Show Notes

Dr. Susan Kirelik, a concussion specialist and emergency medicine physician, discusses the key points of concussion diagnosis and management from the perspective of the emergency medicine clinician. The topics covered include:

The signs and symptoms of concussion and how it is diagnosed in the ED

The initial evaluation of a patient presenting with a head injury, including tools for determining when neuroimaging is indicated

Screening tools for the evaluation of patients with suspected concussion, such as the VOMS examination and the SCAT5 and Child SCAT5 tools

Management of patients in the ED after making a concussion diagnosis and the role of rest, antiemetics, and acute pain management for these patients

The importance of aftercare instructions when discharging concussed patients, in the context of new guidelines for concussion recovery

The risk factors for prolonged recovery from concussion and resources for concussion recovery

Patients seeking concussion clearance in the ED

Addressing patient or parent questions about the long-term complications of concussion, such as second impact syndrome, the potential for cumulative effects of multiple concussions, and risk for CTE (chronic traumatic encephalopathy)

Susan B. Kirelik is the Medical Director of the Rocky Mountain Pediatric OrthoONE Center for Concussion and is an attending pediatric emergency medicine physician at the Rocky Mountain Hospital for Children in Denver, Colorado.

Read the article: Concussion in the Emergency Department: A Review of Current Guidelines - Trauma EXTRA Supplement (Trauma CME)

References

McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838- 847. (Consensus statement)

Meeuwisse WH, Schneider KJ, Dvorak J, et al. The Berlin 2016 process: a summary of methodology for the 5th International Consensus Conference on Concussion in Sport. Br J Sports Med. 2017;51(11):873-876. (Conference summary)

Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170. (Prospective cohort study; 42,412 patients)

Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391-1396. (Prospective cohort study; 3121 patients)

Mucha A, Collins MW, Elbin RJ, et al. A brief vestibular/ocular motor screening (VOMS) assessment to evaluate concussions: preliminary findings. Am J Sports Med. 2014;42(10):2479-2486. (Cross-sectional study; 64 patients)

Links to tools and publications mentioned in the podcast:

PECARN Pediatric Head Trauma: Official Visual Decision Aid for Clinicians

Vestibular/Ocular-Motor Screening (VOMS) for Concussion

SCAT5 tool

Child SCAT5 tool

REAP concussion management (NOTE: this is the new URL for “center4concussion.com,” which is mentioned in the podcast)

Tip sheets for educators, parents, and healthcare providers on managing concussion recovery in the classroom