Concussion and mild traumatic brain injury — formative SAQs

SAQ 1 — Fourteen-year-old rugby player dazed after a tackle (10 marks, 15 minutes)

A fourteen-year-old boy is playing school rugby when he is tackled and strikes the side of his head on the ground. He is briefly dazed, sits out for two minutes, tells the trainer he feels fine, and returns to play for the remaining ten minutes of the half. That evening he complains of a headache, feels foggy and irritable, and is sensitive to the television. He has vomited once. His Glasgow Coma Scale is 15, his pupils are equal and reactive, his neurological examination is normal, and his cervical spine is non-tender. He had one previous concussion a year ago that resolved in two weeks. [6]

a) Identify the errors in the sideline management, and explain the principle that was breached. State whether this presentation is a concussion and justify your answer with the consensus definition. (4 marks) [4] [6]

b) State your imaging decision and the clinical decision rule you apply, naming the specific factors you weigh. Explain why most children in this situation do not need a computed tomography, and the one feature in this vignette that you must monitor. (3 marks) [1] [2]

c) Outline the stepwise management from this evening, including the duration of rest, the order of the return to learn and return to sport, and the role of the previous concussion in your counselling. Explain the safety-net advice you give the family. (3 marks) [4] [9]