Latest Concussion Quality Measurement Set

(July 28, 2021) Concussion represents the immediate and transient symptoms of a mild traumatic brain injury and is defined as a clinical syndrome of biomechanically induced alteration of brain function (Rose et al., 2021).

There is no denying- concussion result in a tremendous economic burden, especially for those individuals whose symptoms linger long after the injury. The 12 months following a concussion, rack up on average $13,564 in concussion-related expenses.

A few things we know for certain:

• Approximately 20-30% of children will experience a delayed return to baseline following a concussion

• Females have a higher likelihood of being faced with lingering concussive symptoms.

• Persistent post-concussion symptoms are associated with significant morbidity; children with persistent symptoms after all-cause concussion report lower quality of life than many other childhood chronic diseases including cancer, end-stage renal disease, and cerebral palsy.

A recent study was conducted by a group of physicians with the end goal of developing evidence based measures to support the delivery of high quality care and to improve patient outcomes.

Ultimately the group agreed upon 3 quality measures, following a concussion, in both the acute and chronic time frame.

1. Concussion Symptoms Evaluation

2. Appropriate Neurological Exam

3. Documentation of return to play strategy or protocol

1. Concussion Symptoms Evaluation

The assessment of subjective symptoms of concussion is foundational to both the diagnosis and management of concussion. Concussion is a “clinical syndrome”, and many patients do not have outward signs of a concussion (i.e. loss of consciousness, imbalance). Therefore, clinicians rely on the patient’s report of symptoms to establish the diagnosis and track recovery. However, symptoms may be diverse and numerous (Rose et al., 2021).

2. Appropriate Neurological Exam

Concussion can cause many different exam abnormalities, but the following exam elements are most commonly affected: cognitive function, vestibular function, extraocular movements, gait, balance, and coordination. Providers who diagnose and manage patients with concussion must be proficient in the identification of abnormal neurological exam findings. Exam abnormalities referable to concussion should be tracked on subsequent examinations until they resolve, but focal exam abnormalities should prompt additional testing such as neuroimaging (Rose et al, 2021).

3. Documentation of return to play strategy or protocol

Following a concussion, there is a window of time wherein a subsequent head impact could prove devastating. To safely return to a contact sport, or other potentially harmful activity, patients with concussion are required to gradually increase physical activity in a series of planned steps. This “return-to-play” progression is intended to test the brain under progressive exertion and, if completed without a return of neurologic signs or symptoms, suggests that the concussion has resolved (Rose et al., 2021).

This measurement set focus on 2 of the most relevant components in the diagnosis of concussion: assessment of symptoms and performance of a neurological exam. The 3rd measured component address the clearance of patients for at risk activities such as contact sport.