Concussion Recognition and Directing to Care

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 Community Centres

1.2

Remove the child/adolescent from the activity immediately if a concussion is suspected to avoid further injury and have the child/adolescent assessed. 

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 physical 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 6 (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 result in a longer recovery time (i.e, higher risk of persisting 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’ symptoms indicated by the Concussion Recognition Tool 6, a more severe head or spine injury should be suspected and an emergency medical assessment is required. These red flag symptoms may appear immediately or within a few hours or days after injury. Delayed red flag symptoms require urgent medical assessment as they may indicate a more severe injury. 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 or loss of vision
  • Weakness or numbness/tingling in extremities
  • Seizure or convulsions
  • Loss of consciousness
  • Increased confusion or deteriorating conscious state
  • Repeated vomiting
  • Increasingly restless, agitated or combative state
  • Slurred speech 
  • Visible skill deformity

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 assessed by 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. 

It is important to note that some patients may experience a delayed onset of concussion symptoms. Delayed concussion symptoms also require medical assessment to exclude more severe injuries.

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:

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