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Concussion Care Pathway

Date of last update: May, 2024

Treatment and Management

 

Management of Symptoms Beyond the Initial Period

Clinical Cornerstone:

  • In most cases of concussion, symptoms go away on their own and most people will recover well within 4-6 weeks.

  • Case management of persistent symptoms includes monitoring and reassessment. Of concern is the overlap between persistent concussion symptoms, the symptoms associated with traumatic mechanisms of injury (e.g. anxiety, depression), and the symptoms of comorbid conditions (e.g. headache, whiplash). Clinical reasoning should be used to tailor clinical management to the patient’s individual needs and goals.
     

Physical Symptoms (Headache, Non-specific neck pain)


Sleep Disturbance / Fatigue


Mental Health Symptoms


Cognitive Symptoms


Vestibular Symptoms

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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