Concussion management in the ED: Beyond GCS

Duignan, Martin; O’Connor, Niall

doi:10.1016/j.ienj.2015.11.005

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…Another simple initiative the ED can employ is better discharge advice for those suspected with concussion on top of a head injury leaflet. As we explored earlier, discharge advice for concussion is minimal 12 13 26. A specific concussion leaflet to be given out in the ED explaining what is it and how to effectively manage the symptoms including return to work or study guidance, similar to the Return to Play guidelines for athletes,7 may help standardise discharge advice.…”

Section: Discussionmentioning

confidence: 99%

“…There is no routinely used, formal assessment for concussion. The mainstay of management for concussion is discharge with advice regarding red flag symptoms, head injury leaflets and no follow-up 12 13. Concussion advice in the ED is minimal compared with Return to Play guidance for athletes 7.…”

Section: Introductionmentioning

confidence: 99%

“…Data collection systems need improving in the community and in the ED 19. This could be achieved by introducing the SCAT into the ED as an adjunct to the clinical diagnosis of concussion 12 20. However, the SCAT is long and cumbersome and unlikely to be adopted in busy EDs.…”

Section: Introductionmentioning

confidence: 99%

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Concussion assessment in the emergency department: a preliminary study for a quality improvement project

Mistry

Rainer

2018

BMJ Open Sport Exerc Med

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BackgroundIn sport, concussion is assessed using the Sports Concussion Assessment Tool (SCAT) 5 and managed with return to play guidelines. Similar, user-friendly tools are rarely, if ever, used in the emergency department (ED).ObjectivesTo evaluate a modified concussion assessment tool designed for the ED (ED-CAT) in patients presenting with a head injury and to identify variables that predict 30-day reattendance.MethodsA preliminary, prospective, evaluation in a quality improvement project was conducted in one hospital in South Wales. Patients were recruited if they were over 13 years, and either did not have an ED-CT head scan or had a scan with no acute changes. The primary outcome was 30-day reattendance.Results40 patients were recruited, 18 of whom had a CT scan. 37 were discharged on the same day with advice, two discharged the next day and one was admitted. Three (7.5%) patients reattended the department. Predictors of reattendance were headache score (median 3.0 vs 5.0; p<0.05), pressure in head score (2.0 vs 5.0; p<0.05), nausea/vomiting score (1.0 vs 3.0; p<0.05), dizziness score (1.0 vs 4.0; p<0.05), blurred vision score (0 vs 4.0; p<0.01), balance problems score (0 vs 4.0; p<0.05), sensitivity to light and confusion score (0 vs 4.0; p<0.01), orientation score (1. 0 vs 0; p<0.05) and immediate memory score (5.0 vs 4.0; p<0.05).ConclusionsKey symptoms and signs predicted 30-day reattendance. The ED-CAT requires validation and refinement in a larger population to produce a short, practical, user-friendly, relevant tool for ED head injury assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Concussion assessment in the emergency department: a preliminary study for a quality improvement project

Mistry

Rainer

2018

BMJ Open Sport Exerc Med

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“…If patients are deemed to be low risk of intracranial pathology, demonstratable using computed tomography or ruled out using the National Institute for Health and Care Excellence (NICE) Head Injury Clinical Guideline, the patient is discharged from the ED (2). These patients are termed to have suffered a mild TBI or concussion (3).…”

Section: Introductionmentioning

confidence: 99%

“…There is also an association between repeated concussions and later-life cognitive decline and chronic traumatic encephalopathy (8,9). Concussion can occur in any patient population, such as elderly patients who attend EDs following falls (~28%), patients who present after road traffic collisions (~20%) non motor-related transport (~5%), assault (~11%), and due to being struck on the head (~19%), which typically encompasses the mechanism for sport-related concussion (SRC) (3,10,11).…”

Section: Introductionmentioning

confidence: 99%

Management of sport-related concussion in emergency departments in England: a multi-center study

2021

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Objective:: To establish the current knowledge of sport-related concussion (SRC) management of clinicians in emergency departments in the North West of England. Methods:: A cross-sectional, multi-center study design was used and included emergency department clinicians (EDCs) across 15 centers in the North West of England. A 22-question survey was issued with questions focused on the 5th International Conference on Concussion Consensus Statement. Absolute and percentages were presented, and comparisons in knowledge of guidelines and confidence between EDCs were made using the Kruskal-Wallis test. Results:: Of an estimated 300 EDCs, 111 (37%) responded. Thirty (27%) were aware of the guidelines, whilst 63 (57%) had heard of a graduated return-to-sport protocol. Physical rest was advised by 106 (95%) respondents, with 68 (61%) advising cognitive rest and 47 (42%) providing written advice. There was no difference (p > .05) in awareness of SRC guidelines or confidence between clinician grade, with most receiving no SRC training. Conclusions:: There is a lack of knowledge amongst EDCs in the North West of England in managing and providing discharge advice to patients with SRC. This is likely due to the limited awareness of guidelines and training, and therefore further education delivery on SRC management guidelines is required.

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Use of the Sports Concussion Assessment Tool 3 in Emergency Department Patients With Psychiatric Disease

Coscia

Stolz²,

Barczak

et al. 2021

Journal of Head Trauma Rehabilitation

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Objective:The Sports Concussion Assessment Tool 3 (SCAT3) Symptom Evaluation (SE) is used in the emergency department (ED). This study aimed to examine the effects of psychiatric history on the SCAT3 SE symptom severity score (SSS). Setting: Three US EDs. Participants: A total of 272 ED patients with suspected concussion. Design: Prospective, nonrandomized, nonblinded study. The SCAT3 SE SSS, demographic data, medical information, and self-reported psychiatric history were obtained from patients by clinical research staff when they presented to the ED seeking standard clinical care. Concussion diagnoses were determined following a comprehensive assessment by an ED physician trained in managing concussions and adjudicated by supervising physicians. Main Measures: The primary outcome measure was SSS. The association between SSS, self-reported psychiatric disease, and concussion diagnosis was analyzed using multivariable linear regression. Results: 68.4% of subjects were diagnosed with a concussion. After controlling for age, sex, race, history of previous concussion, and interval from injury to ED presentation, self-reported psychiatric history (adjusted regression coefficient (β a ): 16.9; confidence interval [CI]: 10.1, 23.6), and concussion diagnosis (β a : 21.7; CI: 14.2, 29.2) were both independently associated with a significant increase in SSS. Subjects with a history of concussion had a significantly higher SSS (β a : 9.1; CI: 1.8, 16.5). Interval from injury to ED presentation was also associated with a significant increase in SSS (β a : 1.6 per 6-hour increase; CI: 0.4, 2.8). Conclusion: Our findings demonstrate that a history of preexisting psychiatric disease, as self-reported by patients with a suspected concussion treated in the ED, is independently associated with significantly higher scores on the SCAT3 SE. This suggests that a history of psychiatric illness may need to be accounted for when the SCAT3 SE is used in the ED for the assessment of concussion.

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Concussion management in the ED: Beyond GCS

Cited by 5 publications

References 23 publications

Concussion assessment in the emergency department: a preliminary study for a quality improvement project

Concussion assessment in the emergency department: a preliminary study for a quality improvement project

Management of sport-related concussion in emergency departments in England: a multi-center study

Use of the Sports Concussion Assessment Tool 3 in Emergency Department Patients With Psychiatric Disease

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