ABSTRACT
Concussions across all the age groups are commonly seen by first line health care providers. Initial evaluation should involve a detailed history of injury and past medical history, including previous psychiatric history and head and neck trauma. Physicians may use various tools, including the Sports Concussion Assessment Tool (SCAT)5, Child-SCAT5, and Acute Concussion Evaluation (ACE), to help assess the concussion-related signs and symptoms, focal neurologic findings, and red flags that may require further investigations or help to predict the prolonged recovery. Certain imaging rules, including the Canadian CT Head Rule and the Pediatric Emergency Care Applied Research Network rule, can help guide the need for CT imaging in patients with head injury. However, concussion is ultimately a clinical diagnosis and there is insufficient evidence for utilizing further neuroimaging or biomarkers in routine evaluation, diagnosis, and prognostication. Following diagnosis, after a period of observation, most patients can be discharged with appropriately written and verbal recommendations, as well as outpatient monitoring and follow-up by a physician. Certain prediction algorithms based on patient demographic and clinical factors have been found to better identify high-risk populations for persistent-post-concussive symptoms, although further validation is required.
