Os pacientes com traumatismo cranioencefálico e seus familiares e prestadores de cuidados devem receber aconselhamento na alta, verbal e impresso, que seja apropriado à idade e inclua:[65]National Institute for Health and Care Excellence. Head injury: assessment and early management. May 2023 [internet publication].
https://www.nice.org.uk/guidance/ng232
Detalhes da natureza e da gravidade da lesão
Sinais de alerta para buscar atendimento médico, incluindo quando retornar a um pronto-socorro,
Uma especificação de que um adulto responsável deve permanecer com o paciente durante as primeiras 24 horas após a lesão
Detalhes sobre o processo de recuperação, incluindo o fato de que algumas pessoas podem parecer ter uma recuperação rápida, mas depois apresentam dificuldades ou complicações,
Infoações de contato dos serviços comunitários e hospitalares em caso de complicações tardias,
Informações sobre o retorno às atividades cotidianas, incluindo escola, trabalho, esportes e condução de veículos
Informações sobre instituições de apoio.
Recomenda-se repouso relativo durante as primeiras 24-48 horas após uma lesão cerebral traumática leve (LCTL).[5]Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med. 2023 Jun;57(11):695-711.
https://bjsm.bmj.com/content/57/11/695
http://www.ncbi.nlm.nih.gov/pubmed/37316210?tool=bestpractice.com
[89]Silverberg ND, Iaccarino MA, Panenka WJ, et al. Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Arch Phys Med Rehabil. 2020 Feb;101(2):382-93.
https://www.archives-pmr.org/article/S0003-9993(19)31305-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/31654620?tool=bestpractice.com
[90]Lumba-Brown A, Yeates KO, Sarmiento K, et al. Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatr. 2018 Nov 1;172(11):e182853.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006878
http://www.ncbi.nlm.nih.gov/pubmed/30193284?tool=bestpractice.com
[93]Schneider KJ, Leddy JJ, Guskiewicz KM, et al. Rest and treatment/rehabilitation following sport-related concussion: a systematic review. Br J Sports Med. 2017 Jun;51(12):930-34.
https://bjsm.bmj.com/content/51/12/930
http://www.ncbi.nlm.nih.gov/pubmed/28341726?tool=bestpractice.com
O descanso completo, como ficar deitado em um quarto escuro e evitar todos os estímulos sensoriais (por exemplo, leitura, interação com outras pessoas, etc.) não acelera a recuperação e, portanto, não é aconselhável.[5]Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med. 2023 Jun;57(11):695-711.
https://bjsm.bmj.com/content/57/11/695
http://www.ncbi.nlm.nih.gov/pubmed/37316210?tool=bestpractice.com
[89]Silverberg ND, Iaccarino MA, Panenka WJ, et al. Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Arch Phys Med Rehabil. 2020 Feb;101(2):382-93.
https://www.archives-pmr.org/article/S0003-9993(19)31305-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/31654620?tool=bestpractice.com
[93]Schneider KJ, Leddy JJ, Guskiewicz KM, et al. Rest and treatment/rehabilitation following sport-related concussion: a systematic review. Br J Sports Med. 2017 Jun;51(12):930-34.
https://bjsm.bmj.com/content/51/12/930
http://www.ncbi.nlm.nih.gov/pubmed/28341726?tool=bestpractice.com
[94]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 Rehabil. 2013 Jul-Aug;28(4):250-9.
http://www.ncbi.nlm.nih.gov/pubmed/22688215?tool=bestpractice.com
Após um período inicial de repouso relativo e estabilização dos sintomas, os pacientes devem ser encorajados a retomarem gradualmente para as atividades diárias normais (incluindo o tempo de tela), conforme toleradas.[5]Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med. 2023 Jun;57(11):695-711.
https://bjsm.bmj.com/content/57/11/695
http://www.ncbi.nlm.nih.gov/pubmed/37316210?tool=bestpractice.com
[89]Silverberg ND, Iaccarino MA, Panenka WJ, et al. Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Arch Phys Med Rehabil. 2020 Feb;101(2):382-93.
https://www.archives-pmr.org/article/S0003-9993(19)31305-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/31654620?tool=bestpractice.com
[90]Lumba-Brown A, Yeates KO, Sarmiento K, et al. Centers for Disease Control and Prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatr. 2018 Nov 1;172(11):e182853.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006878
http://www.ncbi.nlm.nih.gov/pubmed/30193284?tool=bestpractice.com
Diretrizes específicas devem ser consultadas para se obterem orientações detalhadas sobre o retorno à escola, aos esportes e ao serviço militar.[5]Patricios JS, Schneider KJ, Dvorak J, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med. 2023 Jun;57(11):695-711.
https://bjsm.bmj.com/content/57/11/695
http://www.ncbi.nlm.nih.gov/pubmed/37316210?tool=bestpractice.com
[89]Silverberg ND, Iaccarino MA, Panenka WJ, et al. Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Arch Phys Med Rehabil. 2020 Feb;101(2):382-93.
https://www.archives-pmr.org/article/S0003-9993(19)31305-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/31654620?tool=bestpractice.com
[95]McCulloch KL, Goldman S, Lowe L, et al. Development of clinical recommendations for progressive return to activity after military mild traumatic brain injury: guidance for rehabilitation providers. J Head Trauma Rehabil. 2015 Jan-Feb;30(1):56-67.
https://journals.lww.com/headtraumarehab/fulltext/2015/01000/development_of_clinical_recommendations_for.7.aspx
http://www.ncbi.nlm.nih.gov/pubmed/25563414?tool=bestpractice.com
Para mitigar o risco de LCT leve e repetida, os pacientes devem ser aconselhados a não retornarem a atividades que envolvam um risco relativamente alto de exposição ao impacto na cabeça (por exemplo, esportes de colisão) até que estejam clinicamente recuperados.[89]Silverberg ND, Iaccarino MA, Panenka WJ, et al. Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Arch Phys Med Rehabil. 2020 Feb;101(2):382-93.
https://www.archives-pmr.org/article/S0003-9993(19)31305-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/31654620?tool=bestpractice.com
[91]Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013 Jun 11;80(24):2250-7.
https://n.neurology.org/content/80/24/2250
http://www.ncbi.nlm.nih.gov/pubmed/23508730?tool=bestpractice.com
[92]McCrory P, Meeuwisse W, Dvořák 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 Jun;51(11):838-47.
http://bjsm.bmj.com/content/51/11/838.long
Centers for Disease Control and Prevention: HEADSUP
Opens in new window