Jordan Wackett MD, MPH, Joshua Kornegay, MD, Craig Rudy, MD

The most recent recommendation from the Concussion in Sport Group calls for 24-48 hours of rest and a graded return to activity (unrestricted once asymptomatic)2.

Unfortunately, asymptomatic from a concussion standpoint is not always obvious, which can make the new recommendation difficult to implement as patients may remain symptomatic while adhering to rest. Symptomatology is often multifactorial and they may be instructed to rest despite symptoms from etiologies other than concussion.3

Instructions on concussion follow-up figure

Animal models have demonstrated loss of ionic gradients in the CNS following concussion and reduced cerebral blood flow.5 Increased activity of Na/K ATPase leads to a relative insufficiency in ATP

Molecules in concussion
Upside of early activity in concussion patients header
Phases of concussion

1. McCrory P, Meeuwisse W, Johnston K, et al. Consensus statement on concussion in sport – the Third International Conference on Concussion in Sport held in Zurich, November 2008. Phys Sportsmed. 2009;37(2):141-159.
2. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838-847.
3. Leddy JJ, Haider MN, Ellis M, Willer BS. Exercise is medicine for concussion. Curr Sports Med Rep. 2018;17(8):262-270.
4. De Maio VJ, Joseph DO, Tibbo-Valeriote H, et al. Variability in discharge instructions and activity restrictions for patients in a children’s ED postconcussion. Pediatr Emerg Care. 2014;30(1):20-25.
5. Meier TB, Bellgowan PSF, Singh R, et al. Recovery of Cerebral Blood Flow Following Sports-Related Concussion. JAMA Neurol. 2015;72(5):530.
6. Dech RT, Bishop SA, Neary JP. Why exercise may be beneficial in concussion rehabilitation: A cellular perspective. J Sci Med Sport. 2019;22(10):1090-1096.
7. Thomas DG, Apps JN, Hoffmann RG, et al. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015;135(2):213-223.
8. De Kruijk JR. Effectiveness of bed rest after mild traumatic brain injury: a randomised trial of no versus six days of bed rest. J Neurol Neurosurg Psychiatry. 2002;73(2):167-172.
9. Difazio M, Silverberg ND, Kirkwood MW, et al. Prolonged Activity Restriction After Concussion. Clin Pediatr. 2016;55(5):443-451.
10. Lempke L, Jaffri A, Erdman N. The effects of early physical activity compared to early physical rest on concussion symptoms. J Sport Rehab. 2019;28(1):99-105.
11. Leddy JJ, Haider MN, Ellis MJ, et al. Early Subthreshold Aerobic Exercise for Sport-Related Concussion. JAMA Pediatrics. 2019;173(4):319.
12. Silverberg ND, Iverson GL. Is rest after concussion “the best medicine?” Recommendations for activity resumption following concussion in athletes, civilians, and military service members. J Head Trauma Rehab. 2013;28(4):250-259.

Managing Concussions in Acute Care

Jordan Wackett, MD, MPH

OHSU Department of Emergency Medicine, Emergency Medicine Residency

Craig Rudy, MD

OHSU Department of Emergency Medicine, Emergency Medicine Resident

Joshua Kornegay, MD

Assistant Professor; Associate Residency Program Director; and Simulation Director, OHSU Department of Emergency Medicine
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