Having the means to recognize concussion symptoms and signs can help clinicians properly diagnose any insult to the brain caused by the impact. Proper diagnosis is the first step to proper concussion management. There must be a mechanism of injury, together with rapid onset (within 24 hours) of ‘typical signs and symptoms.

The best practice is to assess balance, cognition, symptoms, oculo-motor signs; Use standardized tools in the correct administration (within 48 hours); Rule-out alternative diagnoses; Diagnosing after 48 hours is difficult;

It is also important to gather information of the patient and injury from all available sources, particularly important if you didn’t witness the injury. (See Berlin 2016 for statement about Sideline Evaluation).

Pocket Concussion Recognition Tool
The pocket concussion evaluation was developed with the latest Consensus Statement on Concussion in Sport from 2013. It’s one example of a tool that can be used on the spot, at the point of injury, to help determine whether to suspect a concussion based upon symptoms, signs, and questions related to memory.

The proper management of the injury includes, in part, tracking the resolution of symptoms following a concussion. While the resolution of symptoms should not be the sole basis for determining the return-to-activity status of a concussed patient, it should be utilized as part of a more comprehensive clinical decision-making process. To manage concussion care, you will need a plan for return to activity or Return to Play.

Acute Concussion Evaluation (ACE) Care Plan
The ACE is a part of the Centers for Disease Control and Prevention’s Heads Up: Brain Injury in Your Practice tool kit. The ACE Care Plan provides an example of the guidelines that can be used to help manage the progression of return to activity for individuals who have suffered a concussion. The Heads Up: Brain Injury in Your Practice tool kit also includes the ACE evaluation form, which can be used during the clinical evaluation to help determine whether or not an individual has sustained a concussion.

Another method of monitoring the symptoms during the recovery described in the ACE Care Plan is to use a graded symptom checklist that allows for multiple days to be tracked. Bear in mind that return to activity should not be based solely on the self-reported resolution of symptoms. Symptom scales provide a valuable method for monitoring the progression of concussion symptoms over several days.

Graded Symptom Checklist
The graded symptom checklist is one example of how you can track and monitor concussion symptoms during the recovery process described in the ACE Care Plan. The checklist allows for several days to be tracked on a seven point Likert-type scale.