Concussion management in the ED: Beyond GCS.

Sports related concussions are a frequent presentation to the Emergency Department (ED) Buchanan et al. (2011), and can be effectively managed by nurse practitioners (Jamault and Duff, 2013). Concussion and its sequelae are a significant cause of morbidity for patients, and may result in a premature end to sporting participation. The growing concern regarding concussion in sport has resulted in the publication of 5major position and consensus statements from relevant groups since 2000 (Alla et al., 2011). Concussion, which is a subset of mild traumatic brain injury (mTBI) (McCrory et al., 2013), can be challenging to recognise, assess andmanage in the ED setting. While head injuries and concussion in field sports are generally associated with lower velocity than those in motor sports (Putukian and Madden, 2010), concussion has become an increasingly serious concern for all sporting activities worldwide (King et al., 2014). Among the many reasons for the increasing awareness and concern regarding concussion is the rapidly shifting evidence base, with research emerging suggesting a multifactorial neurometabolic cascade of physiologic changes (Giza and Hovda, 2001), which is challenging the purely “functional model” of concussion. Furthermore, there is evidence of an association between repetitive concussive/sub-concussive injury and lingering cognitive and behavioural dysfunction (Rossetti et al., 2015), as well as a possible link between concussion and neurodegenerative processes (Rowson et al., 2012). Although rare, the potentially catastrophic outcome from second impact syndrome has also heightened awareness of concussion in sports. In addition, several high profile legal cases have served to highlight the importance of appropriate recognition and management of concussion.