Concussion Grading Scale for Measuring Severity

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Unseen Caucasian doctors looking at brain scan images on tablet
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Concussions occur as a result of a head trauma—either a blow to the head or severe shaking. These actions cause your brain to strike the inside of your skull, causing bruising. Concussions, or mild traumatic brain injuries (TBIs), can range in severity from mild to severe. But even mild concussions should be taken seriously and be allowed to heal. Since there are no specific tests for concussions, diagnosis is made based on your history (how you were injured), and your physical examination. Doctors can use a concussion scale to define concussion severity and to help provide an appropriate treatment plan.

Concussion Severity

Concussion severity doesn’t necessarily depend on how hard the blow to the head, but how badly your brain was injured. A fall on the ice could cause you to bang your head hard enough for a Grade 2 concussion, for example. Doctors came up with a grading system, a concussion scale, to explain how severe the concussion is:

  • Grade 1: You did not lose consciousness. If you became confused, it passed quickly. If you had any symptoms, they went away within 15 minutes.

  • Grade 2: You did not lose consciousness. You may have been confused, but it didn’t last very long. Any symptoms related to the concussion lasted longer than 15 minutes.

  • Grade 3: You lost consciousness, even if only for a few moments.

Post-Concussion Symptom Scale

Your doctor may rely on a post-concussion scale to determine how severe your concussion is and how you progress through the healing process. These scales include a list of symptoms related to concussions and a number rating how it feels. 

For example, in one scale used by Nationwide Children’s Hospital, each symptom is graded from 0 (for not present) to 6 (for severe). After a physical and neurological evaluation with a doctor, you would bring the sheet home and keep track of the symptoms, the days you have them, and how long they lasted. There are several kinds of symptoms, but they could include:

Concussion Treatment

There are no specific guidelines for a concussion treatment related to the concussion grading scale. Instead, treatment is based on how each patient feels and how quickly they progress during the healing process. There are various strategies and your doctor may choose this one or a similar one: 

Other than rest, the most important part of a treatment strategy for concussions, particularly for people who play sports, is the gradual reintegration of everyday activities. 

The lower the grade concussion, the more quickly you may be able to go through the stages below:

  • Stage 1: Limit any activity that can bring on concussion symptoms, such as watching TV, texting, reading, or using the computer.

  • Stage 2: Gradually introduce light aerobic activity, such as walking or using a stationary bike, but no resistance.

  • Stage 3: Participate in moderate sports activities, such as running drills, but no activities that may result in head impacts.

  • Stage 4: Increasing effort in sports activities; patient may start resistance training.

  • Stage 5: Return to full contact if medically cleared.

It’s important to keep in mind that all concussions are serious. Resuming activities before you are cleared to do so could result in a return or worsening of symptoms. And if you injure yourself again before you are fully healed, even if you have only a grade 1 concussion, you are susceptible to a condition called second-impact syndrome, which can be fatal. 
Concussion recovery may be easier when you know what to expect. Ask your doctor how long to spend in each stage based on your severity and symptom progression.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Aug 27
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  2. Traumatic Brain Injury & Concussion. Centers for Disease Control and Prevention. https://www.cdc.gov/traumaticbraininjury/index.html
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  7. A Parent's Guide to Concussions. Nationwide Children’s Hospital. https://www.nationwidechildrens.org/specialties/concussion-clinic/concussion-toolkit/a-parents-guide-to-concussions