While concussion is a common type of mild traumatic brain injury (TBI), its signs and symptoms can be subtle and harder to detect than other head injuries (Maas et al., 2022; CDC). This makes diagnosing concussion a challenge without the right concussion assessment tools.
If left untreated, patients have a higher chance of repeat concussions, which can lead to further complications and potentially even increase the risk of chronic illnesses such as Alzheimer's disease (Graham et al., 2022).
So, how does a healthcare professional diagnose concussion? In this article, we cover the common causes of TBI, the signs and symptoms of concussion, and how a concussion is typically diagnosed.
We also discuss ways to improve the patient experience throughout the diagnostic process through computerized cognitive testing. Digital tests evaluate brain function quickly and accurately as compared to traditional screening methods, leading to a more effective treatment process which can improve patient quality of life.
Causes of Traumatic Brain Injury
Some of the common causes of mild TBI or concussion include:
Contact Sports-Related Injuries
Athletes—especially those who play a contact sport like football or hockey—are at a high risk for TBI due to the potential for head impacts in the activities they engage in (Sahler & Greenwald, 2012; Khurana & Kaye, 2012; Clay et al., 2013). For example, a football player might suffer a concussion after colliding with another player in a way that injures their head or neck, and could impair cognitive processing speed, verbal memory, and response inhibition (McCrea et al., 2003; Canseco et al., 2022).
The University of Pittsburgh Medical Center (UPMC) sees about 7,000 concussion patients each year and roughly 70% of them are high school athletes. What's more troubling, however, is that the UPMC estimates as many as half of all concussions may go undetected and untreated.
Car Accidents
There's a reason why people involved in a car accident are checked for concussion, even if they don't have visible head injuries. Sudden stops or collisions can cause the brain to jolt inside the skull, which can cause whiplash and/or concussion (Gil & Decq, 2021). There is considerable overlap between the two conditions.
According to the Centers for Disease Control and Prevention (CDC), motor vehicle accidents account for a significant portion of all reported TBI incidents in the United States, with “motor vehicle crashes accounting for approximately 17% of all TBI-related deaths.”
Workplace Incidents
While TBI and other head injuries can occur in any workplace, research suggests concussion incidents are more frequent in certain industries including construction, trucking, and food service (Konda et al., 2020). Due to the physical nature of these industries, workers may be at a higher risk of falls or injuries.
Other Causes of Concussion and Misconceptions
While athletes, drivers, and manual labor workers more commonly experience concussion, head injuries can happen to anyone. In fact, the CDC found that 32% of all TBI-related hospitalizations in the United States were for individuals aged 75 and older.
Regardless of how a person experiences a head injury, there's a misconception that they only have a concussion if they lose consciousness immediately or shortly afterwards. However, signs and symptoms can vary, and loss of consciousness occurs in only a minority of all concussion cases (Marshall et al., 2017; Tator, 2013) .
It's also possible for a patient to have a concussion and not realize it, perhaps if they are experiencing mild symptoms or attributing symptoms to other causes. This is particularly dangerous if the patient does not receive medical attention and continues to perform regular activities (sports, driving, work, and so on)—leaving them vulnerable to further complications. Without proper diagnosis and management, concussion patients are at risk of further head injury (Haider et al., 2020).
Signs and Symptoms of Concussion
Concussions can present a wide range of symptoms in patients. These symptoms vary depending on the individual and the severity of their head injury, but they often fall into three main categories: cognitive, mental, and physical.
The combination of these symptoms can significantly impact mental status, brain function, and physical well-being, making early medical attention vital for proper management and whole person care.
Cognitive Signs of Concussion
Cognitive symptoms affect a patient’s ability to think, learn, and retain information. Concussion patients may experience difficulty concentrating or focusing on tasks, which can make parts of daily life like work or school challenging.
A study using Creyos (Stafford et al., 2020) to assess cognitive ability in almost 20,000 individuals suggests that concussions are associated with certain deficits in executive function, particularly in the area of inhibitory control. However, it's important to note that cognitive impairments due to concussion can vary depending on the specifics of the injury and the patient's baseline cognitive health.
