How to Asses a Concussion

WHAT ARE THE SYMPTOMS OF A CONCUSSION?

A person does not need to be knocked out (lose consciousness) to have had a concussion. Common symptoms include:

Headaches or head pressure Easily upset or angered
Dizziness Sadness
Nausea and vomiting Nervousness or anxiety
Blurred or fuzzy vision Feeling more emotional
Sensitivity to light or sound Sleeping more or sleeping less
Balance problems Having a hard time falling asleep
Feeling tired or having no energy Difficulty working on a computer
Nothing thinking clearly Difficulty reading
Feeling slowed down Difficulty learning new information

WHAT ARE THE VISUAL SIGNS OF A CONCUSSION?

Visual signs of a concussion may include:

Lying motionless on the playing surface Blank or vacant stare
Slow to get up after a direct or indirect hit to the head Balance, gait difficulties, motor incoordination, stumbling slow laboured movements
Disorientation or confusion or inability to respond appropriately to questions Facial injury after head trauma
Clutching head

RED FLAG SYMPTOMS

If your child shows any of the following Red Flag Symptoms call 911 immediately:

  • Neck pain
  • Increased confusion or irritability
  • Repeated vomiting
  • Seizure or convulsion
  • Weakness in arms/legs
  • Tingling or burning in arms/legs
  • Deteriorating consciousness
  • Loss of consciousness
  • Severe or increasing headache
  • Unusual behaviour change
  • Double vision

ASSESSMENT TOOLS

A. On-Site Medical Assessment

Depending on the suspected severity of the injury, an initial assessment may be completed by emergency medical professionals or by an on-site licensed healthcare professional where available. In cases where an athlete loses consciousness or it is suspected an athlete might have a more severe head or spine injury, Emergency Medical Assessment by emergency medical professionals should take place (see “d” below). If a more severe injury is not suspected, the athlete should undergo Sideline Medical Assessment or Medical Assessment, depending on if there is a licensed healthcare professional present (see “e” below).

B. Emergency Medical Assessment

If an athlete is suspected of sustaining a more severe head or spine injury during a event or training, an ambulance should be called immediately to transfer the patient to the nearest emergency department for further Medical Assessment. Coaches, parents, teachers, trainers and officials should not make any effort to remove equipment or move the athlete until an ambulance has arrived. The athlete should not be left alone until the ambulance arrives. After the emergency medical services staff has completed the Emergency Medical Assessment, the athlete should be transferred to the nearest hospital for Medical Assessment. In the case of youth (under 18 years of age), the athlete’s parents should be contacted immediately to inform them of the athlete’s injury. For athletes over 18 years of age, their emergency contact person should be contacted if one has been provided

WHO: EMERGENCY MEDICAL PROFESSIONALS

C. Sideline Medical Assessment

If an athlete is suspected of sustaining a concussion and there is no concern for a more serious head or spine injury, the player should be immediately removed from the field of play.

SCENARIO 1: IF A LICENSED HEALTHCARE PROFESSIONAL IS PRESENT

The athlete should be taken to a quiet area and undergo Sideline Medical Assessment using the Sport Concussion Assessment Tool 5 (SCAT5) or the Child SCAT5. The SCAT5 and Child SCAT5 are clinical tools that should only be used by a licensed healthcare professional that has experience using these tools. It is important to note that the results of SCAT5 and Child SCAT5 testing can be normal in the setting of acute concussion. As such, these tools can be used by licensed healthcare professionals to document initial neurological status but should not be used to make sideline return-to-sport decisions in youth athletes. Any youth athlete who is suspected of having sustained a concussion must not return to the game or practice and must be referred for Medical Assessment. If a youth athlete is removed from play following a significant impact and has undergone assessment by a licensed healthcare professional, but there are NO visual signs of a concussion and the athlete reports NO concussion symptoms then the athlete can be returned to play but should be monitored for delayed symptoms. In the case of national team-affiliated athletes (age 18 years and older), an experienced certified athletic therapist, physiotherapist or medical doctor providing medical coverage for the sporting event may make the determination that a concussion has not occurred based on the results of the Sideline Medical Assessment. In these cases, the athlete may be returned to the practice or game without a Medical Clearance Letter but this should be clearly communicated to the coaching staff. Athletes that have been cleared to return to games or practices should be monitored for delayed symptoms. If the athlete develops any delayed symptoms the athlete should be removed from play and undergo medical assessment by a medical doctor or nurse practitioner.

SCENARIO 2: IF THERE IS NO LICENSED HEALTHCARE PROFESSIONAL PRESENT

The athlete should be referred immediately for medical assessment by a medical doctor or nurse practitioner, and the athlete must not return to play until receiving medical clearance.

WHO: ATHLETIC THERAPISTS, PHYSIOTHERAPISTS, MEDICAL DOCTOR

 

How:

SPORT CONCUSSION ASSESSMENT TOOL 5 (SCAT5)

CHILD SPORT CONCUSSION ASSESSMENT TOOL 5 (CHILD SCAT5)

Medical Assessment

In order to provide comprehensive evaluation of athletes with a suspected concussion, the medical assessment must rule out more serious forms of traumatic brain and spine injuries, must rule out medical and neurological conditions that can present with concussion-like symptoms, and must make the diagnosis of concussion based on findings of the clinical history and physical examination and the evidence-based use of adjunctive tests as indicated (i.e CT scan). In addition to nurse practitioners, medical doctors[1] that are qualified to evaluate patients with a suspected concussion include: pediatricians; family medicine, sports medicine, emergency department, internal medicine, orthpaedic surgeons, and rehabilitation (physiatrists) physicians; neurologists; and neurosurgeons. In geographic regions of Canada with limited access to medical doctors (i.e. rural or northern communities), a licensed healthcare professional (i.e. nurse) with pre-arranged access to a medical doctor or nurse practitioner can facilitate this role. The medical assessment is responsible for determining whether the athlete has been diagnosed with a concussion or not. Athletes with a diagnosed concussion should be provided with a Medical Assessment Letter indicating a concussion has been diagnosed. Athletes that are determined to have not sustained a concussion must be provided with a Medical Assessment Letter indicating a concussion has not been diagnosed and the athlete can return to school, work and sports activities without restriction. [1] Medical doctors and nurse practitioners are the only healthcare professionals in Canada with licensed training and expertise to meet these needs; therefore all athletes with a suspected concussion should undergo evaluation by one of these professionals.

WHO: MEDICAL DOCTOR, NURSE PRACTITIONER, NURSE
HOW: MEDICAL ASSESSMENT LETTER (SEE APPENDIX B)
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