Stony Brook Children’s Pediatric Primary Care Clinic Curriculum

Concussion Evaluation and Management

April 2016

Materials developed by Susan Walker, MD

Goal:

To understand the cause, evaluation, management, and prevention of concussion

Objectives:

Understand the mechanism of concussion injury

Describe the initial evaluation of a patient with concussion

Decide when to refer patients with concussion to the ED or to a specialist

Create a management plan for a patient with concussion

ABP Content Specifications:

Central nervous system trauma:

Understand the long-term neurologic and behavior consequences of head trauma

Please read:

1.Contemporary Pediatrics Concussion Management

2.ACE for office evaluation of concussion

3.Review the CDC concussion module for practitioners(it takes about 45 minutes to do but is worthwhile)

Case Discussion:

You are seeing Andrew, a 12-year-old patient of yours, in the office for an acute visit. He is here for complaint of headache following an injury sustained during football yesterday.

What information will you elicit from Andrew and his parent?

Andrew tells you that an opposing player hit him on his left shoulder during a game yesterday. He fell backward, hitting his head “hard” on the ground. He did not lose consciousness, but can’t remember being walked off the field. Since the injury, he has had a headache and some nausea, and has been feeling “foggy”. He was unable to complete his homework after the game last night, and had trouble falling asleep. He has no past medical history, no learning disabilities, and has never had a concussion before. His mother says that he’s been a bit teary today and is “just not acting like himself at all.”

What is your diagnosis?

Using the ACE, what is Andrew’s total symptom score?

Does he have risk factors for protracted recovery from this concussion?

Any red flags?

Describe your recommendations for Andrew.

When would you like to see him again?

What would make you refer him to a concussion specialist?

What would make you refer him for emergency evaluation?

You see Andrew back in the office five days after the injury. He is doing better, with almost complete resolution of the headache. He is anxious to go to football practice today, as there is a game this weekend. What is your recommendation? Please discuss the 5-step return to play protocol.

Andrew’s mother invested a significant amount of money in his football helmet and wonders why it failed to protect him. She also wants to know if there is anything she can do to prevent her son from sustaining another concussion. What do you tell her?