Editing Concussion (section)

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{{for|concussion (mild traumatic brain injury) in children and adolescents|Pediatric concussion}}
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{{Infobox medical condition (new)
| name          = Concussion
| image         = Concussion mechanics.svg
| alt           = 
| caption       = [[Acceleration]] (g-forces) can exert rotational forces in the brain, especially the [[midbrain]] and [[diencephalon]].
| field         = [[Emergency medicine]], [[neurology]]
| synonyms      = Mild brain injury, mild traumatic brain injury (mTBI), mild head injury (MHI), minor head trauma
| symptoms      = [[Headache]]; trouble with thinking, memory, or concentration; nausea; [[blurry vision]]; sleep disturbances; [[mood changes]]<ref name=NIH2017Sym/> 
| complications = [[Chronic traumatic encephalopathy]], [[Parkinson's disease]], [[Depression (mood)|depression]], [[post-concussion syndrome]]
| onset         = 
| duration      = Up to 4 weeks<ref name=Mah2018/>
| types         = 
| causes        = [[Motor vehicle collisions]], [[falling (accident)|falls]], [[Concussions in sport|sports injuries]], [[bicycle accidents]]<ref name=Cassidy2004/><ref name=NEJM2007/>
| risks         = [[Physical abuse|Physical violence]]s, drinking [[Ethanol|alcohol]], playing contact sports such as [[American football]], playing martial arts such as [[muay thai]], previous history of concussion<ref name=NIH2017Ca/>
| diagnosis     = Based on symptoms<ref name=NIH2017Diag/>
| differential  = 
| prevention    = Head protection equipment, mouth guards, evidence-informed rules and policies for body checking and contact in sport, seat belts, neuromuscular training exercises <ref name=":1" />
| treatment     = Brief period of relative rest, aerobic exercise to increase heart rate 1-2 days after injury, physiotherapy, gradual return to activities such as school and work<ref name=Mah2018/>
| medication    = [[Paracetamol]] (acetaminophen), [[NSAIDs]]<ref name=Mah2018/>
| prognosis     = 
| frequency     = 6 per 1,000 people a year<ref name=Cassidy2004/>
| deaths        = 
}}
<!-- Definition and symptoms -->
A '''concussion''', also known as a '''mild traumatic brain injury''' ('''mTBI'''), is a [[head injury]] that temporarily affects [[brain function]]ing.<ref name="NIH2017Over">{{cite web|title=Traumatic Brain Injury (TBI): Condition Information|url=https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/Pages/default.aspx|website=NICHD|access-date=18 December 2017|archive-date=18 April 2021|archive-url=https://web.archive.org/web/20210418231705/https://www.nichd.nih.gov/health/topics/tbi/conditioninfo|url-status=live}}</ref><!-- quote = injury from an external force that affects the functioning of the brain. --> Symptoms may include headache, dizziness, difficulty with thinking and concentration, sleep disturbances, a brief period of memory loss, brief [[loss of consciousness]], problems with balance, nausea, [[blurred vision]], and [[mood changes]].<ref name="NIH2017Sym">{{cite web |title=What are common TBI symptoms? |url=https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/Pages/symptoms.aspx |url-status=live |archive-url=https://web.archive.org/web/20210318095345/https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/symptoms |archive-date=18 March 2021 |access-date=18 December 2017 |website=NICHD}}</ref><ref name=":2">{{Cite journal |last=Echemendia |first=Ruben J. |last2=Ahmed |first2=Osman Hassan |last3=Bailey |first3=Christopher M. |last4=Bruce |first4=Jared M. |last5=Burma |first5=Joel S. |last6=Davis |first6=Gavin A. |last7=Gioia |first7=Gerry |last8=Howell |first8=David |last9=Fuller |first9=Gordon Ward |last10=Master |first10=Christina L. |last11=van Ierssel |first11=Jacqueline |last12=Pardini |first12=Jamie |last13=Schneider |first13=Kathryn J. |last14=Walton |first14=Samuel R. |last15=Zemek |first15=Roger |date=2023 |title=Introducing the Concussion Recognition Tool 6 (CRT6) |url=https://pubmed.ncbi.nlm.nih.gov/37316214 |journal=British Journal of Sports Medicine |volume=57 |issue=11 |pages=689–691 |doi=10.1136/bjsports-2023-106851 |issn=1473-0480 |pmid=37316214}}</ref> Concussion should be suspected if a person indirectly or directly hits their head and experiences any of the symptoms of concussion.