Domain 1: Concussion Recognition and Directing to Care

Recommendations

1.1a

School boards, sports organizations, and community centres should provide pre-season concussion education and conduct a review of all concussion policies in effect within the school or sport setting.

Level of Evidence:  

1.1b

School boards, sports organizations, and community centres should ensure updated policies are in place to recognize and accommodate a child/adolescent who has sustained a concussion.

Level of Evidence:  

Tool 1.1: Pediatric Concussion- The Role of School Boards, Community Sports Organizations, and Centres

1.2

Remove the child/adolescent from the activity immediately if a concussion is suspected for immediate assessment and to avoid another injury. 

Level of Evidence:   

Do not leave the child alone and contact the parent/caregiver immediately. Do not let the child/adolescent return to sport (practice or game play) or other activities that day. “If in doubt, sit them out.”

A concussion should be suspected:

  • In any child/adolescent who sustains a significant impact to the head, face, neck, or body and demonstrates/exhibits any of the visual signs of a suspected concussion or reports any symptoms of a suspected concussion as detailed in the Concussion Recognition Tool 5 (Tool 1.2). 

Premature return to activities and sport can lead to another injury. Another blow to the head may complicate the injury further and have a longer recovery time due to the higher risk of prolonged symptoms. Severe brain swelling or cerebral edema after a concussion is very rare but potentially fatal.

Suggested concussion tools to share with teachers, coaches, parents, peers, and others

1.3

Recommend an emergency medical assessment for a child/adolescent with any of the “red flag” symptoms. 

Level of Evidence:   

If a child/adolescent demonstrates any of the ‘Red Flags’ indicated by the Concussion Recognition Tool 5, a more severe head or spine injury should be suspected and an emergency medical assessment is required. Consider arranging an ambulance service as necessary to facilitate urgent medical assessment at the nearest hospital and execution of the Emergency Action Plan for your organization. When calling an ambulance, describe the specific red flags symptoms over the phone. 

Red flag symptoms include:

  • Severe or increasing headache 
  • Neck pain or tenderness
  • Double vision
  • Weakness or numbness in arms/legs
  • Seizure or convulsions
  • Loss of consciousness
  • Deteriorating conscious state
  • Repeated vomiting
  • Increasingly restless, agitated or combative state
  • Slurred speech 

Suggested tools to help identify “Red Flag” symptoms

1.4 

Concussion should be suspected and diagnosed as soon as possible to maintain health and improve outcomes. Concussion can be suspected in the community by healthcare professionals, parents, teachers, coaches, and peers. Those with a suspected concussion should be referred to a physician or nurse practitioner to perform a thorough medical assessment to exclude more severe injuries, consider a full differential diagnosis, and confirm the diagnosis of concussion. 

Level of Evidence:   

Tool 1.3: Manage Acute and Prolonged Concussion Symptoms Algorithm

Suggested tool for the general community to suspect a concussion

Suggested tools for experienced healthcare professionals to suspect a concussion:

  • Link: Sport Concussion Recognition Tool 5 (SCAT5) for Children aged 5-12 English / French
  • Link: SCAT5 for Athletes aged 13+ English / French