Management of Sports-Related Concussions: Staying Ahead of the Game, 2nd Edition: Summary 30
Step 5: Memory and Maddocks Questions • What venue are we at today? • Which half is it now? • Who scored last in this match? • What team did you play last week/game? • Did your team win the last game? Step 6: Progress to Off-field Assessment • Athlete background/risk factors • Symptom evaluation • Standardized Assessment of Concussion (SAC) King-Devick Test The King-Devick Test is a rapid sideline screening tool that assesses saccadic eye movements (not convergence or pursuits). While useful, it should not be used as a standalone diagnostic tool. CLINICAL EVALUATION Clinical evaluation builds upon the sideline assessment and aims to determine the specific clinical trajectory of the concussion. This approach recognizes that not all concussions are the same and may require different management strategies. Clinical Trajectories Research has identified several common trajectories: • Vestibular —may take longer to recover: ○ Risk factors: history of motion sensitivity ○ Signs: abnormal VOR and visual motion sensitivity • Cervical : ○ Risk factors: whiplash injury ○ Signs: VOMS, VOR, near point convergence, headaches, nausea, dizziness, fatigue, numbness/tingling • Cognitive/fatigue : ○ Risks: history of learning disability ○ Signs: fatigue, concentration/memory problems, foggy, feeling slowed down, normal VOMS • Post-traumatic migraine • Anxiety/mood : ○ Risks: history of anxiety
LEARNING TIP! The SCAT should inform clinical decision-making but should not be used as the sole basis for diagnosis or return-to-play decisions.
Step 0: Red Flags • Neck pain, seizures, convulsions, double vision, loss of consciousness, weakness/ tingling/burning more than one extremity, deteriorating conscious state, vomiting, severe headache, agitation or combative behavior, GCS <15, deformity of the skill Step 1: Observable Signs of Head Trauma Coaches and medical professionals should be aware of observable signs such as: • Lying motionless on the playing surface • Falling without protective action • Motor coordination/balance problems/ ataxia • Disorientation/confusion/altered mental status • Blank or vacant look • Facial injury after head trauma • Seizure • High-risk mechanism of injury • Loss of consciousness • Tonic posturing • Slow to get up following a hit to the head • Clutching the head after contact • Behavior changes Step 2: Glascow Coma Scale: out of 15 • Best eye response (4) • Best verbal response (5) • Best motor response (6) Step 3: Cervical Spine Assessment • Pain, tenderness, ROM, extremity strength and sensation Step 4: Coordination and Oculomotor Screen • Finger to nose test • Eye movements in all directions without double vision
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