sleeping less than usual
  • trouble falling asleep
  • trouble staying asleep

Learn more about how to assess a potential concussion here.

Indications for Emergency Management

A hit to the head can sometimes be associated with a more serious brain injury. Any of the following warrants consideration of activating emergency procedures and urgent transportation to the nearest hospital:

  • Glasgow Coma score less than 15
  • Deteriorating mental status
  • Potential spinal injury
  • Progressive, worsening symptoms, or new neurologic signs
  • Persistent vomiting
  • Evidence of skull fracture
  • Post traumatic seizures
  • Coagulopathy
  • History of neurosurgery (eg. Shunt)
  • Multiple injuries

CATT for Medical Professionals

This online educational module will provide you with the up-to-date information to help you manage your patients who have sustained or are at risk for sustaining another concussion.

The course is divided into five topic areas:

  • Background
  • Etiology
  • Signs and symptoms
  • Assessment
  • Treatment and follow-up

You can either work your way through the course in the order provided (40-45 minutes), or you can jump to the sections that are of interest to you by going to the menu tab on the top of each slide. Please remember that you can claim CME Mainpro-M2 credits.

Take the Medical Professional Course here.

Cranial Evaluation

We have some instructional videos on how to perform a cranial nerve evaluation on our Resources page.

SCAT5

The SCAT5 is a standardized tool for evaluating for a suspected concussion and can be used on individuals aged 13 years and older. It supersedes the original SCAT (2005), the SCAT2 (2009), and the SCAT3 (2013). For children aged 12 and under, please use the Child SCAT5.

The Adult SCAT5 is designed for use by medical professionals. If you are not a licensed medical professional, please use the Concussion Recognition Tool (CRT5). If a concussion is suspected, adults should undergo medical assessment by a medical doctor or nurse practitioner.

The SCAT5 scoring summary includes the following sections:

  • Red flags
  • Memory assessment – Maddocks Questions
  • Glasgow Coma Scale (GCS) examination
  • Cervical spine assessment
  • Symptom evaluation
  • Cognitive screening
  • Neurological screening
  • Balance examination
  • Delayed recall

Please fill in all of the sections in order for the scoring summary to be complete.

Child SCAT5

The Child SCAT5 is a standardized tool for evaluating injured children for concussion and can be used in children aged from 5 to 12 years. For older persons aged 13 years and over, please use the SCAT5.

The Child SCAT5 is designed for use by medical professionals. If you are not a licensed medical professional, please use the Concussion Recognition Tool (CRT5). If a concussion is suspected, youth should undergo medical assessment by a medical doctor or nurse practitioner.

Note: The diagnosis of a concussion is a clinical judgment, ideally made by a physician or other licensed medical professional. The SCAT5 and Child SCAT5 should not be used solely to make, or exclude, the diagnosis of concussion in the absence of clinical judgement. A person may have a concussion even if their SCAT5 or Child SCAT5 is “normal.”

Red Flag Symptoms

If someone shows any of the following Red Flag Symptoms, call 911 immediately.

  • Neck pain or Tenderness
  • Double vision
  • Weakness or tingling/burning in arms/legs
  • Severe or increasing headache
  • Seizure or convulsion
  • Loss of consciousness
  • Deteriorating conscious state
  • Vomiting
  • Increasingly restless, agitated, or combative