Return-to-play (RTP) recommendation tool following a

concussion

3 key questions

(Must be completed by a MD or a professional authorised in the context of a medically supervised

concussion management protocol)

Are all the symptoms that initially suggested the

presence of a concussion completely resolved?

YES

NO

Was a complete and unrestricted return to a full day

of school achieved without recurrence of symptoms?

YES

NO

YES

NO

Were vigorous endurance and resistance physical

activities performed without recurrence of
symptoms?

RECOMMENDATION A: If all answers are YES, RTP

without restriction can be authorised:
-

However, the presence of one or more aggravating

factors (table 2) can justify further delay before RTP
or require a referral to a specialised concussion
clinic (table 3).
The presence of a more restrictive concussion
management protocol in the patients sport
environment has priority over this
recommendation.

If one or more of the responses is NO, but symptoms do not increase

and have been present for less than 10 days:
RECOMMENDATION B:
No immediate RTP;
Provide and explain return-to-learn and return-to-play
recommendations;
Plan follow-up visit in the event symptoms increase or persist
more than 10 days after the injury without improvement.
If one or more of the responses is NO and symptoms increase or have
been present for more than 10 days without improvement:
RECOMMENDATION C:
No immediate RTP;
Plan follow-up visit and consider referral to a specialised
environment;
Evaluate the possibility of associated conditions.

Circle the recommendation made:

Comment :
__________________________________________________________________________________________
______

Name : ____________________________________
______________________

Licence #: _________________ Date :

Table 1: Symptoms suggesting the presence of a concussion.

Headache
Dont feel right
Pressure in head
Difficulty concentrating
Neck Pain
Difficulty remembering
Nausea or vomiting
Fatigue or low energy
Dizziness
Confusion
Blurred vision
Drowsiness
Balance problems
Trouble falling asleep
Sensitivity to light
More emotional
Sensitivity to noise
Irritability
Feeling slowed down
Sadness
Feeling like in a fog
Nervous or Anxious
Note: These symptoms are not specific to concussions and can sometime be present in some people even
in the absence of a concussion. The decision should therefore be based on the resolution of the
symptoms that led to the identification of the concussion. (Source: SCAT 3)
Table 2: Modifying factors that should be considered in the management of a concussion: the
presence of one or more of the following factors can justify a more conservative management of a
concussion or a referral to a specialised environment*. (adapted from McCrory et al. 2013)
Symptoms:
Signs:
Sequelae:
Temporal:

Number, Duration (>10 days), Severity

Prolonged loss of consciousness (LOC) (>1 min), Amnesia
Concussive convulsions
Frequency (repeated concussions over time) Timing (injuries close together in time),
Recency (recent concussion or traumatic brain injury (TBI)
Threshold:
Repeated concussions occurring with progressively less impact force or slower
recovery after each successive concussion
Age:
Child and adolescent (<18 years old)
Comorbidities: Migraine, depression or other mental health disorders, attention deficit hyperactivity
disorder (ADHD), learning disabilities (LD), sleep disorders
Medication:
Psychoactive drugs, anticoagulants
Behaviour :
Dangerous style of play
Sport:
High-risk activity.
Table 3: Referral to specialised concussion clinics for the management of concussions:
-

Following a concussion, patients with prolonged symptoms or other modifying factors can benefit
from a multidisciplinary evaluation in a specialised environment.
Such an evaluation can better document the cognitive impairment associated with the concussion and
assess the presence of associated conditions such as headaches resulting from cervical spine
problems, vestibular (balance) system or psychological conditions that results in anxiety or depressive

symptoms.
The results of such an evaluation will assist in a personalised intervention plan that will address the
individual needs.
Specialised environments should provide or have timely access to licenced health professionals with
experience and expertise in a spectrum of clinical disciplines including medicine, rehabilitation and
neuropsychology.