Mild Traumatic Brain Injury Concussion Assessment
- Definition of TBI should include one of the following
- Direct blow to the head or acceleration/deceleration mode of injury
- Any head related injury (facial #s, mandible #, broken nose)
- Significant mechanism (pedestrian vs car, bicycle struck or collision, RTC high speed – rollover, ejection, fall from height > 1m, thrown, head trampled on)
- Patient has other major trauma injuries
- Decreasing level of conscious at any time
- Assault
- Vague or no recollection of events pre or post injury
- Active symptoms of concussion such as headache, blurred vision, sensitivity to light or noise, drowsiness, balance problems, nausea/vomiting, poor concentration, fatigue, poor sleep
- **Discharge home criteria
- No ongoing clinical indication for prolonged observation e.g no abnormal behaviour, severe post-concussive symptoms, no drugs and/or alcohol intoxication.
- GCS 15/15
- if has been tested A-WPTS 18/18
- Responsible person at home
- Patient or responsible person understands head injury instructions (provide printout MIDAS document 65632)
- During assessment
- Treat symptoms, hydrate and encourage rest and sleep between assessments
- Referral to Concussion Clinic
- Attach large patient sticker and patient’s ACC number to concussion clinic form (ACC883)
- Sign and date form
- Print clinical notes from EDIS
- Email ACC883 form, clinical notes and Rivermead symptom evaluation to
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- Patients admitted to a ward prior to their concussion evaluation (eg for other significant injuries or illnesses)
- These should have their assessment as an inpatient. Please document the need for this in patient’s notes and if possible let the admitting team know.
Specifications
- Last Updated: 2019
- Author(s): Southern District Health Board, New Zealand
- Category: Guidelines
- Tags: 2019, English, New Zealand National Clinical Network, Southern District Health Board
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