Australian-first guidelines address assessment and management of all forms of concussion and mild traumatic brain injury across a variety of healthcare settings.
Professor Karen Barlow.
Led by University of Queensland researchers, the guidelines provide an evidence-based and nationally unified model for the initial assessment and management of concussion and mild traumatic brain injury, return-to-activity procedures, persisting symptoms, sleep disturbance, mental health and cognitive difficulties.
There are also recommendations on repeat concussions and long-term effects, including the diagnosis and risk factors for traumatic encephalopathy syndrome.
The guidelines address the current gaps in practice, pointing out evidence that suggests as many as 20-50% of adults with concussion have delayed recovery.
“Good acute management including patient education, avoidance of repeat injury, and early follow-up can reduce the risk of persisting post-concussion symptoms and its significant emotional and financial burden,” the guidelines state [link here] .
“However, between 40-80% of people leave the emergency department without education or discharge instructions and without a clear follow-up plan.”
The guidelines include the latest diagnostic criteria for mild traumatic brain injury, which require a biomechanically plausible mechanism of injury such loss of consciousness, an altered mental state, or amnesia, and at least one other factor such as an acute physiological disruption of brain function, two or more acute symptoms, clinical or laboratory findings or neuroimaging evidence.
Writing in a perspective for the Medical Journal of Australia [link here], the guideline authors said about 240,000 Australians and New Zealanders required medical attention for concussions each year, at an estimated cost of $100 million AUD. However, around half did not receive appropriate care, they said.
While there were already some evidence-based clinical practice guidelines available for concussion, these were focused on specific populations such as children and sport-related concussion or single settings like ED.
The authors said sport-related concussion in particular had dominated the media, however concussions were more often a result of falls and motor vehicle accidents, while repeated concussions did not just occur in athletes but also in people who experienced domestic violence and assault or incarceration.
“Concussion management is highly variable across health professionals and community and health care settings. This reflects limited appreciation of the associated morbidity and impact on quality of life, and low levels of knowledge about best practice care,” the perspective authors said.
Lead author paediatric neurologist Professor Karen Barlow from University of Queensland’s Child Health Research Centre said children and people living in rural communities were among those most affected by inconsistencies in care delivery.
“GPs and healthcare practitioners are crucial in concussion care but often lack confidence in managing recovery. There is currently a gap in knowledge among clinicians and patients, despite strong evidence-based recommendations for improving concussion outcomes,” she said.
“Australians are asking for more consistency in care. This new model of care will improve patient outcomes, particularly among vulnerable communities.”
The guidelines will be implemented across Australian and New Zealand healthcare systems through an education initiative called Mind the Gap.
The initiative will include a web-based best-practice care guide for clinicians and patients, and a tool to support shared decision-making.