<ref name=":2" /> Symptoms of a concussion may be delayed by 1–2 days after the accident. It is not unusual for symptoms to last 2 weeks in adults and 4 weeks in children.<ref name=":1">{{cite journal |last1=Patricios |first1=Jon S |last2=Schneider |first2=Kathryn J |last3=Dvorak |first3=Jiri |last4=Ahmed |first4=Osman Hassan |last5=Blauwet |first5=Cheri |last6=Cantu |first6=Robert C |last7=Davis |first7=Gavin A |last8=Echemendia |first8=Ruben J |last9=Makdissi |first9=Michael |last10=McNamee |first10=Michael |last11=Broglio |first11=Steven |last12=Emery |first12=Carolyn A |last13=Feddermann-Demont |first13=Nina |last14=Fuller |first14=Gordon Ward |last15=Giza |first15=Christopher C |date=2023 |title=Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022 |url=https://bjsm.bmj.com/lookup/doi/10.1136/bjsports-2023-106898 |journal=British Journal of Sports Medicine |language=en |volume=57 |issue=11 |pages=695–711 |doi=10.1136/bjsports-2023-106898 |pmid=37316210 |issn=0306-3674}}</ref><ref name="Mah2018">{{cite journal | vauthors = Mahooti N | title = Sports-Related Concussion: Acute Management and Chronic Postconcussive Issues | journal = Child and Adolescent Psychiatric Clinics of North America | volume = 27 | issue = 1 | pages = 93–108 | date = January 2018 | pmid = 29157505 | doi = 10.1016/j.chc.2017.08.005 }}</ref> Fewer than 10% of sports-related concussions among children are associated with loss of consciousness.<ref name="Peds2010">{{cite journal | vauthors = Halstead ME, Walter KD | title = American Academy of Pediatrics. Clinical report--sport-related concussion in children and adolescents | journal = Pediatrics | volume = 126 | issue = 3 | pages = 597–615 | date = September 2010 | pmid = 20805152 | doi = 10.1542/peds.2010-2005 | url = http://pediatrics.aappublications.org/content/126/3/597.full | access-date = 2012-07-18 | url-status = live | doi-access = free | archive-url = https://web.archive.org/web/20161118025507/http://pediatrics.aappublications.org/content/126/3/597.full/ | archive-date = 2016-11-18 }}</ref>

<!-- Cause and diagnosis -->
Common causes include [[motor vehicle collisions]], [[falling (accident)|falls]], [[Concussions in sport|sports injuries]], and [[bicycle accidents]].<ref name="Cassidy2004">{{cite journal | vauthors = Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, Kraus J, Coronado VG | display-authors = 6 | title = Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury | journal = Journal of Rehabilitation Medicine | volume = 36 | issue = 43 Suppl | pages = 28–60 | date = February 2004 | pmid = 15083870 | doi = 10.1080/16501960410023732 | doi-access = free }}</ref><ref name="NEJM2007">{{cite journal | vauthors = Ropper AH, Gorson KC | title = Clinical practice. Concussion | journal = The New England Journal of Medicine | volume = 356 | issue = 2 | pages = 166–172 | date = January 2007 | pmid = 17215534 | doi = 10.1056/NEJMcp064645 }}</ref> Risk factors include physical violence, drinking [[ethanol|alcohol]] and a prior history of concussion.<ref name="Mc2017">{{cite journal | vauthors = McCrory P, Meeuwisse W, Dvořák J, Aubry M, Bailes J, Broglio S, Cantu RC, Cassidy D, Echemendia RJ, Castellani RJ, Davis GA, Ellenbogen R, Emery C, Engebretsen L, Feddermann-Demont N, Giza CC, Guskiewicz KM, Herring S, Iverson GL, Johnston KM, Kissick J, Kutcher J, Leddy JJ, Maddocks D, Makdissi M, Manley GT, McCrea M, Meehan WP, Nagahiro S, Patricios J, Putukian M, Schneider KJ, Sills A, Tator CH, Turner M, Vos PE | display-authors = 6 | title = Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016 | journal = British Journal of Sports Medicine | volume = 51 | issue = 11 | pages = 838–847 | date = June 2017 | pmid = 28446457 | doi = 10.1136/bjsports-2017-097699 | doi-access = free | hdl = 2263/61384 | hdl-access = free }}</ref><ref name="NIH2017Ca">{{cite web|title=What causes TBI?|url=https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/Pages/causes.aspx|website=www.nichd.nih.gov|access-date=18 December 2017|archive-date=9 March 2021|archive-url=https://web.archive.org/web/20210309061935/https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/causes|url-status=live}}</ref> The mechanism of injury involves either a direct blow to the head or forces elsewhere on the body that are transmitted to the head.<ref name=Mc2017 /> This is believed to result in [[neuron]] dysfunction, as there are increased [[glucose]] requirements, but not enough [[blood]] supply.