- Recognising concussion in primary care can be challenging as symptoms and signs are often subtle, non-specific, and can progress over time. Initial loss of consciousness only occurs in one in ten people with concussion.
- The Brain Injury Screening Tool (BIST) is a standardised and validated assessment tool to evaluate patients with suspected concussion; this is specifically tailored for use in time-limited clinical consultations (takes 5-6 minutes to complete).
- Initial management of patients with concussion involves physical and mental rest for 24 – 48 hours; in most cases patients should then progressively re-engage in normal activities after this rest period, assuming the degree of engagement does not significantly worsen symptoms – excessive rest can prolong recovery.
- Patients who have sustained a sports-related concussion should be immediately removed from play, and not return until they have been medically cleared after completing a graduated return-to-play protocol.
- Patients can be reassured that most people who experience a concussion will fully recover within two to four weeks. However, recovery is strongly influenced by the timeliness of clinical review and follow-up, effective education delivered at an appropriate level of health literacy (and whether the advice given is culturally appropriate/relevant), as well as other patient-specific factors, e.g. initial symptom burden, ‘yellow flags’.
- On-line educational resources are available from ACC for adult patients (English and Te Reo Maori) and for carers of an affected child.
- Post-concussion syndrome is no longer a recognised as a diagnosis in DSM-5. ICD-11 or by ACC. The preferred term is ‘persistent concussion symptoms’ (beyond three months).
Concussion is not yet localised on Te Manawa Taki’s community healthpathways, and referral to support services in each region can be difficult.
A comprehensive list of who can provide patient care and support and how to refer to them is available from ACC.