Diagnosis and Management
There is no gold standard test for the diagnosis of concussion. The diagnosis is made clinically based on how the injury occurred and the symptoms associated with the injury.
In the evaluation of the patient with a potential concussion the healthcare provider’s most important responsibility is in assessing for symptoms that would suggest a fracture or other injury to skull or neck or an underlying structural injury of the brain such as bleeding in the brain. These conditions may warrant immediate or emergent evaluation.
Once an athlete is diagnosed with a concussion the initial treatment consists of relative physical and cognitive rest. The athlete diagnosed with a concussion is not allowed to return to sports participation while still symptomatic or in the first days after injury. In particular activities with a risk of contact or collision to the head should be avoided.
In the first few days after injury the goal is to allow initial brain healing and recovery. Part of this healing is the avoidance of activities that exacerbate symptomatology. Each patient is different in regards to what activities may exacerbate symptomatology. As the days progress the patient is typically educated that she/he may reengage in some cognitive and physical activities. These steps in treatment and progression are monitored and individualized for each patient.
Most concussions resolve in an uneventful manner over days to weeks. The progression of recovery is typically a steady progression of resolution. In less frequent instances, the patient may have a delayed recovery or protracted symptoms. These patients will often benefit from consultation from a collaborative treatment team approach. Healthcare providers that may be consulted in a case-by-case approach include Sports Medicine Physicians, Athletic Trainers, Physical Therapists, Occupational Therapists, Physical Medicine & Rehabilitation physicians, Neurosurgeons, Psychologists, Sports Psychologists, Psychiatrists, Neuropsychologists, Neuroradiologists, Neuroopthamologists, Neurooptometrists, Sports Neurologists, Sleep Medicine specialists, and ENT (Ears, Nose, and Throat) physicians.
Returning to sports participation is only considered once the patient is determined to be fully recovered from the injury. Progression of sports reintegration must not only take into account any applicable state or organizational laws but also the athlete’s unique needs.