Concussions: A Succinct Clinical Picture

To the Editor:

I read with interest the article by Drs Wright and Islas ¹ describing concussion in wilderness settings. Colleagues practicing in both wilderness and more standard clinical milieus might benefit from the conclusions from a recent literature analysis. ² Carney et al ² found that the only finding required for the diagnosis is immediate disorientation or confusion. Other findings may occur during the following days (Table). Their results also suggest that although more than half of concussed patients (58%) have cognitive deficits (including reaction time, memory, and attention/processing speed/working memory) on day 1, that decreases to 8% on day 7.

Table

Concussion clinical findings

Observed and documented disorientation or confusion immediately after the event Impaired balance within 1 day after injury Slower reaction time within 2 days after injury, OR Impaired verbal learning and memory within 2 days after injury