Acute Concussion Management with Remove-Reduce/Educate/Adjust-Accommodate/Pace (REAP).

BACKGROUND: With increased concussion awareness and significantly increased numbers of emergency department (ED) visits for pediatric concussion, a seamless process of managing a patient with a concussion can begin in the ED. CASE REPORT: This article demonstrates the effectiveness of the Remove-Reduce/Educate/Adjust-Accommodate/Pace (REAP) concussion management program in the evaluation, management, and return to play of an acutely concussed pediatric patient. The REAP program was developed in Colorado and promotes a multidisciplinary team approach to concussion management. The team consists of parents, teachers, athletic personnel, and clinicians. The patient described in this case report had concussion management initiated in the ED. He was able to successfully return to sports, having recovered from his concussion with the guidance of the Center for Concussion (Centennial, Colorado) staff utilizing the REAP model of care and the currently recommended graduated return-to-play process. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Busy EDs are often the initial point of contact for school-aged patients with concussion. We present a program that we believe represents a good model of patient care with concussion management implemented in the ED and carried through to clearance of the patient.

Eye tracking for classification of concussion in adults and pediatrics.

Introduction: In order to obtain FDA Marketing Authorization for aid in the diagnosis of concussion, an eye tracking study in an intended use population was conducted. Methods: Potentially concussed subjects recruited in emergency department and concussion clinic settings prospectively underwent eye tracking and a subset of the Sport Concussion Assessment Tool 3 at 6 sites. The results of an eye tracking-based classifier model were then validated against a pre-specified algorithm with a cutoff for concussed vs. non-concussed. The sensitivity and specificity of eye tracking were calculated after plotting of the receiver operating characteristic curve and calculation of the AUC (area under curve). Results: When concussion is defined by SCAT3 subsets, the sensitivity and specificity of an eye tracking algorithm was 80.4 and 66.1%, The AUC was 0.718. The misclassification rate (n = 282) was 31.6%. Conclusion: A pre-specified algorithm and cutoff for diagnosis of concussion vs. non-concussion has a sensitivity and specificity that is useful as a baseline-free aid in diagnosis of concussion. Eye tracking has potential to serve as an objective "gold-standard" for detection of neurophysiologic disruption due to brain injury.

Concussion in the emergency department: a review of current guidelines

The annual number of emergency department (ED) visits for traumatic brain injury (TBI) is rising in the United States, with the majority of these visits resulting in a diagnosis of mild traumatic brain injury (mTBI), or concussion. There are limited data to support objective clinical measures to guide the management of concussion, but several guidelines have been published that provide recommendations for evaluation and management of concussion and mTBI. This supplement provides a summary of 2 recently published, consensus-based guidelines and discusses practical aspects of ED management of patients with concussive injuries, including the initial evaluation, diagnostic criteria, assessment tools, and aftercare recommendations.