New Evidence-Based Guidelines: 4 Signs of Concussion

New Evidence-Based Guidelines: 4 Signs of Concussion

The first part of new evidence-based guidelines, published in the September 2014 issue of Neurosurgery, sought to identify which signs, symptoms, and neurologic and cognitive deficits have the highest and most consistent prevalence in samples of individuals sustaining a potentially concussive event. The researchers, composed of a team led by Nancy Carney, PhD, Oregon Health & Science University, Portland, and Jamshid Ghajar, MD, Brain Trauma Foundation, New York, New York, sifted through over 5,000 studies and systematically narrowed the stack down to 26 that met their strict criteria. According to the results, the four indicators of concussion, observed in alert individuals (defined as a Glasgow Coma Scale Score, 13 to 15) after a force to the head are the following: 1. Observed and documented disorientation or confusion immediately after the event 2. Impaired balance within 1 day after injury 3. Slower reaction time within 2 days after injury 4. Impaired verbal learning and memory within 2 days after injury The main symptoms experienced by subjects with potential concussive events were headache (93%), blurred vision (75%), dizziness (64%), and nausea (61%). Other key findings from the review include: * Decrements in cognitive function decreased from 58% on day 1 to 8% on day 7, indicating that in the majority of cases, cognitive deficits resolve within 1 week. * Tests of reaction time, memory, and attention/processing speed/working memory most consistently showed deficits in cognitive function within the first week of injury. * Individuals with a history of previous concussions had lower scores on tests from baseline to 5 days after injury, compared to those without previous concussions. The research team hopes...

Caring for Mild Traumatic Brain Injuries

The CDC estimates that about1.5 million traumatic brain injuries (TBIs) occur each year in the United States, making these injuries a leading cause of disability. The cost of TBIs has been estimated to be approximately $60 billion per year. About 52,000 deaths are attributed to TBIs annually. Roughly 80% of patients who experience a TBI have a mild TBI, or concussion, caused by a bump or blow to the head. The American Association of Neuroscience Nurses (AANN) has existing guidelines for the care of patients with moderate or severe TBI, but until now, there have not been evidence-based, clinical guidelines for the care of patients with mild TBI. The AANN has teamed up with the Association of Rehabilitation Nurses (ARN) to create a clinical guideline called “Care of the Patient With Mild Traumatic Brain Injury,” which was released in 2011. The guidelines— available for free at and—are meant to help registered nurses, advanced practice nurses, and institutions provide safe and effective care to injured patients with a mild TBI. “Follow-up care is critical for patients with mild TBI, along with patient education.” “Recently, there has been a strong focus on TBIs among high school, college, and professional athletes, with new research showing the residual effects that remain in some patients with mild TBI,” says Therese West, RN, CPN, MSN, APN-C, lead author of the AANN/ARN guidelines. “Previously, it was thought that when patients received a blow to the head, they would get a little lump and maybe a headache, but they would ultimately be fine. The literature, however, is now showing that this is not necessarily the case. Most...