Tool 1.3: Manage Acute and Prolonged Concussion Symptoms Algorithm

pediatric concussion care icon

TOOL 1.3: Manage Acute and Prolonged Concussion Symptoms Algorithm

Download Here

No diagnosed concussion 

 

 

 

 

 

 

 

Clinically recovered

 

 

 

 

 

 

 

 

 

 

 

 

 

Medical clearance to return to  full-contact sport and high risk activities

Initial medical assessment
(Physician or Nurse Practitioner)

  • Clinical history, physical examination, determine need for imaging 
  • Rule out more severe traumatic brain injury (TBI), structural spine injury, neurological/medical causes of concussion-like symptoms (Sidebar 1: Symptom attributes) 
  • Post-injury education and guidance 
  • Assess any modifiers that may delay recovery and consider early referral to interdisciplinary team 
  • Arrange follow-up in 1-2 weeks to re-assess clinical status

Diagnosed concussion 

 

Medical follow-up and referral to healthcare professionals/interdisciplinary concussion team

(1-4 weeks following acute injury)
  • Re-assess post-concussion symptom severity, functional status, worsening or new symptoms, return to school/activity/sport status 
  • Focused history, physical examination, determine need for imaging (depending on nature of prolonged symptoms) 
  • Complete a psychological assessment (Sidebar 2) 
  • Post-injury education and guidance, recommend additional assessments or accommodations if symptoms worsen or fail to improve 
  • Assess any modifiers that may delay recovery and consider early referral <4 weeks post acute injury 
  • Refer to interdisciplinary concussion team or appropriate sub-specialist if symptoms last longer than 4 weeks (or sooner as needed/using clinical judgment) 
  • Arrange frequent clinical follow-up while awaiting for consultation •See guideline sections for specific post-concussion symptoms

Not yet recovered > 4 weeks prolonged symptoms

 

Specialized therapy/ interdisciplinary concussion team

(1-4 weeks following acute injury)
  • Medical assessment by physician with expertise in concussion 
  • Adjunctive testing •Interdisciplinary management 
  • Targeting/symptom specific care

Suspected structural brain or spine injury
Immediate referral

arrow post concussion vision page

Neurosurgery or emergency department

Modifiers that may delay recovery (Sidebar 3) – high risk of prolonged postconcussion symptoms

Links to Recommendations:

  1. Recognition and Directing to Care
  2. Initial Medical Assessment and Management
  3. Medical Follow-up
  4. Medical Clearance: Full-contact sport or high-risk activity
  5. Sport Concussion Considerations
  6. Headache
  7. Sleep
  8. Mental Health
  9. Cognition
  10. Vision/vestibular/oculomotor
  11. Fatigue
  12. Return-to-School and Work

SIDEBAR 1
Symptom Attributes

  • Duration, onset, triggers, location
  • Intensity and impact
  • Perception of symptoms
  • Impact on functioning
  • Previous episodes • Previous treatment and response

SIDEBAR 2
Psychosocial Evaluation

  • Support system
  • Mental health history
  • Comorbid conditions (chronic pain, mood/stress/personality disorder)
  • Substance use disorder
  • Absence from school or academic difficulties

SIDEBAR 3
Modifiers That May Delay Recovery

  • Age (increases with age) 
  • Sex (female) 
  •  Personal and family history of migraines 
  • History of learning or behavioural difficulties 
  • Personal and family history of mental health  
  • Family socioeconomic status/ education 
  • High pre-injury symptom presentation

Resources

Adapted with permission from the Ontario Neurotrauma Foundation Standards for Post-Concussion Care – Post Concussion Care Pathway