II. Indications

  1. Sideline Concussion evaluation in age over 10 years

III. Advantages

  1. Most comprehensive Concussion sideline assessment tool
  2. Widely used

IV. Disadvantages

  1. Not validated

V. Components: Initial, Immediate Evaluation (on Field)

  1. Red Flags
    1. Neck Pain/tenderness
    2. Diplopia
    3. Extremity Paresthesias
    4. Severe or increasing Headache
    5. Seizure
    6. Loss of consciousness
    7. Deteriorating mental status
    8. Vomiting
    9. Increasingly restless, agitated or combative
  2. Observable signs
    1. Lying motionless on playing field
    2. Balance or gait difficulties, motor Incoordination, stumbling or slow, labored movements
    3. Disorientation or confusion, or inability to respond appropriately to questions
    4. Blank or vacant look
    5. Facial injury after Head Trauma
  3. Cervical Spine Assessment
    1. Neck Pain at rest
    2. Abnormal active neck range of motion (if no pain at rest)
    3. Abnormal Limb strength and sensation
  4. Other immediate tests
    1. Glasgow Coma Scale (15 points)
    2. Maddocks Score (5 points)

VI. Components: Additional Evaluation (on Field, office or emergency department)

  1. Concussion Symptom Checklist (22 points)
  2. Modified Balance Error Scoring System or MBess (30 points)
  3. Cognitive Screening (Standardized Assessment of Concussion)
    1. Orientation (5 points)
    2. Immediate Memory (5 or 10 points)
    3. Delayed Recall (5 or 10 points)
    4. Concentration with Digits Backwards and Months in Reverse (5 points)
  4. Neurologic screening exam
    1. Read aloud
    2. Cervical Neck passive range of motion
    3. Finger-to-Nose Test
    4. Diplopia
    5. Tandem gait

VIII. Resources: Other Tools

  1. Computer based Neuropsychological Testing (e.g. ImPACT)
    1. In some sports, baseline testing is performed
    2. Baseline testing is not recommended in young children (high variability)
  2. Postconcussive Symptom Scale
    1. http://www.hawaiiconcussion.com/pdf/post-concussion-symptom-scale.aspx

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