Referral Indicators

It is incumbent upon all healthcare professionals to understand and work within their regulated scopes of practice and individual level of competency, which requires that referrals be made when symptoms are outside of a healthcare professional’s scope of practice or level of competency.

Referral indicators were developed to guide healthcare providers to address specific patient symptoms by ensuring appropriate referrals to other regulated healthcare professionals. The intention is to get patients the appropriate and required care within a timely manner.

Information that is Important to Include in a Referral to Health Care Providers

The following information is considered critical to convey in a referral as it improves the quality/appropriateness of the referral (including risk factors) which can thus improve triage.

  • Age
  • Date of injury
  • Specific reason for referral
  • Presence of risk factors:
    • high score on either the Post-Concussion Symptom Scale (PCSS) >40, or the Rivermead Post-Concussion Questionnaire
    • female gender
    • previous concussion history
    • migraines/headaches
    • history of neurological conditions or complex medical issues/conditions
    • premorbid history of mental health issues, learning disabilities, behavioural issues, attentional problems
    • current symptoms consistent with depression/anxiety or other mental health conditions
    • signs/symptoms of vestibular abnormalities
    • signs/symptoms of visual abnormalities
    • signs/symptoms of cognitive difficulties
    • changes in sleep patterns, difficulty sleeping
    • increased symptoms with return to school, work, or exercise
    • returning to a contact sport activity

It is incumbent on the practitioner making the referral to consider the underlying etiology of the symptom when making the referral, in order to choose the appropriate registered healthcare professional to refer to. For example, headache may be cervicogenic, tension, migraine or vestibular/ocular in origin, thus the referral would go to different practitioners depending on scope of practice.

Refer to

For the following symptoms

  • Prolonged tinnitus
  • Sensitivity to sound

For the following symptoms

  • Physical fatigue, sleep difficulties
  • Headache
  • Sensitivities to light and sound, nausea and/or vomitting

For the following symptoms

  • C-spine dysfunction and neck pain
  • Some dizziness, balance or postural issues
  • Prolonged headache not responding to other therapies
  • Requiring support returning to physical activities

For the following symptoms

  • Requiring support for integration to school or work and day-to-day activities
  • Cognitive deficits
  • Fatigue (mental/cognitive)
  • Sleep difficulties
  • Co-occurring orthopaedic injuries

For the following symptoms

  • Prolonged tinnitus, sound sensitivity, hearing loss
  • Disorders of taste/smell, disorders of motor speech/swallowing
  • Treatment-resistant vertigo, dizziness, nausea

For the following symptoms

  • Dizziness/balance
  • Vision loss, blurry vision
  • Sensitivities to light
  • Requiring support with return to activities

For the following symptoms

  • Requiring support returning to physical activities
  • Dizziness and vestibular issues
  • Physical fatigue
  • Headache

  • Physician (Family Physician, Pediatrician, Sports Medicine Physician, ENT, Neurologist)
  • Speech language Pathologist

For the following symptoms

  • Co-occurring orthopaedic injuries
  • Structural spine injury

For the following symptoms

  • Headache
  • Muscular issues

For the following symptoms

  • Requiring decisions about return to learn, school, work, and play
  • Prolonged post-traumatic headaches
  • Physical, cognitive and emotional symptoms impacting a patient’s function, that are not already being addressed by another specialist

For the following symptoms

  • Seizures, movement disorder or focal neurological deficits
  • Cognitive fatigue and confusion, sleep difficulties
  • Treatment-resistant post-traumatic headaches
  • Disorders of taste/smell, disorders of motor speech/swallowing
  • Requiring decisions about return to learn, school, work, and play

For the following symptoms

  • Requiring decisions about return to learn, school, work, and play
  • Sleep difficulties, physical fatigue
  • Headache
  • Seizures
  • Sensitivities to light and/or sound, vestibular abnormalities, dizziness, nausea and/or vomitting, tinnitus
  • Disorders of taste and smell, disorders of motor speech and swallowing
  • Co-occurring orthopaedic injury
  • Structural brain or spine injury

For the following symptoms

  • Vision loss, blurry vision/diplopia
  • Headache
  • Prolonged symptoms of post-trauma vision dysfunction

For the following symptoms

  • Decreased balance, persisting dizziness, benign paroxysmal positional vertigo (BPPV), tinnitus
  • Oculomotor dysfunction
  • Headache
  • C-spine dysfunction, neck pain, postural issues
  • Physical fatigue
  • Co-occurring orthopaedic injury
  • Requiring support returning to activities

For the following symptoms

  • Prolonged cognitive deficits/fatigue impacting function, sleep, performance issues.
  • Requiring support returning to school, work, normal activities
  • Prolonged symptoms of depression/anxiety, PTSD and suicidal ideation
  • Sensitivities to light and sound
  • Sports performance issues

For the following symptoms

  • Prolonged symptoms of depression/anxiety including Post traumatic stress disorder (PTSD)
  • Suicidal ideation
  • Requiring support returning to learn, work, and play

For the following symptoms

  • Structural brain or spine injury

For the following symptoms

  • Need Education/support of family members
  • Depression/anxiety
  • Sleep difficulties
  • Financial difficulties
  • Difficulty with return to regular activity (fatigue, sleep, performance issues) and community integration

For the following symptoms

  • Requiring decisions about return to learn, school, work, and play
  • Physical fatigue, sleep difficulties
  • Headache
  • Sensitivities to light and sound, vestibular abnormalities, dizziness, nausea and/or vomitting

For the following symptoms

  • Cognitive communication deficits (word finding, word formulation, reading comprehension, processing)
  • Requiring support for return to activity (social communication , school)
  • Disorders of motor speech and swallowing
Key Messages
  • Concussion management is symptom-based
  • Referral indicators were developed to guide healthcare providers to facilitate appropriate referrals
  • Healthcare providers must be mindful to always work within their scope of practice and their level of competence
  • Focus should be on getting patients the right care in a timely manner