Heads Up to Schools: Know Your ABCs — for School Nurses Centers for Disease Control and Prevention Page 1 of 3

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  Dr. James Kelly is professor of Neurosurgery and Physical Medicine and Rehabilitation at the University of Colorado Denver School of Medicine and associate director of the Colorado Area Health Education Center System. This is BrainLine's exclusive interview with Dr. Kelly recorded on July 11, 2008. Transcript of the program here.
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What is a concussion?

A concussion is a type of brain injury that changes the way the brain normally works. A concussion is caused by a bump, blow, or jolt to the head. Concussions can also occur from a fall or blow to the body that causes the head and brain to move rapidly back and forth. Even what seems to be a mild bump to the head can be serious.

How can I recognize a concussion?

To help you recognize a concussion, ask the injured student or witnesses of the incident about:

1. Any kind of forceful blow to the head or to the body that resulted in rapid movement of the head, AND
2. Any change in the student’s behavior, thinking, or physical functioning. (See the signs and symptoms of concussion.)

How can concussions happen in schools?

Children and adolescents are among those at greatest risk for concussion. Concussions can result from a fall, or any time a student’s head comes into contact with a hard object, such as the floor, a desk, or another student’s head or body. The potential for a concussion is greatest during activities where collisions can occur, such as during physical education (PE) class, playground time, or school-based sports activities.

Students may also get a concussion when doing activities outside of school, but then come to school when symptoms of the concussion are presenting. For example, adolescent drivers are at increased risk for concussion from motor vehicle crashes.

Concussions can have a more serious effect on a young, developing brain and need to be addressed correctly. Proper recognition and response to concussion symptoms in the school environment can prevent further injury and can help with recovery.

What are the signs and symptoms of concussion?

Students who experience one or more of the signs and symptoms listed below after a bump, blow, or jolt to the head or body should be referred to a health care professional experienced in evaluating for concussion.

There is no one single indicator for concussion. Rather, recognizing a concussion requires a symptom assessment. The signs and symptoms of concussion can take time to appear and can become more noticeable during concentration and learning activities in the classroom. For this reason, it is important to watch for changes in how the student is acting or feeling, if symptoms become worse, or if the student just “doesn't feel right.”

Signs observed by school nurses

• Appears dazed or stunned
• Is confused about events
• Answers questions slowly
• Repeats questions
• Can’t recall events prior to the hit, bump, or fall
• Can’t recall events after the hit, bump, or fall
• Loses consciousness (even briefly)
• Shows behavior or personality changes

Symptoms reported by the student

Thinking/Remembering

• Difficulty thinking clearly
• Difficulty concentrating or remembering
• Feeling more slowed down
• Feeling sluggish, hazy, foggy, or groggy

Physical

• Headache or “pressure” in head
• Nausea of vomiting
• Balance problems or dizziness
• Fatigue or feeling tired
• Blurry or double vision
• Sensitivity to light or noise
• Numbness or tingling
• Does not “feel right”

Emotional

• Irritable
• Sad
• More emotional than usual
• Nervous

Sleep*

• Drowsy
• Sleeps less than normal
• Sleeps more than normal
• Has trouble falling asleep

*Only ask about sleeping symptoms if the injury occurred on a prior day.

Remember, you can’t see a concussion and some students may not experience or report symptoms until hours or days after the injury. Most young people with a concussion will recover quickly and fully. But for some, concussion signs and symptoms can last for days, weeks, or longer.

What are concussion danger signs?

In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. The student should be taken to an emergency department right away if s/he exhibits any of the following danger signs after a bump, blow, or jolt to the head or body:

• One pupil larger than the other
• Is drowsy or cannot be awakened
• A headache that gets worse and does not go away
• Weakness, numbness, or decreased coordination
• Repeated vomiting or nausea
• Slurred speech
• Convulsions or seizures
• Cannot recognize people or places
• Becomes increasingly confused, restless, or agitated
• Has unusual behavior
• Loses consciousness (even a brief loss of consciousness should be taken seriously)

What can school nurses and school professionals do?

Below are steps for you to take when a student comes to your office after a bump, blow, or jolt to the head or body.

• Observe student for signs and symptoms of concussion for a minimum of 30 minutes.
• Complete the Concussion Signs and Symptoms Checklist and monitor students consistently during the observation period. The form includes an easy-to-use checklist of signs and symptoms that you can look for when the student first arrives at your office, fifteen minutes later, and at the end of 30 minutes, to determine whether any concussion symptoms appear or change.

From the Centers for Disease Control and Prevention. www.cdc.gov.

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