A concussion is a mild traumatic brain injury that results from a blow to the head, neck or body. Concussions are commonly seen in sports injuries, falls, and motor vehicle accidents. There are 45 to 54 million mild traumatic brain injuries (mTBI) a year globally, (1) and about 1.6 to 3.8 million concussions occur every year in the US alone.(2) Head injuries can range from minor to serious. Knowing when to seek immediate medical attention is crucial in ensuring the best possible outcome. If you or someone near you has recently suffered a blow/jolt to the head, neck or body, you must recognize the signs and symptoms of a concussion so you know when a trip to the emergency department (ED) might be necessary.
A concussion itself is not necessarily an injury that requires emergency room care; however more serious brain injuries like skull fractures, swelling, or bleeding in the brain are, and can lead to long-term consequences if not treated immediately.
In this blog post, we’ll discuss when you should go to the emergency department for concussions, how they are diagnosed in the ED setting, and suggest some treatment options. We will also provide guidelines that can be used at home to monitor for signs of more serious issues over time and help prevent complications from occurring.
Symptoms of a concussion can vary, and may not present immediately after the incident. For some people, signs and symptoms continue to develop up to two days later. Note that fewer than 9% of people with concussions lose consciousness. (3)
Common symptoms include:
| Cognitive symptoms:
| Emotional symptoms:
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Recognizing concussions in the very young can be particularly challenging as they may not be able to communicate their symptoms effectively. Unlike adults, young children might not complain of headaches or dizziness. Instead, parents and caregivers should look for nonverbal signs of a concussion. These might include a notable change in eating or sleeping patterns, a loss of interest in favorite toys or games, consistent crying and inability to be comforted, unsteady walking or loss of balance, or any unusual irritability or change in mood.
If your child has received a blow to the head/body, or a whiplash-type movement that could move the brain inside the skull, and you notice any of these signs, it is important to seek immediate medical attention. It’s always best to call your pediatrician if your child experiences a bump to their head. The American Academy of Pediatrics recommends you call your doctor for anything more than a mild head bump.
Most concussions do not require a visit to the emergency department. However, some red flags may indicate a more serious head injury and need immediate medical attention. You should go to the emergency department if you experience any of these symptoms after a suspected concussion:
If you experience any of these symptoms, do not hesitate to seek medical attention. Note that some concussions can present delayed symptoms that may not be recognizable until later. If signs and symptoms worsen over time, make sure to get a medical evaluation from someone trained in concussion management.
For infants and toddlers, seek emergency care if the child shows these signs and symptoms:
Parents and caretakers should note that vomiting is more common in young children, and it is a red flag if a child vomits repeatedly in a brief period of time (e.g., more than once or twice within an hour) after a head injury.
Another reason to consider whether to go to the ER after a concussion is that it is a difficult injury to diagnose. Up to half of concussion diagnoses may be missed on an emergency department (ED) evaluation. (4) Symptoms can be very subtle, and the environment can be stressful to patients, making it difficult for them to communicate how they are feeling. Since it is a brain injury, there is often no outward sign of injury.
The diagnostic process for concussions in an emergency department involves several steps. Initially, the doctor will conduct a physical examination, focusing on your neurological function. This may include checking your balance, coordination, reflexes, and strength, as well as assessing your eye movements and pupil response. Vital signs, like heart rate and blood pressure, will also be taken.
Next, your doctor will likely ask about your symptoms and the circumstances that led to your injury, or how the injury occurred. You might also be asked questions to evaluate your memory and concentration, known as cognitive testing. It’s important to relay any loss of consciousness or loss of memory surrounding the traumatic event.
