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Was looking over the concussion section in the ER section. Not sure how picky the ABP will be on this issue, but I believe the system you enumerated is no longer current. I don’t believe that anyone is grading the concussions any longer – at least that’s how we’re practicing now ourselves and in conjunction with the specialists.
For this topic, it really depends on where you look. UpToDate has a VERY comprehensive discussion, but it’s too difficult to simplify. The American Academy of Neurology is currently working on a new set of guidelines, but still refers physicians to their 1997 guidelines – http://www.aan.com/professionals/practice/guidelines/pda/Concussion_sports.pdf
For now, I’m fairly comfortable with the way I’ve written it. I think it’s a good way to evaluate “ABP patients” and will likely lead you to the correct answer. Here is the section again, no changes made:
POST CONCUSSION TREATMENT
Post concussion treatment varies depending on whether there was loss of consciousness and/or amnesia:
* GRADE 1: NO LOC + NO amnesia + Confusion. Reevaluate every 5 minutes for neurologic changes. May return to sports if mentation is clear and there are no symptoms for 20 minutes.
* GRADE 2: NO LOC + AMNESIA + Confusion. Patient should have medical follow-up at 24 hours. May return to sports once the patient is asymptomatic for 1 week.
* GRADE 3: LOC + AMNESIA + Confusion. Take these patients to the ER for further evaluation and probable imaging. May return to sports once the patient is asymptomatic for 2 weeks.
- PROGNOSIS: Worse if concussion was associated with amnesia, prolonged confusion, prolonged recovery or repeated trauma.
* IMAGING: Required if loss of consciousness (LOC) > 1 minute, or if there are still neurologic symptoms at presentation in the ER.
* MNEMONIC: Instead of “LOC,” think “LAC” for the 3 differentiating factors (LOC, Amnesia and Confusion). Grades 1 through 3 add one finding per grade, and they happen to go in the reverse order of C-A-L (Gr 1 = Confusion, Gr 2 = Confusion and Amnesia, Gr 3 = Confusion, Amnesia and LOC). Regarding timings for return to play, they are 0 weeks, 1 week and then 2 weeks of symptom-free time.
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