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CNS Publishes New Concussion Guidelines

By CNS Spotlight, Concussion, Cross Post, GuidelinesNo Comments

Published online in Neurosurgery, the official journal of the Congress of Neurological Surgeons (CNS), in August, the “Concussion Guidelines Step 2: Evidence for Subtype Classification,” provides support for re-thinking the way we diagnose concussion.

Angela K. Lumba-Brown, MD, co-director of the Stanford Brain Performance Center, Assistant Professor of Emergency Medicine at Stanford University, and co-author of the guideline, states that because concussion symptoms may vary greatly from person to person, early subtyping can direct strategies for recovery.

The study represents the work of a multidisciplinary team of experts across the country, unified to define five common concussion subtypes:

1. Headache/Migraine
2. Vestibular
3. Cognitive
4. Oculomotor
5. Anxiety/Mood

Notably, two concussion-associated conditions — sleep disturbance and cervical strain — often occur in relation to subtypes, but do not stand alone as concussion diagnostic criteria.

Through a rigorous review of the scientific literature and meta-analysis, the expert workgroup identified differences in the prevalence of each subtype shortly following head injury. Studying the first few days following a concussion is critical because the majority of scientific literature to-date examines concussion signs and symptoms spanning the first week to a month following injury, during which large variability in recovery patterns occur.

  • This study provides support for the presence of all five subtypes as early as three days following injury — directing an urgent change in the way concussion is currently diagnosed. For example:
    Anxiety and mood symptoms, often thought to manifest much later in the concussion course, are present in a large portion of patients early on.
  • Both children and adults exhibit vestibular impairments immediately following a concussion, representing an opportunity for early intervention with vestibular therapies.

This work demonstrates that a comprehensive, initial concussion assessment should incorporate evaluations of all five subtypes and two associated conditions. This work was supported by the Brain Trauma Evidence-Based Consortium, a U.S. Department of Defense-funded project in collaboration with the Brain Performance Center at Stanford University and the Brain Trauma Foundation.

To read the full Neurosurgery article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #CNSGuidelines.

AANS and CNS Unveil 2014 Legislative Agenda

By Access to Care, Antitrust, Coding and Reimbursement, Congress, Emergency Care, Fraud and Abuse, GME, Guidelines, Health, Healthcare Costs, HIT, IPAB, Medicaid, Medical Innovation, Medical Liability, Medical Research, Medicare, Patient Safety, Quality Improvement, SGR, Workforce ShortageNo Comments

Earlier this year, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) released its 2014 legislative agenda, which includes action items such as abolishing the…

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