Diagnosis

Diagnosis of concussion is the first critical step in successful management leading to improved outcomes and prevention of further injury.
The purpose of the initial medical assessment is to establish the diagnosis of concussion by ruling out other conditions with similar symptom profiles such as more severe forms of TBI, cervical spine injuries and medical and neurological conditions.1 The need for neuroimaging should also be determined using the Canadian CT Head Rule (Figure 1.1).2,3 Symptoms should be formally documented at the time of the initial assessment for the purpose of subsequent comparative analysis in the event of prolonged symptoms. Blood-based biomarkers4 are still considered investigational and therefore are not recommended for use in diagnosing/assessing patients in the ED or PCP’s office.
Once a diagnosis of concussion is established, Primary Care Provider’s (PCP’s) should provide patients and their support person with written, verbal and/or pictorial education regarding management and prognosis.5 Follow-up by a PCP should be arranged for all patients with a diagnosed concussion to monitor progress and ensure that the patient's symptoms are improving according to expected timelines. PCPs may also consider referral to a regulated healthcare professional if necessary.
Introduction-only references:
- Parachute. Canadian Guideline on Concussion in Sport. In. Toronto: Parachute; 2017.
- Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391-1396
- Sharp AL, Nagaraj G, Rippberger EJ, et al. Computed Tomography Use for Adults with Head Injury: Describing Likely Avoidable Emergency Department Imaging Based on the Canadian CT Head Rule. Academic Emergency Medicine. 2017;24:22-30
- Mondello S, Schmid K, Berger RP, et al. The Challenge of Mild Traumatic Brain Injury: Role of Biochemical Markers in Diagnosis of Brain Damage. Medicinal Research Reviews. 2014;34(3):508-531.
- Nygren-de Boussard C, Holm LW, Cancelliere C, et al. Nonsurgical interventions after mild traumatic brain injury: a systematic review. Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil. 2014;95(3 Suppl):S257-264.
( recognition )
( referral for diagnosis )
( taking a history, physical examination, and review of mental health status )
( using a standardized concussion symptom inventory tool (including cognition) )
( Canadian CT rule )
( anticoagulation or bleeding disorders )
( MRI )
( x-ray )
( first bullet )
( second bullet )
( first bullet )
( second bullet )
( third bullet )
( fourth bullet )