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Concussion Care Pathway

Date of last update: May, 2024

Report of Findings (ROF)

Clinical Cornerstone:

  • The ROF aims to educate the patient about their condition, set a common understanding of expectations, and build trust. It's essential to communicate effectively, using language that the patient can comprehend, and to create an environment where the patient feels comfortable asking questions and participating in their care. Depending on the patient, it may be necessary to involve family or caregivers at this stage.

1. Review of Patient's History: Summarize main complaints, concerns, and relevant history.

2. Clinical Examination Findings: Discuss key results that shaped your understanding or planning.

 

3. Diagnostic Results: If applicable, summarize imaging or test results in plain language.

4. Diagnosis: State the diagnosis and explain contributing factors through a biopsychosocial approach. This should include reviewing any yellow flags identified. It may include summarizing the following sections of their History Assessment as well: Narrative (how the issue affects their daily living, PSFS), Social History (support system), Social determinants of health (occupational or domestic stressors), Lifestyle (exercise, nutrition/smoking, stress) . It may also include summarizing relevant outcome questionnaires (e.g. SCOAT-6, HIT-6).

5. Prognosis: Outline the expected course, discuss negative prognostic factors, and provide an anticipated recovery time.

 

6. Treatment Recommendations: Engage in shared decision-making for the management plan treatment goals and expected outcomes. Discuss benefits and risks of treatment, discuss alternate treatment options (e.g., medication, CBT, self-management only, treatment with other providers/disciplines), explain any proposed interventions (e.g., manual therapy, exercises, modalities) and how they fit with the agreed treatment goals and expected outcomes.

 

7. Patient's Role in Recovery: Engage in conversation emphasizing  the importance of patient involvement and self-management; suggest home exercises, lifestyle modifications, behaviour changes, and any other self-care measures; emphasize adherence to recommendations.

8. Address Concerns and Questions: Encourage patient queries and provide clear answers.

Conclusion: Summarize the ROF and emphasize collaborative care.

Documentation: Record all findings, discussions, and recommendations in the patient's 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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