Patient discussions

Provide both verbal and printed advice for people with a head injury, and their families and carers, and ensure that this is age appropriate. Printed advice should include:[42]

  • Details of the nature and severity of the injury.

  • Risk factors, signs and symptoms that mean people need to return to the emergency department such as focal weakness, persistent or worsening headache or vomiting, decrease in consciousness, rhinorrhoea, otorrhoea, or agitation.

  • A specification that a responsible adult should stay with the person for the first 24 hours after their injury.

  • Details about the recovery process, including the fact that some people may appear to make a quick recovery but later have difficulties or complications. During your discussion, patients can be advised that confusion typically clears within 24 hours in cases of uncomplicated mild TBI (i.e., no brain lesions found on CT scan) diagnosed in the emergency room.[76]​ Mild symptom exacerbation during physical activity, during prescribed aerobic exercise treatment, or during cognitive activity is typically brief (under an hour) and does not delay recovery.[7]​ Post-concussion symptoms, including somatic (e.g., headaches, dizziness), cognitive (e.g., poor attention and memory), and emotional (e.g., irritability, depression), gradually resolve in most patients with mild TBI during the 12 weeks following injury.[76]​ A subset of patients may have ongoing symptoms. For further details, see Prognosis.

  • Contact details of community and hospital services in case of delayed complications.

  • Information about return to everyday activities, including school, work, sports, and driving, and details of support organisations. Written/verbal advice may include to gradually return to normal activities, including school, work, sports, and driving, as tolerated and in a stepwise fashion.[4][7]​​[90]​​​[110]Physical activity and cognitive exertions (including screen time) should be stopped if symptom exacerbation is more than mild and brief, and may be resumed once symptoms have returned to pre-injury levels.[7]

  • Details about supporting organisations.

Offer information and advice on alcohol or drug misuse to people who presented to the emergency department with drug or alcohol intoxication when they are fit for discharge.[42]

Inform patients with a head injury, and their families and carers, about the possibility of persistent or delayed symptoms after a head injury and who to contact if they have ongoing problems.[42]

In addition, advise the patient and/or family/carers to:

  • Temporarily discontinue activities that present a risk of additional head injury and consequently second impact syndrome.[4]​ Specifically, to mitigate the risk of repeated mild TBI, patients should be counselled to not return to activities that involve a relatively high risk of head impact exposure (e.g., collision sports) until they are clinically recovered.[90][111][112]​​

  • Take relative rest for the first 24-48 hours after a mild TBI.[7][90]​​[110][113]​​ Complete rest, such as lying in a dark room and avoiding all sensory stimuli (eg, reading, interaction with others etc.) does not accelerate recovery and is therefore not advisable.[7][90]​​​[113][114]​

Headway - the brain injury association: mild head injury and concussion Opens in new window

Give patients self-care advice.

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