<ref name=Mah2018/> A thorough evaluation by a qualified medical provider working in their scope of practice (such as a physician or nurse practitioner) is required to rule out life-threatening head injuries, injuries to the cervical spine, and neurological conditions and to use information obtained from the medical evaluation to diagnose a concussion.<ref name="NIH2017Diag">{{cite web|title=How do health care providers diagnose traumatic brain injury (TBI)?|url=https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/Pages/diagnose.aspx|website=www.nichd.nih.gov|access-date=18 December 2017|archive-date=8 March 2021|archive-url=https://web.archive.org/web/20210308151259/https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/diagnose|url-status=live}}</ref><ref name=Marshall2023>{{cite web |last1=Marshall |first1=S |last2=Lithopoulos |first2=A |last3=Curran |first3=D |last4=Fischer |first4=L |last5=Velikonja |first5=D |last6=Bayley |first6=M |date=2023 |title=Living Concussion Guidelines: Guideline for Concussion & Prolonged Symptoms for Adults 18 years of Age or Older |url=https://concussionsontario.org |access-date=February 2, 2024}}</ref><ref>{{cite journal | vauthors = Silverberg ND, Iverson GL, Cogan A, Dams-O'Connor K, Delmonico R, Graf MJ, Iaccarino MA, Kajankova M, Kamins J, McCulloch KL, McKinney G, Nagele D, Panenka WJ, Rabinowitz AR, Reed N, Wethe JV, Whitehair V, Anderson V, Arciniegas DB, Bayley MT, Bazarian JJ, Bell KR, Broglio SP, Cifu D, Davis GA, Dvorak J, Echemendia RJ, Gioia GA, Giza CC, Hinds SR, Katz DI, Kurowski BG, Leddy JJ, Sage NL, Lumba-Brown A, Maas AI, Manley GT, McCrea M, Menon DK, Ponsford J, Putukian M, Suskauer SJ, van der Naalt J, Walker WC, Yeates KO, Zafonte R, Zasler ND, Zemek R | display-authors = 6 | title = The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury | journal = Archives of Physical Medicine and Rehabilitation | date = May 2023 | volume = 104 | issue = 8 | pages = 1343–1355 | pmid = 37211140 | doi = 10.1016/j.apmr.2023.03.036 | s2cid = 258821806 | url = https://pure.rug.nl/ws/files/854321520/1-s2.0-S0003999323002976-main.pdf }}</ref> [[Glasgow coma scale]] score 13 to 15, loss of consciousness for less than 30 minutes, and memory loss for less than 24 hours may be used to rule out moderate or severe [[traumatic brain injury|traumatic brain injuries]].<ref name=NIH2017Diag/> Diagnostic imaging such as a CT scan or an MRI may be required to rule out severe head injuries.<ref name="Marshall2023" /> Routine imaging is not required to diagnose concussion.<ref name="www.cdc.gov_2020">{{cite web|date=2020-07-28|title=CDC Pediatric mTBI Guideline {{!}} Concussion {{!}} Traumatic Brain Injury {{!}} CDC Injury Center|url=https://www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html|access-date=2020-08-05|website=www.cdc.gov|language=en-us|archive-date=2021-04-17|archive-url=https://web.archive.org/web/20210417045249/https://www.cdc.gov/traumaticbraininjury/PediatricmTBIGuideline.html|url-status=live}}</ref>

<!-- Prevention and treatment -->
Prevention of concussion approaches includes the use of a [[helmet]] and [[Mouthguard|mouth guard]] for certain sporting activities, seatbelt use in motor vehicles, following rules and policies on body checking and body contact in organized sport, and [[neuromuscular training]] warm-up exercises.<ref>{{Cite web |title=Prevention of Concussion, Sport-Related Concussion, Medical Clearance to Return to High-Risk Activities and Sport |url=https://pedsconcussion.com/section/sports/#domain-prevention |access-date=2025-01-13 |website=Living Guideline for Pediatric Concussion Care |language=en-US}}</ref><ref name=":1" /> Treatment of concussion includes relative rest for no more than 1–2 days, aerobic exercise to increase the heart rate and gradual step-wise return to activities, school, and work.<ref name="Mah2018" /><ref name=":1" /> Prolonged periods of rest may slow recovery and result in greater depression and anxiety.<ref name="Mah2018" /><!-- Quote =  prolonged physical and cognitive rest may impede recovery and lead to mood and/or anxiety disorders --> [[Paracetamol]] (acetaminophen) or [[NSAIDs]] may be recommended to help with a headache.<ref name="Mah2018" /> Prescribed aerobic exercise may improve recovery.<ref>{{cite journal | vauthors = Vuu S, Barr CJ, Killington M, Jill G, van den Berg ME | title = Physical exercise for people with mild traumatic brain injury: A systematic review of randomized controlled trials | journal = NeuroRehabilitation | volume = 51 | issue = 2 | pages = 185–200 | date = 2022 | pmid = 35527580 | doi = 10.3233/NRE-220044 | s2cid = 248569748 }}</ref> [[Physiotherapy]] may be useful for persisting balance problems, headache, or whiplash; [[cognitive behavioral therapy]] may be useful for mood changes and sleep problems.<ref name="Mah2018" /> Evidence to support the use of [[hyperbaric oxygen therapy]] and [[chiropractic therapy]] is lacking.<ref name=Mah2018/>

