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BIRS Concussion Clinic

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Useful management information

The BIRS Concussion Clinic is a specialist interdisciplinary clinic attached to the Princess Alexandra Hospital Brain Injury Rehabilitation Service that provides comprehensive medical and allied health (physiotherapy, neuropsychology & occupational therapy) assessment and treatment for adults aged 16 – 70 years who have suffered a concussion within the last 12 months and are experiencing persisting post concussive concerns greater than 4 weeks.

Objectives of the Service

The focus of the clinic is on early intervention and prevention of persisting post concussive symptoms. The key objectives of the clinic are to:

  • Provide specialised patient-centred, evidence based early interdisciplinary assessment and treatment for patients experiencing persisting concerns to facilitate return to usual activities
  • To provide patients and families/caregivers with relevant education regarding their injury and ways to self-manage and support recovery.
  • To support coordination of care via provision of feedback and recommendations to the patient, family and their GP, and assist with linkage with community supports

Information for Referrers

  • Referrals are accepted from medical practitioners within the hospital and community (e.g., GP, private specialists). 
  • Further information - Concussion clinic Overview for Referrers (PDF, 311.75 KB)

Service Eligibility

Injury Characteristics

  • Confirmed or suspected diagnosis of concussion according to the American Congress of Rehabilitation Medicine (ACRM) mild TBI special interest group definition.
  • New injuries sustained within the last 12 months (*injuries within 3 months prioritised). Individuals who have had history of one or multiple prior concussions, and a new concussion injury are eligible.

Symptoms & Functional Impact

  • Persisting post concussive symptoms (with high symptom burden) for greater than 4 weeks (and not improving or showing benefit from education & reassurance). Initiating earlier referral (e.g., 3-4 weeks) may be helpful when a patient has high symptom burden, are unable to progress with return to usual activity / roles and has known risk factors for poor recovery.
  • Presence of symptoms / impact across at least two symptom domains (emotional, cognitive & physical)
  • Impact on function, including activities of daily living, usual valued roles and/or vocational (work, study)

Age

  • Aged between 16- 70 years, with individuals aged 16-18 and 65-70 considered on a case-by-case basis
    • Ages 16-18 will be eligible for the clinic if they are not attending school (to go via children’s hospital if attending school)
    • Ages 65-70 dependent on rehabilitation goals (i.e., goals around return to work)

Additional Information

  • Patients with who have sustained a concussion, but their injury was (1) greater than 12 months ago (2) have a past history of moderate to severe ABI, (3) sustained ‘complicated’ mild TBI (positive neuroimaging) who  can still be referred to the Statewide Brain Injury Rehabilitation Day Hospital Service.
  • Patients with active compensation claims are accepted, though this clinic does not offer medicolegal assessment services.

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark “urgent” on your referral

  • Referred within 3 months post injury
  • Presence of new symptoms following concussions across at least 2-3 domains, including;
    • Physical complaints that may benefit from early specialist medical or physiotherapy assessment & input (e.g., complaints of headaches, dizziness, sleep)
    • Emotional concerns that may benefit from early psychological intervention– evidence of high emotional distress, presence of concurrent stressors, development of comorbid MH concerns post injury that may benefit from early intervention
    • Cognitive concerns impacting on work or usual activities, or causing frustration or distress
  • Presence of risk factors for poor recovery (e.g., high emotional distress post injury, comorbid mental health concerns, high physical symptom burden, work related stressors / demands, other stressors, prior history of concussion, history of poor premorbid health & history of pain, migraine or sleep disturbance, lack of social / family supports)

Category 2

(appointment within 90 calendar days)
 

  • Referred 3 - 12 months post injury
  • Presence of risk factors for poor recovery (see Category 1)

Category 3

(appointment within 365 calendar days)

  • No category 3 criteria

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Essential referral information for Concussion Clinic (Referral will be returned without this)

  • Date of Injury, circumstances & mechanism of injury
  • Current symptoms across the three symptom domains (Physical, Cognitive, Emotional), including any results from formal screening measures completed (e.g., Rivermead Post Concussion Symptom Questionnaire, Sport Concussion Assessment Tool, 5th Edition or online)
  • Impact of current symptoms on function, including usual activities and work
  • Medical history, including history of prior acquired brain injury, prior concussion injury, neurodevelopmental concerns (e.g., ADHD), history of chronic pain, prior sleep disturbance, migraine and past psychological history
  • Current occupation & employment status

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Concussion Clinic

  • Injury Classifications markers - PTA, GCS & LOC, any post-traumatic seizures
  • Results of any investigations to date
  • Potential rehabilitation goals (e.g., support with returning to work, study, usual activities or roles)
  • Any interventions or treatment to date (pharmacological, education provided, specialist input, allied health input)
  • Patients response / coping with current symptoms (e.g., any evidence of distress in relation to symptoms, current strategies patient is employing to manage)
  • Living situation, current informal and formal supports
  • Alcohol & substance use history

Out of Catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 19 December 2023
Last reviewed 3 March 2023