Concussion and mild traumatic brain injury

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Target exams

Red flags

• A deteriorating level of consciousness or a falling Glasgow Coma Scale after a head injury is not concussion and mandates urgent imaging and neurosurgical referral
• Focal neurological signs, seizures, or repeated vomiting after a head injury are red flags that exclude concussion and demand computed tomography
• A GCS below 13 is not a mild traumatic brain injury and must be managed as a moderate or severe injury
• Symptoms persisting beyond four weeks in a child are persistent post-concussion symptoms and need a structured active rehabilitation plan, not further rest
• Return to contact sport before full recovery risks repeat concussion and the rare catastrophic second impact syndrome
• A non-accidental mechanism must be considered in any infant with a head injury and an inconsistent history
• Prolonged strict rest beyond 48 hours worsens symptoms and recovery and is no longer recommended

Life stages

Care settings

Clinical exam formats

Board mappings

• Defines concussion as a functional brain injury with a Glasgow Coma Scale of 13 to 15 and short-lived neurological impairment
• Names the red flags that exclude concussion and mandate computed tomography after a head injury
• States the graduated return to learn before return to sport pathway
• Applies the PECARN and CATCH clinical decision rules to safely reduce computed tomography in minor head injury
• Explains the Amsterdam 2022 shift from prolonged strict rest to 24 to 48 hours of relative rest then early symptom-limited activity
• Manages persistent post-concussion symptoms with active rehabilitation, sub-symptom threshold exercise, and targeted therapy
• The PECARN rule for children under and over two years and the very low risk criteria for clinically important traumatic brain injury
• The Amsterdam 2022 graduated return to learn and return to sport strategy with return to learn first
• The predictors of persistent post-concussion symptoms and the four week recovery benchmark
• Assesses a child with a minor head injury, applies the imaging decision rule, and counsels the family
• Coordinates the graduated return to school and sport with the family, the school, and the club
• Manages the child whose symptoms persist beyond four weeks with a structured active rehabilitation plan
• Level 1: Recognition of concussion and the red flags that demand imaging
• Level 2: Application of the imaging decision rule and the graduated return to activity pathway
• Level 3: Coordination of persistent symptom rehabilitation and the school reintegration plan
• The consensus definition of concussion and its distinction from moderate and severe traumatic brain injury
• The PECARN and CATCH clinical decision rules for computed tomography in minor head injury
• The recovery trajectory and the predictors of persistent post-concussion symptoms
• Structured assessment and counselling of a child after a minor head injury
• Explanation of the graduated return to learn and return to sport pathway to the family
• Management of the child with persistent post-concussion symptoms
• Concussion as a mild traumatic brain injury with a Glasgow Coma Scale of 13 to 15
• The PECARN rule to reduce computed tomography in paediatric minor head injury
• Graduated return to activity and the management of persistent symptoms
• Recognition of concussion and application of the imaging decision rule
• Graduated return to learn before return to sport counselling
• Identification and rehabilitation of persistent post-concussion symptoms
• Canadian CATCH rule for computed tomography in paediatric minor head injury
• The Amsterdam 2022 consensus pathway of relative rest then graduated activity
• Active rehabilitation of persistent post-concussion symptoms