Evaluation of Concussion: Signs and Symptoms

Clinically observable signs and symptoms of concussion are the result of the pathophysiological processes that ensue immediately after the introduction of traumatic external forces. Although, additional information is necessary to further clarify the most common signs and self-reported sequelae of concussion: post-concussive symptoms, amnesia, and LOC. Proper concussion management begins as soon as an injury is suspected, often on the playing field, court, or sidelines. Once more serious injury is ruled out (e.g., open head injury, airways obstructed, etc.) and concussion is the working diagnosis, a thorough assessment of signs and symptoms should be completed. Often this assessment is performed by the team physician, athletic trainer, or emergency medical personnel. These professionals are often faced with the decision of whether the injured athlete should be sent to the emergency room for further evaluation, including a brain imaging examination. A proper assessment of concussion should include a thorough assessment of signs and symptoms, with documentation of the presence and duration of each.

Apart from self-reported symptoms, cognitive impairments are less observable by medical staff, teammates, or coaches, less transient than other signs of concussion (e.g., LOC, vomiting, etc.), and less susceptible to dissimulation and underreporting from an athlete who is motivated to return to play. Additionally, in the absence of signs and symptoms, lingering cognitive deficits which may be undetectable to the athlete may be apparent on neuropsychological tests, thus serving as a valuable indicator of concussion severity.