Traumatismes crânio-cérébraux - Commotion cérébrale

CLIENTÈLE ADULTE, Algorithme décisionnel pour l'évaluation et la gestion du risque de complications neurologiques graves à la suite d’un TCCL, INESSS, mai 2021

CLIENTÈLE PÉDIATRIQUE, Algorithme décisionnel pour l'évaluation et la gestion du risque de complications neurologiques graves à la suite d’un TCCL, INESSS, mai 2021

Évaluation et gestion du risque de complications neurologiques graves à la suite d’un traumatisme craniocérébral léger, Guide réalisé en soutien à la révision de l’algorithme sur l’évaluation et la gestion du risque de complications neurologiques graves à la suite d’un traumatisme craniocérébral léger, INESSS, mai 2021

Protocole de gestion des commotions cérébrales, Éducation et enseignement supérieur, Gouvernement du Québec

PROTOCOLE DE GESTION DES COMMOTIONS CÉRÉBRALES pour le milieu de l’éducation et dans le cadre d’activités récréatives et sportives, 2e édition 2019

INESSS: Guide de pratique clinique pour la réadaptation des adultes ayant subi un traumatisme craniocérébral modéré-grave

Vidéo: Le diagnostic du traumatisme craniocérébral léger, CISSS Chaudière-Appalaches

Formulaires de référence TCCL, Chaudière-Appalaches

Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. McCrory P, Meeuwisse W, Dvořák J, Aubry M, Bailes J, Broglio S, Cantu RC, Cassidy D, Echemendia RJ, Castellani RJ, Davis GA, Ellenbogen R, Emery C, Engebretsen L, Feddermann-Demont N, Giza CC, Guskiewicz KM, Herring S, Iverson GL, Johnston KM, Kissick J, Kutcher J, Leddy JJ, Maddocks D, Makdissi M, Manley GT, McCrea M, Meehan WP, Nagahiro S, Patricios J, Putukian M, Schneider KJ, Sills A, Tator CH, Turner M, Vos PE. Br J Sports Med. 2017 Jun;51(11):838-847. doi: 10.1136/bjsports-2017-097699. Epub 2017 Apr 26. PMID: 28446457

The suspected diagnosis of SRC can include one or more of the following clinical domains:

Symptoms: somatic (eg, headache), cognitive (eg, feeling like in a fog) and/or emotional symptoms (eg, lability)

Physical signs (eg, loss of consciousness, amnesia, neurological deficit)

Balance impairment (eg, gait unsteadiness)

Behavioural changes (eg, irritability)

Cognitive impairment (eg, slowed reaction times)

Sleep/wake disturbance (eg, somnolence, drowsiness)

If symptoms or signs in any one or more of the clinical domains are present, an SRC should be suspected and the appropriate management strategy instituted.

Canadian Guideline on Concussion in Sport, Parachute

Canadian CT Head Injury/Trauma Rule, calculateur

Risk of Posttraumatic Stress Disorder and Major Depression in Civilian Patients After Mild Traumatic Brain Injury: A TRACK-TBI Study., JAMA Psychiatry. 2019 Jan 30. doi: 10.1001/jamapsychiatry.2018.4288. [Epub ahead of print]

Incidence of intracranial bleeding in anticoagulated patients with minor head injury: a systematic review and meta-analysis of prospective studies. Minhas H, Welsher A, Turcotte M, Eventov M, Mason S, Nishijima DK, Versmée G, Li M, de Wit K. Br J Haematol. 2018 Oct;183(1):119-126. doi: 10.1111/bjh.15509. Epub 2018 Jul 20. PMID: 30028001

In conclusion, around 9% of patients on vitamin K antagonists with a minor head injury develop ICH. There is little data on the risk of traumatic intracranial bleeding in patients who have a GSC 15 post-head injury and are prescribed a direct oral anticoagulant.

Chez l'enfant:

Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children. JAMA Pediatr. 2018 Sep 4:e182853. doi: 10.1001/jamapediatrics.2018.2853. [Epub ahead of print]

Guides patients:

Concussion Trekk

Management of the paediatric patient with acute head trauma, POSITION STATEMENT, Canadian Paediatric Society, Paediatr Child Health 2013;18(5):253-8

Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study, The Lancet, Published online April 11, 2017

PECARN Pediatric Head Injury/Trauma Algorithm, calculateur


Rest and treatment/rehabilitation following sport-related concussion: a systematic review. Br J Sports Med. 2017 Jun;51(12):930-934. doi: 10.1136/bjsports-2016-097475. Epub 2017 Mar 24.

Summary/conclusions: A brief period (24–48 hours) of cognitive and physical rest is appropriate for most patients. Following this, patients should be encouraged to gradually increase activity. The exact amount and duration of rest are not yet well defined and require further investigation. The data support interventions including cervical and vestibular rehabilitation and multifaceted collaborative care. Closely monitored subsymptom threshold, submaximal exercise may be of benefit.

Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents, JAMA. 2016;316(23):2504-2514. doi:10.1001/jama.2016.17396

Conclusions and Relevance: Among participants aged 5 to 18 years with acute concussion, physical activity within 7 days of acute injury compared with no physical activity was associated with reduced risk of PPCS at 28 days. A well-designed randomized clinical trial is needed to determine the benefits of early physical activity following concussion.

Benefits of strict rest after acute concussion: a randomized controlled trial. Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Pediatrics. 2015 Feb;135(2):213-23. doi: 10.1542/peds.2014-0966. Epub 2015 Jan 5. PMID: 25560444

CONCLUSIONS: Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents’ symptom reporting was influenced by recommending strict rest.


Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours:a retrospective cohort study, Lancet, 380 (2012), pp. 499–505