Evidence-based Management Strategies for Adult Concussion

Traumatic brain injury (TBI) is a growing public health concern. Majority are estimated to be mild in severity, also referred to as a concussion. Although most concussions are self-limiting, there has been more interest in investigating somatic symptoms, cognitive dysfunction, mood disturbances, and sleep abnormality in the acute setting as prognostic markers for persistent symptoms. This article serves to provide a comprehensive review on acute management of concussions sustained in various mechanisms of injury including sports acquired and military-related. This article will also offer up-to-date evidence-based strategies in re-integrating the patient to full return of functional activity. Regardless of mechanism of injury, the initial step of management is recognition and then removal from further risk of injury. Education and further reassurance should be provided, followed by a supervised incremental return to activity protocol that monitors tolerance and exacerbation of symptoms. Since concussions have a heterogenous presentation, management should be individualized and symptom based. Prolonged symptoms may warrant specialty-specific referrals and further diagnostic evaluation. Management is optimized when treatment is patient-centered and with interdisciplinary collaboration.