Concussion Guidelines for Healthcare Providers: What You Need to Know from the Latest Research

Jun 04, 2025

Whether you’re helping a professional athlete, a weekend warrior, an injured worker, or a senior who slipped at home, concussion management is part of your everyday clinical practice. If you’ve been in the field for a while, you’ve seen firsthand how much things have evolved.

Thirty years ago, we relied on grading systems like the Cantu Classification, Colorado Medical Society Guidelines, and AAN Guidelines. These were based largely on loss of consciousness and symptom duration, criteria we now know don’t reliably predict outcomes. Thankfully, modern concussion guidelines for healthcare providers are more evidence-informed and patient-specific.

In this blog, we’ll review three key resources that can elevate your clinical reasoning and outcomes:

By reviewing all three, you'll gain a deeper understanding of concussion assessment and treatment across populations.

1. Consensus Statement on Concussion in Sport (6th Edition, 2023)

Definition of Concussion:
Sport-related concussion is a traumatic brain injury caused by a direct blow to the head, neck or body resulting in an impulsive force being transmitted to the brain that occurs in sports and exercise- related activities. This initiates a neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change and inflammation affecting the brain. Symptoms and signs may present immediately, or evolve over minutes or hours, and commonly resolve within days, but may be prolonged. No abnormality is seen on standard structural neuroimaging studies (computed tomography or magnetic resonance imaging T1- and T2- weighted images), but in the research setting, abnormalities may be present on functional, blood flow or metabolic imaging studies. Sport- related concussion results in a range of clinical symptoms and signs that may or may not involve loss of consciousness. The clinical symptoms and signs of concussion cannot be explained solely by (but may occur concomitantly with) drug, alcohol, or medication use, other injuries (such as cervical injuries, peripheral vestibular dysfunction) or other comorbidities (such as psychological factors or coexisting medical conditions).

Dizziness Management:

Encourages early, controlled physical activity within 24–48 hours, even if dizziness or other symptoms are present.
Recommends referral to vestibular therapy if dizziness persists.
Uses the SCOAT6, which includes vestibular and balance screening.

Strength of Recommendations:
Several recommendations are consensus-based. For example, the guideline permits a 2/10 symptom increase during rehab, a threshold not based on published research but on expert agreement. This is a conservative safeguard until stronger evidence becomes available.

Best For: Acute concussion care and return-to-play protocols
Limitations: Less guidance for long-term symptoms or non-athletic populations

2. VA/DoD (United States Veteran Affairs/Department of Defense) Clinical Practice Guideline for Post-Acute mTBI (2022)

Definition of Concussion:
An acute brain injury caused by mechanical force, with one or more of the following: LOC < 30 min, PTA < 24 hrs, altered mental state <24 hrs, post traumatic amnesia 0-1 day, or GCS 13–15 in first 24 hours.

Dizziness Management:

Strongly supports symptom-targeted vestibular rehab
Encourages individualized care for vestibular, visual, and cervical symptoms
Recommends against routine imaging unless red flags exist

Strength of Recommendations:
Backed by GRADE methodology with moderate to high-quality evidence in many areas. Especially strong on symptom-based rehabilitation and multidisciplinary care.

Best For: Complex or prolonged recovery cases—military, workplace, or civilian
Limitations: More focused on post-acute care; less on immediate post-injury management

3. ACRM (American Congress of Rehabilitation Medicine) Diagnostic Criteria for mTBI (2023 Update)

Definition of Concussion (mTBI):
An alteration in brain function caused by external force (head being struck with an object; head striking a hard object or surface, brain undergoing an acceleration/deceleration movement without direct contact between the head and an object or surface; and/or forces generated from a blast or explosion) with one or more of the following:

One or more clinical signs: loss of consciousness, post traumatic amnesia, altered mental state, focal neurologic signs (observed motor incoordination upon standing, seizure, or tonic posturing immediately following injury).
At least 2 acute symptoms (any acute subjective alteration in mental status; physical, cognitive, or emotional symptoms) and at least one clinical or laboratory finding attributable to brain injury (cognitive impairment on acute clinical examination, balance impairment on acute clinical examination, oculomotor impairment or symptom provocation in response to vestibular-oculomotor challenge on acute clinical examination, and/or elevated blood biomarker(s) indicative of intracranial injury).
Neuroimaging evidence of TBI, such as unambiguous trauma-related intracranial abnormalities on computed tomography or structural magnetic resonance imaging. Notes: Neuroimaging is not necessary to diagnose mild TBI. Its primary clinical role is to rule out head and brain injuries that might require neurosurgical or other medical intervention in an acute care setting. When obtained, neuroimaging may reveal intracranial abnormalities indicative of TBI such as contusion(s) or intracranial hemorrhage.

And not better accounted for by confounding factors (i.e. pre-existing and co-occurring health conditions).

Dizziness Management:
While the ACRM criteria don’t include treatment guidance, they acknowledge dizziness as a key symptom supporting the diagnosis of concussion. This helps validate clinical decisions and referrals.

Strength of Recommendations:
Focused on standardizing diagnosis, not treatment. Built on consensus with strong utility for documentation, referrals, and insurance claims.

Best For: Clarifying and supporting your diagnosis across all settings
Limitations: No direction on rehabilitation or symptom management

The Catch: Guidelines Aren’t Everything

Even the best concussion guidelines for healthcare providers have limits. By the time they’re agreed upon and published, new research may already be available. That’s why you need to:

Stay critical—evaluate studies for sample size, methodology, and conflicts of interest
Recognize consensus—some recommendations, like the 2/10 symptom increase rule, are precautionary, not proven
Supplement with research—especially in rapidly evolving areas like vestibular therapy or pediatric care

Use guidelines as your foundation, but stay engaged with the literature to stay truly up to date.

Pulling It All Together

Use the Sport Consensus for acute management and RTP decisions
Use the VA/DoD Guideline for persistent symptoms and complex rehab
Use the ACRM Criteria to confirm diagnosis and improve documentation

Together, these concussion guidelines for healthcare providers form a comprehensive, multidimensional framework to improve patient outcomes.

The Path Forward

There’s still more to learn: subtyping, biomarkers, better outcome tracking, but you’re not starting from scratch. By applying these guidelines and staying engaged with current evidence, you’ll continue to grow as a provider and improve the care you deliver.

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