In general, common cognitive symptoms of concussion (Mavroudis et al., 2024) can include:
- Impaired inhibitory or impulse control
- Trouble paying attention or concentrating
- Difficulty retaining new information
- Memory lapses or disturbances
- Decreased reasoning and problem-solving capabilities
Mental Signs of Concussion
Symptoms of concussion related to mental health can significantly affect a patient's emotional well-being. The same study using Creyos tests (Stafford et al., 2019) found that post-concussion participants reported higher levels of anxiety and depression. These mental health challenges can lead to difficulties in social interactions, personal relationships, and general daily activities.
Common mental signs of concussion may include:
- Feelings of anxiety or depression
- Changes in mood, such as feeling irritable or overly emotional
- Feeling confused or disoriented
- Mental exhaustion or fatigue
Physical Symptoms of Concussion
The physical symptoms of a concussion are often the most noticeable. These symptoms can happen immediately following the injury or develop hours to days afterward. Overall, the physical symptoms of a concussion can be debilitating, leaving patients unable to manage day-to-day tasks without significant difficulty.
Common physical signs of a concussion include:
- Sensitivity to light and noise
- Dizziness and balance problems—which can further impair physical coordination and increase the risk of multiple concussions
- Sleep disturbances, such as difficulty falling asleep or excessive sleepiness
- Headaches, which are often described as persistent or throbbing
- Nausea and vomiting
- Vision problems
- Loss of consciousness in some cases
Concussion Complications
If a concussion is left untreated or is poorly managed, the consequences can potentially be long lasting. Untreated concussions can lead to serious injury and long-term complications, such as:
Second Impact Syndrome
Second impact syndrome (SIS) is a serious condition that can develop from an untreated concussion (McAllister & McCrea, 2017; Committee on Sports-Related Concussions in Youth, 2014). SIS happens when a patient experiences a second concussion before the previous concussion has fully recovered.
The chances of a second impact may increase after the first due to the initial concussion symptoms. Concussion symptoms like dizziness and a loss of coordination increase the chances of a fall, leaving individuals vulnerable to a second head injury. Additionally, depending on the nature of the injury, the second impact can be even more debilitating – potentially interrupting or reversing the progress made from recovery.
Post-Concussion Syndrome
Another complication is post-concussion syndrome (PCS). When a concussion patient experiences persistent headaches, dizziness, memory problems and mood changes for months, it's possible they may have PCS (Permenter et al., 2025). PCS can significantly affect a patient's recovery process and hinder their quality of life if left unaddressed.
Over time, concussion-related complications may evolve into more serious concerns. Ongoing, repeated concussions have been linked to chronic conditions like mild cognitive impairment (MCI) and dementia (Belding et al., 2024).
While research on the exact connection between TBI and MCI is still ongoing, it's best to be cautious and gain a complete understanding of how to properly detect a concussion early, determine the appropriate treatment, and provide careful symptom treatment and pain management to ensure the best possible outcomes for patients.
How is Concussion Diagnosed?
Diagnosing concussion is a complex process. Understanding the symptoms, complications, and impacts of concussion on mental, cognitive, and physical health is just the beginning.
So, how do medical professionals diagnose concussion?
Although many tools exist to assess symptoms of concussion, there's no single test for concussion detection.
A physician might use various concussion assessment tools to understand a patient’s symptoms. Questionnaires allow physicians to efficiently screen a patient.
Examples include:
- The Rivermead Post-Concussion Symptoms Questionnaire (RPQ)
- The Sports Concussion Assessment Tool, or SCAT-6
One of the more common screeners is the acute concussion evaluation (ACE) tool, which is often used to assess concussion symptoms and risk factors, providing a checklist of 22 signs that can affect recovery.
For more intensive testing, a physician might send a patient for neuropsychological testing to evaluate the cognitive impacts of a concussion. Unfortunately, referrals for neuropsychological evaluation can often include long wait times, which can affect the quality of care and outcomes a patient experiences.
Digital cognitive tests are a much more immediate option than neuropsychological evaluation that can measure aspects of cognitive performance and support physicians in making their diagnosis.
Using imaging techniques, like magnetic resonance imaging (MRI) or computed tomography (CT) scans, is another option. Imaging tests and scanning tools can help rule out more serious complications such as severe TBI, skull fractures, brain swelling, or hemorrhaging—all of which require emergency medical intervention. However, they may not be appropriate in all cases as the brain injury from a concussion doesn’t always show up on scans (McCrory et al., 2012).
By measuring aspects of memory, concentration, and coordination, the physician can capture a clearer picture of the patient’s condition and make an accurate diagnosis supported by both objective and subjective measurements.
