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Practical Management: Brief Physical Examination for Sport-Related Concussion in the Outpatient Setting.

ABSTRACT: This article presents a brief, focused physical examination [PE, the Buffalo Concussion Physical Examination (BCPE)] for sport-related concussion (SRC) to be considered for use in the outpatient setting by sports medicine physicians, pediatricians, and primary-care physicians. This companion paper describes how to perform the PE, which was derived in a separate study presented in this journal. It is envisioned for use at the initial and follow-up outpatient visits both for acute concussions and in patients with prolonged symptoms. A pertinent PE, combined with other assessments, can help identify specific treatment targets in those with persistent symptoms after SRC. The BCPE includes orthostatic vital signs and examinations of the cranial nerves, oculomotor/ophthalmologic, cervical, and vestibular systems. Supplementary tests, including testing for exercise tolerance and neurocognitive function, may be performed if indicated. It is recommended that a PE be performed at the initial visit and every 1 to 2 weeks after SRC. On return of symptoms, cognition, and the PE to baseline, as well as normalization of any supplementary tests, patients can begin a return to play program.

SUBMITTER: Haider MN

PROVIDER: S-EPMC6504626 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Practical Management: Brief Physical Examination for Sport-Related Concussion in the Outpatient Setting.

Haider Mohammad N MN Leddy John J JJ Du William W J Macfarlane Alexander A Viera Kaitlin B KB Willer Barry S BS

Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 20200901 5

This article presents a brief, focused physical examination [PE, the Buffalo Concussion Physical Examination (BCPE)] for sport-related concussion (SRC) to be considered for use in the outpatient setting by sports medicine physicians, pediatricians, and primary-care physicians. This companion paper describes how to perform the PE, which was derived in a separate study presented in this journal. It is envisioned for use at the initial and follow-up outpatient visits both for acute concussions and ...[more]

PMID: 30418199

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Project description:ImportanceThere is limited research on clinical features and symptom recovery from sport-related concussion (SRC) and non-SRC in younger children.ObjectiveTo investigate the trajectory of symptom recovery in children aged 5 to 7 years and 8 to 12 years with SRC and non-SRC at 1, 2, 4, 8, and 12 weeks postinjury.Design, setting, and participantsThis secondary analysis of a prospective multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics) included participants aged 5 to 12 years with acute concussion who presented to 9 pediatric emergency departments within the Pediatric Emergency Research Canada network between August 2013 and June 2015. Analyses were conducted from September 2023 to May 2024.ExposureParticipants had a concussion consistent with the Zurich consensus diagnostic criteria and 85% completeness of the Post-Concussion Symptom Inventory (PCSI) at each time point.Main outcomes and measuresThe primary outcome was symptom change, defined as current minus preinjury ratings 1, 2, 4, 8, and 12 weeks postinjury, measured using the PCSI. Symptoms were self-rated for children aged 8 to 12 years and child- and parent-rated for children aged 5 to 7 years. Mixed-effect models were conducted using total PCSI score adjusting for random effects; fixed-effect indicators included injury setting (SRC and non-SRC), time, injury setting × time, and other variables associated with recovery.ResultsA total of 1747 children, including 513 aged 5 to 7 years (mean [SD] age, 6.57 [0.85] years; 320 male [62.4%]) and 1234 aged 8 to 12 years (mean [SD] age, 10.68 [1.40] years; 806 male [65.3%]) were recruited, of whom 477 aged 5 to 7 years and 1157 aged 8 to 12 years were included in the analysis. Of those included in the analysis, 207 aged 5 to 7 years (43.4%; mean [SD] age, 6.68 [0.84] years; 142 male [68.6%]) and 790 aged 8 to 12 years (67.2%; mean [SD] age, 10.77 [1.40] years; 547 male [69.2%]) sustained an SRC. No significant differences in recovery curves across time postinjury were found between those with SRC and non-SRC (5-7 years: β = -0.09; 95% CI, -1.10 to 0.92; 8-12 years: β = 0.11; 95%CI, -1.50 to 1.70).Conclusions and relevanceIn this cohort study of children aged 5 to 12 years with an acute SRC or non-SRC, symptom recovery trajectories over time were similar in both groups. This finding suggests similar management protocols can be used for sport and nonsport mechanisms of injury (excluding assault and motor vehicle crash) in the younger population.

Dataset Information

Practical Management: Brief Physical Examination for Sport-Related Concussion in the Outpatient Setting.

Publications

Practical Management: Brief Physical Examination for Sport-Related Concussion in the Outpatient Setting.

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