Postconcussion Syndrome in the ED
PCS is a controversial condition, particularly in its protracted form. The absence of objective neurological findings, the variance in duration, severity and presentation as well as the poor understanding of the underlying aetiology have all spawned debate. Despite such speculation, however, the fact remains that the condition can be severe and debilitating, regardless of whether it has an organic or psychogenic derivation.
No individual tool has both the accuracy to reliably predict those at risk and the simplicity to enable its use by busy emergency physicians in the acute setting.
Pre-empting the development of PCS is the key to its management, recognising that all patients who present with head injury are at some risk, with frequency not being proportional to the extent of injury. Head injury advice leaflets that highlight symptoms that patients may experience with some simple mechanisms and strategies for their management may be all that is required for the majority of patients.
There are a number of risk factors for protracted PCS, and these should be taken into account in the ED so that such patients can be referred for early intervention. It may be impractical to review every patient with mTBI, but those at 'high-risk' should be prioritised for optimum management. If potential sufferers were picked up earlier, this would translate to decreased patient morbidity and potential less days off work, less burden on primary care services and decreased benefits claims.
However, risk factors for PCS are often subjective and vague, and more studies are needed to validate objective predictors of PCS (ie, neuropsychiatric testing). PCS definitions, stratification of patients (ie, ED guidelines) and PCS management all need to be standardised so that patients could potentially be prevented from suffering from this often debilitating condition.
Recommendations and Conclusions
PCS is a controversial condition, particularly in its protracted form. The absence of objective neurological findings, the variance in duration, severity and presentation as well as the poor understanding of the underlying aetiology have all spawned debate. Despite such speculation, however, the fact remains that the condition can be severe and debilitating, regardless of whether it has an organic or psychogenic derivation.
No individual tool has both the accuracy to reliably predict those at risk and the simplicity to enable its use by busy emergency physicians in the acute setting.
Pre-empting the development of PCS is the key to its management, recognising that all patients who present with head injury are at some risk, with frequency not being proportional to the extent of injury. Head injury advice leaflets that highlight symptoms that patients may experience with some simple mechanisms and strategies for their management may be all that is required for the majority of patients.
There are a number of risk factors for protracted PCS, and these should be taken into account in the ED so that such patients can be referred for early intervention. It may be impractical to review every patient with mTBI, but those at 'high-risk' should be prioritised for optimum management. If potential sufferers were picked up earlier, this would translate to decreased patient morbidity and potential less days off work, less burden on primary care services and decreased benefits claims.
However, risk factors for PCS are often subjective and vague, and more studies are needed to validate objective predictors of PCS (ie, neuropsychiatric testing). PCS definitions, stratification of patients (ie, ED guidelines) and PCS management all need to be standardised so that patients could potentially be prevented from suffering from this often debilitating condition.
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