Can Patients Self-Diagnose Concussion?
Self-diagnosing a concussion is generally discouraged, compared to having the support of a healthcare provider. Without the medical experience to accurately make a concussion diagnosis, patients may risk missing critical signs of more serious brain injuries. Concussion symptoms may not fully emerge right away, making it difficult for patients to connect the symptoms they experience to the concussion impact.
In other scenarios, patients might feel pressure to return to play or regular activity while symptomatic, despite the risk of repeated injury. Reasons cited include not knowing they experienced a concussion, not wanting to let their teammates or coach down, or fears of losing their position or damaging their career (Kroshus et al., 2017).
In the event of a head injury or suspected concussion, patients should seek medical attention immediately. A healthcare provider can perform the necessary assessments and determine if a concussion is present, as well as guide the patient through the appropriate recovery process. Delaying proper medical evaluation could result in complications, and without professional guidance, patients may risk further injury by returning to their regular activities too soon.
How Creyos Can Assist with Concussion Detection and Recovery
Cognitive assessments are valuable tools for concussion diagnosis, and can even play a role throughout the recovery process by tracking changes in cognition over time and monitoring treatment progress. Traditional pen-and-paper screeners and questionnaires tend to have limited sensitivity, are often only able to provide subjective data, and can require a concussion patient to make a potentially difficult trip to the clinic.
Another option, complete neuropsychological examination, may prove to be more accurate. However, a comprehensive exam can take hours to complete and usually requires a referral along with additional appointments and even more travel—disrupting continuity of care and inconveniencing the patient.
Creyos offers a third option: computerized cognitive tests and psychological questionnaires that combine accuracy and convenience. Computerized assessment allows for the measurement of key cognitive functions from the comfort of a TBI patient's home.
One common method to measure PCS is the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), which can help quantify the presence and severity of symptoms from a concussion.
On top of that, Creyos cognitive tests can be completed in minutes, while providing objective data to complement subjective patient self-reports. The combination of both objective and subjective data helps physicians to make well-informed healthcare decisions, enabling accurate concussion diagnoses and efficient treatment plans.
Concussion Baseline Testing
In addition to diagnosis, Creyos cognitive tests can also play a role in baseline testing and recovery management. Baseline testing, conducted before any potential head or brain injuries, is vital to patient care, as it provides a reference point for comparison should a patient experience a concussion.
Concussion Recovery
For concussion recovery, computerized tests are ideal for capturing longitudinal data over time. Because patients don't have to interrupt their daily lives with trips to the clinic, physicians can track their recovery through a convenient process that prioritizes patient-centered care.
Creyos closes the gap between light cognitive screening and extensive neuropsychological exams, while maximizing patient convenience and agency. Here's how Creyos helped optimize workflows at a sports neurology clinic:
How Kerlan-Jobe Retains More Concussion Patients With Creyos
The Kerlan-Jobe Centre is an orthopedic and sports medicine clinic that works with elite athletes and professional teams throughout the United States. Their Centre for Sports Neurology and Pain Medicine was founded by Dr. Williams, with the goal of optimizing brain health and neurological function for all patients interested in the relationship between exercise and the brain.
However, their brain injury and sports-related concussion patients who required cognitive assessments had to be referred out for neuropsychological exams. This caused scheduling and travel demands on patients, and disrupted continuity of care with potential communication gaps between providers.
Looking to optimize their workflow and retain patients in their care, Dr. Williams sought a solution that combined scientifically validated cognitive function testing with immediate and easy-to-interpret results. After evaluating their options, Kerlan-Jobe chose Creyos.
Since partnering with Creyos, Kerlan-Jobe has been able to:
- Reduce referrals by 10% and retain more patients within their care
- Deliver faster cognitive assessments, often with same-day results
- Provide patients with a satisfying healthcare experience that tangibly improves their quality of life
Advancing Concussion Diagnosis with Digital Cognitive Assessments
Diagnosing a concussion can be challenging due its subtle and varied symptoms. At the same time, early detection and treatment are crucial to prevent long-term complications for the patient.
While traditional cognitive screening methods may have limitations, advancements in computerized cognitive testing, such as Creyos, offer a more efficient and accessible patient experience. By streamlining the concussion diagnosis and recovery process with digital cognitive assessments, both healthcare providers and patients benefit from a more effective and convenient path to recovery.