What is the Grady Concussion Project?
- In an effort to improve the rate of evaluation for patients with a possible mTBI an EPIC-based screen, Alert, and SMARTFORM will be used to aid patient evaluations
What will you see?
- An Alert will inform you that your Patient has Screened positive for a possible concussion during triage
- The alert will inform you of the Dot Phrase you can use to trigger the Concussion Smart Form
- This Smart Form will also automatically be available for certain Cheif Complaints (i.e MVC, Assault, Fall)
Nursing Triage Screen
mTBI Smart Form
- mTBIs affect the brain globally and as such an exam investigating their presence and severity are going to investigate larger (less focal) brain functions
- Visual Ocular Motor system
- Gait & Balance
Gait & Balance
Vestibular Ocular Motor Exam
Gait and Balance
Purpose: Assess the patient's ability to integrate sensory and motor domains to maintain body position
Exam Conditions: Have the patient standing.
Actions: Initially assess the ability of the patient to maintain their body position for ~10 seconds while standing in their normal stance(feet approximately shoulder width apart). This is done once with the patient's eyes open and once with their eyes closed. Further testing is based upon the ability of the patient. The exam can be made more difficult by place the feet together, one in front of the other(tandem), or lifting one off of the floor. Whichever level of exam variations that is used it should be attempted with the patient's eyes open and closed.
Abnormal: An inability of the patient to maintain their body position
Purpose: Assess the patient's ability to integrate sensory and motor domains to generate coordinated movements
Exam Conditions: Have the patient standing with room to walk at least 10 feet straight forward
Actions: Initially have the patient walk in a straight line with their eyes open. After walking a few steps, have the patient turn 180 degrees and walk back to their starting position. This exam can be repeated with the patient's eyes open and eyes closed. For more advanced gait testing have the patient walk heel to toe (tandem) forwards and then return walking heel to toe backwards. This tandem forwards and backwards gait can also be completed with the patient's eyes open or closed.
Abnormal: Unstable gait or if the patient required adjustment to maintain their balance or direction
Purpose: Understand the cognitive ability of the patient at the time of the exam.
Exam Conditions: Patient awake and alert enough to cooperate
Actions: Portions of this exam can vary from an informal evaluation to a formal evaluation.
1. Informal: Note how the patient interacts with their care team. Do they repeat themselves often, answer questions slowly, or have an inability to concentrate?
2. Abbreviated: serial 7s from 100 to 65 for ages >14, serial 3’s for ages 8-13; and serial 1’s ages 6-7
3. Full length Validated testing: Mini-Mental status exam or Standardized Assessment of Concussion (SAC)Link to the right ->>
1. Based on clinicians observation
2. More than 4 errors (wrong subtraction, lengthy delays, loss of place) is considered abnormal.
3. Follow formal criteria noted in the document to the right -->