STEP 2: Concussion Live Course - November 5-6, 2024, in San Diego, CA-Assessing Concussion in the Emergency Department

Pdf Summary

This document, authored by Dr. Scott R. Laker, is focused on assessing concussion in the emergency department (ED). It aims to educate medical professionals on identifying concerning signs and symptoms of concussions, performing focused history and physical examinations, understanding the utility and limitations of imaging, and reviewing the latest relevant publications. Concussions are diagnosed through a combination of historical factors, examination findings, and clinical suspicion, as symptoms are often broad and non-specific.<br /><br />The historical assessment involves understanding the injury mechanism and evaluating consciousness levels, while also considering factors like intoxication or mental health concerns that may help predict persistent post-concussive symptoms (PCS).<br /><br />Imaging guidelines are critical for stratifying risk and standardizing diagnostic processes in the ED. CT scans are typically employed for rapid assessment of skull fractures and intracranial bleeding, whereas MRIs are more sensitive but less accessible and costly. Various criteria, such as PECARN, New Orleans Criteria, and Canadian CT Head Rules, aid clinicians in determining the necessity of CT scans in minor head injuries.<br /><br />Research indicates that certain demographic groups, like black adults and females, may be less likely to receive concussion diagnoses or head CTs compared to their counterparts, reflecting a potential disparity in ED settings.<br /><br />Overall, emergency evaluation primarily targets detecting serious intracranial or musculoskeletal injuries, with a significant emphasis on the mechanism of injury. Despite comprehensive evaluations, concussion cannot always be ruled out during an ED visit, necessitating follow-up care and education for patients and their families. Biomarkers present currently low-quality evidence and aren't yet suitable for isolated use in clinical practices. Protocols exist to ensure the consistent identification and treatment of critical injuries in emergency settings.

Asset Subtitle

Scott R. Laker, MD

Keywords

concussion

emergency department

imaging guidelines

CT scans

MRI

diagnostic processes

post-concussive symptoms

demographic disparities

biomarkers

follow-up care