Concussion Management, Over 70% of Doctors Got It Wrong – Part 3Written By: Leah Concannon, MD; Stanley Herring, MD
Evaluating the Child With a Suspected Concussion
Evaluation of a child with a suspected concussion in the office setting requires a more thorough and detailed history and examination than that performed on the sidelines. It is important to gather information about how the concussion occurred. The absence of loss of consciousness (LOC) should not be used to rule out a concussion, because LOC may be present in less than 10% of concussions.
It is imperative to completely assess the presence and severity of symptoms, including whether any of these symptoms increase with physical or cognitive exertion. A thorough review of any prior concussions should be performed, including mechanism of injury, presenting symptoms, duration and severity of symptoms, and how long the athlete was held out from play. A personal and family medical history, with special attention to any conditions that may predispose to prolonged recovery, should also be obtained. A social history should include current academic level and performance as well as the patient’s level of participation in sport.
On physical examination, special attention should be given to the neurologic examination, as much to evaluate the concussion as to rule out other neurologic injury. Cognitive and balance assessment should also be performed. The SCAT2 (Sport Concussion Assessment Tool 2), can be modified for in-office use. The National Football League (NFL) provides links to preinjury and postinjury assessment tools. These tools may be more helpful if the same test has been performed as a baseline before the start of the season.