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History & Physical Exam

  • General medical history

  • Mechanism of injury

  • Physical Exam- detailed head and neck exam and detailed neurological exam, including balance

  • Assessment tools: 

    • The most recent consensus statement on concussion in sport from the 4th International Conference on Concussion in Sport, held in Zurich, 2012 (McCrory et al., 2013) states using symptom scales, balance assessment and neurocognitive testing provide the best assessment of injury. Neurocognitive testing has not been validated in the ED.

    • From the included studies, neurocognitive assessment tools appear to have variations in scores based on factors other than the index injury. Upper class high school students and females had higher scores than freshman high school students and males (Covassin, 2012; McLeod, 2012). In a study by Baillargeon (2012), there were no differences between the group with concussion and the group without concussion for six neuropsychological tests. They reported differences in the BESS (balance assessment) test

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.