<!-- Epidemiology and prognosis -->
Worldwide, concussions are estimated to affect more than 3.5 per 1,000 people a year.<ref name="Ng2016">{{cite journal | vauthors = Nguyen R, Fiest KM, McChesney J, Kwon CS, Jette N, Frolkis AD, Atta C, Mah S, Dhaliwal H, Reid A, Pringsheim T, Dykeman J, Gallagher C | display-authors = 6 | title = The International Incidence of Traumatic Brain Injury: A Systematic Review and Meta-Analysis | journal = The Canadian Journal of Neurological Sciences. Le Journal Canadien des Sciences Neurologiques | volume = 43 | issue = 6 | pages = 774–785 | date = November 2016 | pmid = 27670907 | doi = 10.1017/cjn.2016.290 | doi-access = free }}</ref> Concussions are classified as mild traumatic brain injuries and are the most common type of TBIs.<ref name=Cassidy2004/><ref name=Ng2016 /> Males and young adults are most commonly affected.<ref name=Cassidy2004/><ref name=Ng2016/> Outcomes are generally good.<ref name="Mer2013Pro">{{cite web|title=Traumatic Brain Injury|url=http://www.merckmanuals.com/professional/injuries-poisoning/traumatic-brain-injury-tbi/traumatic-brain-injury|website=Merck Manuals Professional Edition|access-date=18 December 2017|date=October 2013|archive-date=23 March 2021|archive-url=https://web.archive.org/web/20210323045039/https://www.merckmanuals.com/professional/injuries-poisoning/traumatic-brain-injury-tbi/traumatic-brain-injury|url-status=live}}</ref> Another concussion before the symptoms of a prior concussion have resolved is associated with worse outcomes.<ref>{{cite web|title=Sports-Related Concussion|url=http://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/sports-related-concussion|website=Merck Manuals Consumer Version|access-date=18 December 2017|archive-date=7 May 2021|archive-url=https://web.archive.org/web/20210507102438/https://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/sports-related-concussion|url-status=live}}</ref><ref>{{cite book|collaboration=Institute of Medicine and National Research Council of the National Academies Committee on Sports-Related Concussions in Youth, Board on Children, Youth, and Families|veditors=Graham R, Rivara FP, Ford MA, Spicer CM|title=Sports-related concussions in youth : improving the science, changing the culture|chapter=Consequences of Repetitive Head Impacts and Multiple Concussions |date=2014|publisher=National Academies Press|isbn=978-0-309-28800-2|page=Chapter 5|url=https://www.ncbi.nlm.nih.gov/books/NBK185336/|access-date=18 December 2017|archive-date=15 May 2021|archive-url=https://web.archive.org/web/20210515202154/https://www.ncbi.nlm.nih.gov/books/NBK185336/|url-status=live}}</ref> Repeated concussions may also increase the risk in later life of [[chronic traumatic encephalopathy]], [[Parkinson's disease]] and [[Mood disorder|depression]].<ref name="Merck2017">{{cite web |work=The Merck Manual Home Health Handbook |url=http://www.merckmanuals.com/home/injuries_and_poisoning/head_injuries/concussion.html?qt=&sc=&alt= |title=Concussion |date=January 2008 |author=Kenneth Maiese |access-date=2012-07-03 |archive-date=2014-12-02 |archive-url=https://web.archive.org/web/20141202131323/http://www.merckmanuals.com/home/injuries_and_poisoning/head_injuries/concussion.html?qt=&sc=&alt= |url-status=live }}</ref>
[[File:Traumatic Brain Injury (TBI) in Kids.webm|thumb|upright=1.3|Video explanation of concussions in children<ref>{{cite web |title=Traumatic Brain Injury (TBI): Condition Information |url=https://www.nichd.nih.gov/health/topics/tbi/conditioninfo/default |website=National Institute of Child Health and Human Development |access-date=1 June 2018 |archive-date=18 April 2021 |archive-url=https://web.archive.org/web/20210418231705/https://www.nichd.nih.gov/health/topics/tbi/conditioninfo |url-status=live }}</ref>]]