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Concussion Care Pathway

Date of last update: May, 2024

Prognosis

Clinical Cornerstone:

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

  • Symptoms may be reported in 18% - 31% of people at 3 to 6 months after concussion injury.
     

Negative Prognostic Factors are associated with a poorer outcome or longer duration of pain and disability. The presence of one or more of these factors does not necessarily mean that a patient will have a poor outcome, but they can be used to guide treatment and set realistic expectations.

 

Concussion:

1. Demographic: Age (<29 years of age)

2. Lifestyle-related factors: Work status, Students

3. Intensity of symptoms at onset: Headache, Neck pain/stiffness, Co-morbid injuries (back pain)

4. Extra-cranial symptoms: e.g., Pain in arms or hands

5. Vestibular disorders: Dizziness or unsteadiness

6. Pre-existing conditions: Moderate-to-severe headache, Learning disorders

7. Attitudes and Beliefs: Low recovery expectations

Associated Complaints:

8. Lifestyle-related factors: Low job dissatisfaction, heavy physical work demands, lack of job flexibility, disputed compensation claims

9. Intensity of symptoms at onset: Higher initial pain levels

10. Psychological factors: Symptoms of depression or anxiety, Fear avoidance, Somatization

 

11. Duration of symptoms: Chronic symptoms (lasting more than 12 weeks), Previous episodes of neck pain

 

12. Attitudes and Beliefs: A belief that the pain is disabling

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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