Assessments and Tools
Concussion Symptoms Checklist [PDF 952KB]
Signs of Deterioration.pdf [PDF 873KB]
ACE Care Plan Returning to Work
ACE Care Plan_School Version
CDC Field Triage Guideline
U.S. Trauma Center Map
There are five gradual steps to help safely return an athlete to play. These steps should not be completed in one day, but instead over days, weeks, or months. Individuals should be monitored for symptoms and cognitive function carefully during each stage of increased exertion. Athletes should only progress to the next level of exertion if they are asymptomatic at the current level.
Baseline: The athlete needs to have completed physical and cognitive rest and be asymptomatic.
- Step 1: Begin with light aerobic exercise, but only to increase an athlete’s heart rate. This translates into 5 to 10 minutes on an exercise bike, walking, or light jogging. There should be no weight lifting, jumping or hard running at this point.
- Step 2: Add activities that increase an athlete’s heart rate, and incorporate limited body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, and moderate-intensity weightlifting (reduced time and/or reduced weight from your typical routine).
- Step 3: Bump it up a notch to heavy, non-contact physical activity. This includes sprinting/running, high-intensity stationary biking, the player’s regular weightlifting routine, and non-contact sport-specific drills (in 3 planes of movement).
- Step 4: Reintegrate the athlete in practice sessions, even full contact in controlled practice if appropriate for the sport.
- Step 5: Put him or her back into play.
During each step, with proper permission, instruct coaches and athletic trainers to be aware and report any concussion signs or symptoms to you. If an athlete’s symptoms return, or she or he exhibits new symptoms with this increased activity, stop these activities and take it as a sign that the athlete is pushing him/herself too hard at this stage of recovery. Only after additional rest, when he or she is once again asymptomatic should the athlete start again at the previous stage.
Always remember, the younger the athlete, the more conservative
the treatment. And for athletes with a suspected concussion, there is no
same day return to play.
The Glasgow Coma Scale or GCS, a clinical tool designed to assess coma and impaired consciousness, is one of the most commonly used severity scoring systems for moderate and severe traumatic brain injuries; however, it may have limited use for concussion. Persons with GCS scores of 3 to 8 are classified with a severe TBI, those with scores of 9 to 12 are classified with a moderate TBI, and those with scores of 13 to 15 are classified with a mild TBI. While they have limitations, GCS and other classification systems, such as the Abbreviated Injury Scale, the Trauma Score, and the Abbreviated Trauma Score are important to understanding the clinical management and the likely outcomes of this injury.
Diagnosis of concussion using the following ICD-9 codes may be applicable:
- 850.0 (Concussion, with no loss of consciousness) – Positive injury description with evidence of a direct or indirect forcible blow to the head plus evidence of active symptoms and/or signs of any type and number related to the trauma; no evidence of LOC, skull fracture, internal bleed (i.e., intracranial injury).
- 850.1 (Concussion, with brief loss of consciousness < 1 hour) – Positive injury description with evidence of a direct or indirect forcible blow to the head plus evidence of active symptoms and/or signs of any type and number related to the trauma; positive evidence of LOC; no skull fracture, internal bleed.
- 850.9 (Concussion, unspecified) – Positive injury description with evidence of a direct or indirect forcible blow to the head plus evidence of active symptoms and/or signs of any type and number related to the trauma; unclear or unknown injury details and unclear evidence of LOC; no skull fracture, internal bleed.
- If there is evidence of prolonged LOC (>1 hour), skull fracture, and/or intracranial injury, the diagnosis of 854 (Traumatic Brain Injury) should be considered. Use of the ICD-9-CM 959.01 Head injury, unspecified is not recommended for concussion/MTBI, as it excludes the above concussion diagnoses and is non-specific.