Clinical Domains
CRM: Symptoms—Clinical Domains
Concussion Recognition & Management
Module 3 Symptoms & Signs

Clinical Domains

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The Fourth International Conference on Concussion in Sport held in Zurich identified five clinical domains of concussion symptoms and signs: symptom clusters, physical signs, behavior changes, cognitive impairment, and sleep disturbance. If the youth mentions — or if you observe — the presence of even one component from any of these clinical domains, suspect concussion and institute an appropriate management strategy. It’s important to keep in mind that your vocabulary may be different than the young person’s.

group of student athletes

Clinical Domains

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Select each tab on the left for more information.

Symptom Clusters

young athlete talking to medical professional: "I’m so edgy. If I could just sleep, or my headache would lay off . . .  I can’t think."

A young person probably won't tell you, "I've had a concussion!" But the symptoms he or she reports just might.

When a youth has suffered a concussion, he or she can experience clusters of symptoms from any or all of the categories identified in the Zurich statement. Your patient may report symptoms that are:

  • Somatic / Physical (such as headache).

  • Cognitive (such as feeling in a fog).

  • Emotional (such as being irritable over nothing).

  • Sleep-related (such as being unable to sleep).

Physical Signs

Physical signs of a concussion may or may not be present. Whether a youth mentions them or not, you or others may observe signs such as:

  • Loss of consciousness (LOC).

  • Amnesia.

  • Balance issues.
young athlete being examined by medical professional who thinks, "He can’t tell me how he got from the playing field to here."

Behavior Changes

young athlete being examined by medical professional who thinks, "Wow, this child goes ballistic over nothing!"

Even in a young person you have not met before, you may observe behavioral signs of concussion, such as extreme irritability. Questioning the youth and the family or coaching staff will help confirm a change in temperament with a sudden onset, which may signal a concussion.

Cognitive Impairment

It’s important to watch for cognitive signs of a concussion, especially since the young person may be unaware he or she is having trouble. For example, as you spend time with the young person, you may notice slowed reaction time or difficulty concentrating. These problems may signal cognitive impairment resulting from a concussion.

young athlete being examined by medical professional who thinks, "He is cooperative, but there"s a lag of seconds before he complies."

Sleep Disturbance

young athlete being examined by medical professional who thinks, "The parent says this child is usually really active, but now she can’t keep her eyes open, even at meals."

Sleep-related signs of a concussion, such as drowsiness, may be observable. Any disruption of the normal sleep pattern can indicate a concussion has occurred.

Module 3 Symptoms & Signs

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