Concussion Guidelines
Written by Editor   
Wednesday, August 06, 2014 05:02 PM

The Congress of Neurological Surgeons in the September 2014 - Volume 75 - Issue of their Journal: Neurosurgery is reporting the first in a series of articles on concussion guidelines.  In the summary and article reported here they note:

This is the first in a series of reports that will be generated by this working group that are intended to build an evidence base for concussion. This first report, Step 1, is a systematic review of prevalent indicators of concussion that used the highest-quality published literature and a rigorous process of publication selection, quality assessment, and data abstraction and synthesis. It is the foundation on which we will base future work to derive a classification system for concussion and guidelines for diagnosis, prognosis, and treatment.

The report defines a concussion as:

A change in brain function after a force to the head that may be accompanied by temporary loss of consciousness but is identified in awake individuals with the use of measures of neurologic and cognitive dysfunction.

At this time, there are no known objective measures to identify the change in brain function called concussion. Consequently, observed signs, subjective reports, and objective measures of neurologic and cognitive function that may be indicators of the underlying change in brain function are used to identify individuals with a high likelihood of having a concussion.

The task of this project was to identify which signs, symptoms, and neurologic and cognitive deficits have the highest and most consistent prevalence in samples of individuals sustaining a PCE and to assess how they are associated. From the available evidence, slowed reaction time, impaired verbal learning and memory, impaired balance, and disorientation or confusion were found to be significantly prevalent in early samples of exposed individuals. There is insufficient evidence to assess the relationships among these measures.

From the available evidence the article notes:

  • increased reaction time,
  • impaired verbal learning and memory,
  • impaired balance, and
  • disorientation or confusion
were found to be significantly prevalent in early samples of exposed individuals.

For this report key questions were identified and electronic literature searches conducted from 1980 to September 2012.  

Of 5592 abstracts of potentially relevant studies, 1362 full-text publications were acquired and read.  Two hundred thirty-one met the prespecified criteria, and of those, 62 publications were rated as medium potential for bias and confound. Of the 62 publications, 26 had inclusive case definitions, reported data at fixed time points relevant to 1 or more of the key questions, and are included in the analysis.

Specific indicators of concussion were noted in alert (Glasgow Coma Scale Score, 13 to 15) individuals after a force to the head, are the following:

* Observed and documented disorientation or confusion (disorientation or confusion: loss of one's sense of direction, position, or relationship with one's surroundings) immediately after the event

* Impaired balance (balance: a state of body equilibrium) within 1 day after injury,

* Slower reaction time (reaction time: the interval of time between application of a stimulus and detection of a response) within 2 days after injury, and

* Impaired verbal learning and memory (verbal learning and memory: the acquisition, retention, and retrieval of verbal material; memory of words and other abstractions involving language) within 2 days after injury.

What is needed next is a “decomplicated” body of information that provides simple counts of signs, symptoms, neurologic and cognitive deficits; and valid and reliable outcome measures; and that associates those measures across time in the form of proportions. The forthcoming report from this working group, “Concussion Guidelines Step 2: Diagnostic Criteria,” will serve to fill this information gap and will take the next step in developing guidelines for the diagnosis, prognosis, and treatment of concussion.

Source:  Executive Summary

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