Thread by @PEMatCHOP

#Concussion Week! 🧵
Our first goals – review symptoms and accurate diagnosis.

Make sure to view the whole thread for some great videos to enhance your physical exam!

Symptoms:
Concussion symptoms can be grouped into 4 areas:
- Physical
-Sleep
-Cognitive
-Emotional

Symptom Review
Physical: HA, n/v, dizziness, balance and vision problems, photo/phonophobia
Sleep: Difficulty falling/staying asleep, sleeping more
Cognitive: Difficulty concentrating, remembering, feeling slow and foggy
Emotional: irritability, anxiety, depression, mood changes

Any robust diagnosis is supported by the physical exam. In #concussion, vestibular testing is critical . One battery is the visio-vestibular exam (VVE). VVE is reliable from the #ED and accurately distinguishes concussed v. non-concussed.

pubmed.ncbi.nlm.nih.gov/32745919/

Physical Exam Pearls Alert! View below to enhance the quality of your #concussion PE.

There are multiple components to the exam. The 1st tests for smooth pursuits.

Next you evaluate horizontal and vertical saccades

An exam wouldn’t be complete without evaluating horizontal and vertical gaze stability

Testing for convergence can be performed using any object with writing on it

In testing for monocular accommodation, a pt holds object with letters at arm’s length with 1 eye covered, brings toward face until becomes BLURRY. Repeat w/ opposite eye

It's abnormal if letters become blurry at (must measure!):
≥ 10 cm for kids <= 12
≥ 12 cm for kids >= 13

And you can conclude your testing with a tandem gait analysis

You can view the full #concussion #physicalexam video, here:

So why do this?
Earlier dx from the #ED matters. Those diagnosed at 1st visit have a shorter recovery than those w/ multiple visits until dx.
All of these skills are important for school and known deficits can help tailor school accommodations
pubmed.ncbi.nlm.nih.gov/33036827/

And last but not least, the VVE is highly predictive of prolonged recovery
pubmed.ncbi.nlm.nih.gov/29064869/

We hope this was helpful in tailoring your #concussion physical exam in the acute setting. Please share and tune in tomorrow for more important information during Concussion Week!

@CIRPatCHOP @PennNeurology @PennInjury @savir_org @ConcussionAlly @ShiftConcussion @CHOP_Research @UPennTrauma @UPennEM