Concussion grading (Cantu)
Info
Loss of consciousness? None <1 minute >=1 minute
Post Traumatic Amnesia (Antero or Retrograde)? <30 minutes >=30 minutes - <24 hours >=24 hours
Post concussion signs/symptoms other than amnesia? <24 hours (or None) >=24 hours - <7 days >=7 days
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Concussion Severity
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Concussion grading (Cantu)

Minor Head Trauma (MHT) and concussion are somewhat interchangeably used. A definition of concussion, is an affect on the brain due to traumatic biomechanical forces that results in temporary impairment of neurological function, self resolves and results in no abnormalities on neuroimaging.

The definition of Minor Head Trauma is:

  • Glasgow Coma Scale >12

PLUS 1 or both of the following:

  • History of loss of consciousness (LOC)
  • Posttraumatic amnesia

Recommendations for return to sport that could risk further head trauma include consideration of:

  • Death from second-impact syndrome
  • Permanent neurologic impairment from repetitive head trauma
  • Post-concussion syndrome

Cantu Evidence-Based Grading System for Concussion

Grade Description
Grade 1
  • No LOC
  • PTA <30 minutes
  • PCSS <24 hours
Grade 2
  • LOC <1 minute OR
  • PTA >=30 minutes OR
  • PCSS >=24 hours and <7 days
Grade 3
  • LOC >=1 minute OR
  • PTA >=24 hours OR
  • PCSS >=7 days

LOC = Loss of consciousness

PTA = Posttraumatic amnesia (anterograde/retrograde)

PCSS = Post concussion signs/symptoms other than amnesia

PCSS symptoms may include:

  • Confusion
  • Difficulty with concentration
  • Dizziness
  • Fatigue
  • Headache
  • Irritibility/Personality change
  • Memory difficulties
  • Nausea
  • Sleep disturbances
  • Tinnitus
  • Visual changes
  • Vomiting

References:

  1. Anderson T, Heitger M, Macleod AD. Concussion and mild head injury. Practical Neurology . 2006;6:342-57.
  2. Atabaki SM, Stiell IG, Bazarian JJ, et al. A Clinical Decision Rule for Cranial Computed Tomography in Minor Pediatric Head Trauma. Arch Pediatr Adolesc Med . 2008;162(5):439-45.
  3. Cantu RC, Aubry M, Dvorak J, et al. An overview of concussion consensus statements since 2000. Neurosurgical Focus . 2006 Oct;21:1-6.
  4. Harmon KG. Assessment and Management of Concussion in Sports. Am Fam Physician . 1999;60:887-92.
  5. Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommitte. Neurology . 1997;48-581-5.