Please note that diagnosis in an emergency department is designed to rule out life-threatening conditions. Concussion by itself is not considered life-threatening. Very few cases of concussion (4% to 6%) are associated with any observable changes to the brain that a doctor can see using common neuroimaging technologies such as computerized axial tomography (CT scan) or magnetic resonance imagery (MRI).(5)
However, many of the symptoms of concussion (eg, headache, vomiting, mental status changes) overlap with those of gross structural injury, intracranial hemorrhage, or both, and decisions regarding when to use advanced imaging can be challenging. If there are warning signs of a more serious brain injury, additional diagnostic tests, including imaging, may be required and can reveal brain bleeding, brain swelling, or skull fractures.
Once the ED staff has ruled out the need to admit you for more care, further testing or observation, you will likely be discharged with home care instructions. Follow-up care with a healthcare provider experienced in concussion management is essential for a more comprehensive evaluation and recovery plan. You may be given medication to relieve pain from headaches or neck soreness, or anti-nausea medicine.
Once discharged, the majority of concussions can usually be handled on an outpatient basis with a call to a primary care physician, pediatrician, or concussion specialist. Ideally, the next provider you see will have experience managing concussions and is up-to-date with current best-practice recommendations.
If you suffer from mild concussion symptoms, the best approach for children and adults is to take two to three days off of work or school. Recent studies say that 24-48 hours of limited screen use can help, but beyond the second day, does not seem to make a difference. (6) Light, symptom-limited physical activity (i.e., walking, stationary bike, etc.) can begin the second day after the initial injury. Research has proven that those who exercise regularly, within their symptom limits, tend to have better outcomes. (7) It is important, though, to avoid activities that could lead to another injury, or that make symptoms worse.
Following your concussion diagnosis, it is important to be aware of the expected recovery timeline. According to current guidelines, most people experience a full recovery within 4 weeks after their concussion. However, this timeframe can vary based on individual factors such as age and overall health. (8) Additionally, some individuals may require longer recovery times if they have experienced multiple concussions or have a history of migraine headaches, or if they delay seeking help from a concussion-trained provider as soon as possible post-injury.. It is important to continue following up with your healthcare provider and monitoring your symptoms during this time.
It is also essential to take proper precautions to avoid another concussion while recovering from the initial injury. This includes avoiding activities that put you at risk for head injuries, such as contact sports or activities that involve high speeds or heights. Additionally, pay attention to any lingering symptoms and seek medical attention if they worsen or are not resolved by day 10. With proper care and management, most individuals can make a full recovery from a concussion and return to their normal brain function and physical activities. Remember, early detection and prompt treatment are key to managing concussions effectively. “Rest and Wait” is no longer considered best practice and will very likely delay recovery. (7)
Student-athletes will likely have a return-to-play (RTP) protocol required by their school or state that they must complete before returning to sports. In addition to a gradual return to sports, a stepwise approach to returning to the classroom might be included. Final clearance for the student-athlete to return to competition will only occur once they are symptom free during steady and dynamic exercise.This extra step of achieving exercise tolerance is necessary due to the inherent risk of sport-related injuries.
The most effective way to recognize a possible concussion is by being educated on how to recognize the signs and symptoms, and also knowing the red flags that warrant emergency care. Remember that even a blow to the neck or body that creates enough force to move the brain inside the skull can cause concussion symptoms, so awareness is critical in getting the right care at the right time. In addition, ANY blow to the head or face that causes symptoms should be taken seriously.
The majority of concussions are not life-threatening and do not require evaluation at the emergency department. However, all suspected concussions should be evaluated by a healthcare clinician who is trained in the recognition and management of mild traumatic brain injuries. Most often, an urgent care or doctor’s office visit is sufficient for a concussion diagnosis. If you do not have access to any other healthcare provider, the ER is always there to help.
If there are any warning signs at all of a more serious brain injury, do not hesitate to go to the ER. Only there can imaging for fractures, brain bleeds or swelling of the brain occur, and immediate care provided to prevent serious complications. Being educated on how to recognize concussion symptoms is the first step to care, and having baseline data can help with recovery.
To learn more, visit https://completeconcussions.com/resources/concussion-tracker-app/.
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