Concussion Recovery Pattern and Pathway

Concussion Recovery Pattern

Follow-up with primary care provider – majority will recover over a few days to weeks, with education about symptom management.

Follow-up required, further assessment may be required if symptoms are not resolving fully or considered as higher risk for a prolonged recovery.

Persistent symptoms, interdisciplinary care required.

Post-Concussion Care Pathway

† A patient can enter this pathway immediately, shortly following injury, or after a period of time when it is recognized that concussion-like symptoms are not resolving. It is necessary that all patients be properly assessed and diagnosed. Patients suspected of having had an earlier concussion should enter the pathway from the beginning so that they can be assessed and diagnosed by the appropriate professional.

* Warning Signs (risk factors) for poor prognosis

  • High score on the Post-Concussion Symptom Scale (PCSS) >404,25, OR on the Rivermead Post-Concussion Questionnaire15
  • Previous Concussion History5,12,19,27
  • Persistent post –traumatic headache and migraine19,32
  • Depression/Anxiety2,16,19,21,24,26,27
  • Symptoms/signs of vestibulo-ocular abnormalities (problems maintaining visual stability during head movements)7,9,12
  • Signs/symptoms of cognitive difficulties (problems with perception, memory, judgment, and reasoning) 5,12,18,26
  • Pre-injury history of sleep disturbance and/or post-injury changes in sleep patterns, difficulty sleeping2,29,31
  • Increased symptoms with return to school, work, or exercise9
  • Returning to a contact/risk of contact sport activity8,21

Note:

  1. Research has found that being female seems to be a risk factor for prolonged recovery and this should be considered along with the other risk factors when determining if multidisciplinary care is required3,4,6,14,26,32
  2. The impact that any single risk factor or combination of risk factors will have on a person’s care must be assessed on an individual basis. Presence of one or more risk factors should be identified in care plans and referrals.
  3. A recent pediatric study conducted in the emergency department indicates a risk profile with a combination of these factors that results in a risk factor score32 Research has not yet connected this risk score to long term prognosis.