Monitoring
Refer people with a head injury to investigate its causes and manage contributing factors, if appropriate. This could include, for example, referral for a falls assessment or to safeguarding services.[42]
The appearance of psychiatric symptoms must be taken seriously and treated immediately, referring to a neurologist, psychiatrist, or psychologist when necessary. A subset of patients may have ongoing physical and cognitive symptoms. Consider referring people who have persisting problems to a clinician trained in assessing and managing the consequences of traumatic brain injury (for example, a neurologist, neuropsychologist, clinical psychologist, neurosurgeon or endocrinologist, or a multidisciplinary neurorehabilitation team).[42]
Neuropsychological testing involves paper-and-pencil or computerised tests assessing attention, memory, and executive functions, as well as reaction times. Referral for cognitive (psychometric) assessment is not routinely recommended after mild traumatic brain injury, and careful assessment of the nature of the injury and symptoms, including bedside cognitive tests is more appropriate in the first instance.[46][51] Cognitive performance can be affected by stress, fatigue, effort, and medications and therefore, if testing is required, neuropsychological evaluations should be carried out by trained neuropsychologists who can disentangle the effects of these factors from the consequences of mild traumatic brain injury (TBI). Most guidelines on sport-related concussion support the use of neuropsychological testing to diagnose the effects of mild TBI, help make return-to-play decisions for athletes, and monitor recovery.[7][109]
It is important to ensure that an appropriate amount of time has passed between testing sessions to guard against practice effects and uphold test validity. Although neuropsychological tests are an important component of mild TBI assessment, they should not be the only benchmark in making decisions about recovery from a mild TBI.
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