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Concussion Care Pathway

Date of last update: May, 2024

Differential Diagnosis

Clinical Cornerstone:

  • The majority of traumatic brain injuries are considered “mild”. Concussion is considered a concussion.

  • Diagnosing a concussion requires a patient-centered approach that integrates physical and psychological aspects of the patient’s symptoms. Clinical reasoning is needed to increase confidence in a diagnosis of concussion and decrease the likelihood that more serious conditions or conditions with similar symptoms are present. A comprehensive diagnostic strategy integrates clinical findings with patient narratives and risk factor evaluations for a complete understanding of the patient's condition.

  • Diagnosis may be complicated by comorbid conditions that mimic concussion symptoms (e.g. anxiety, migraine, etc.).

Physical Disorders (Headache, Non-specific neck pain)

Migraine:

  • Commonly disabling. More prevalent in women.

    • Without aura (commonly lasting 4-72 hours, unilateral, pulsing, sensitive to light/sound, nausea).

    • With aura (commonly moderate-to-severe, brief episode of neurological symptoms (visual, speech or sensory disturbances) which last less than 60 minutes and precede the headache).

Cervicogenic Headache:

  • Moderate intensity headache. Does not throb.

  • Unilateral from nuchal-area to oculo-frontal area.

Tension-type Headache:

  • May be associated with sensitivity to light/sound.

  • Headaches vary in intensity from mild to moderate.

  • Not associated with nausea or vomiting.

  • Does not worsen with physical activity.

Trigeminal Neualgia:

  • May cause tinnitus.

  • May cause dizziness/vertigo.

  • Superficial pain on one side of face.

Non-specific Neck Pain:

  • May cause neck stiffness, or irritation of neck area with certain movements.

  • May be sharp, dull, shooting, or ache.

Mental Health Disorder

Anxiety

  • May be associated with sleep disturbance or fatigue.

  • May be associated with irritability or emotional lability.

  • May be associated with focus/concentration difficulties.

  • May be associated with dizziness.

 

Depression:

  • May be associated with irritability.

  • May be associated with sleep disturbance or fatigue.

  • May be associated with decrease cognitive flexibility or verbal recall.

 

Post-Traumatic Stress:

  • May be associated with sleep disturbance or fatigue.

  • May be associated with irritability or emotional lability.

  • May be associated with focus/concentration difficulties.

 

Other Disorders

Stroke

  • May be associated with severe neck pain and/or headache.

  • May be associated with dizziness or difficulty walking.

  • May be associated with nausea.

 

Moderate/Severe TBI:

  • May be associated with loss of consciousness > 30 minutes.

  • May be associated with post-traumatic amnesia >24 hours.

 

Intracranial Hemorrhage:

  • May be associated sudden and intense onset headache (thunderclap headache).

  • May be associated with repetitive vomiting.

  • May be associated with falls due to imbalance.

  • May be associated with extreme drowsiness.

  • May be associated with unusual confusion or irritability or behaviors.

 

Documentation: Record all findings in the patient record.

Conduct patient assessment

Red flags or Orange flags present

Red flags or Orange flags present

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Refer to appropriate emergency or healthcare provider

No

Yes

Acute mTBI

  • Structured patient education

  • Self Care

  • Return to work / school

  • Return to driving

  • Return to sport / activity

Persistent mTBI

  • Monitoring and Reassessment

  • Tailored clinical management of symptoms:

    • Headache
    • Neck Pain
    • Sleep Disturbance
    • Fatigue
    • Emotional / Behavioural
    • Cognitive Disorders
    • Vestibular Disorders

Differential Diagnosis

Diagnosis

 

Diagnosis

Follow-up

Follow-up

(Align with patient goals, Criteria for discharge)

Major symptom/sign change

Goals not achieved

Discharge

No

Yes

Re-evaluate

Adjust treatment and management plan or refer

References or links to primary sources

  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. CDC Heads Up [Internet]. CDC February 2022. Available from: https://www.cdc.gov/headsup/index.html.

  • David L. MacIntosh Sports Medicine Clinic, University of Toronto. Post-Concussion Return to Activity Guidelines. EMPWR Our Toolkit [Internet]. EMPWR Foundation 2019. Available from: https://empwr.ca/our-toolkit.

 

Contact information for further inquiries or feedback

carolina.cancelliere@ontariotechu.ca

Disclaimer:

These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.

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