Emergency department evaluation of the concussed athlete

The concussion evaluation commonly takes place in the emergency department (ED), but most clinicians have not received formal training in concussion diagnosis and management. Proper diagnosis and management of concussion in the ED diminish postconcussion complications and improve the likelihood of successful concussion recovery. The ED assessment begins with early recognition of the signs and symptoms of concussion, a directed history, appropriate documentation, and identification of conditions ("red flags") that need immediate intervention such as traumatic intracranial hemorrhage, followed by a systematic assessment for risk factors that can predict prolonged recovery, and a concussion-focused physical exam. The four key components to this exam are determining the level of alertness, assessing memory and attention, assessing vestibular function, and determining the adequacy of ocular near response. After assessment, ED management focuses on treating acute symptoms, setting expectations for recovery, educating patients regarding prevention of subsequent concussion, determining suitability for discharge, and providing meaningful written discharge instructions.