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Red-flag indicators of concussion for physiotherapy practice
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Objective: To systematically evaluate international literature on clinical red-flags and diagnostic
tools used to identify concussion in the neurocognitive, sensorimotor, vestibular, and
visual/oculomotor domains, thereby informing physiotherapists who act as first-contact healthcare
providers. Design: Diagnostic systematic review of empirical studies and grey literature. Data
Sources: Nine databases and grey literature were searched from inception dates to January
2025. Eligibility criteria for selecting studies: English- or Portuguese-language publications
involving adults (≥18 years) with suspected concussion that assessed red flags or diagnostic tools
in the target domains. Four quality-appraisal instruments were applied, and reporting followed
PRISMA guidelines. Results: From 222 424 records, 222 383 were excluded at title/abstract
screening. Forty full texts were assessed and 17 met inclusion criteria: cross-sectional (n = 6),
longitudinal (n = 7), reviews (n = 3), and one validation study. Five analytical domains emerged—
neurocognitive (n = 7), sensorimotor (n = 3), vestibular (n = 3), visual/oculomotor (n = 4), and
general (n = 3). Some studies contributed to more than one domain; therefore, domain counts
exceed the total number of included articles. One single tool was applied consistently within the
general domain, being the only one, highlighting substantial heterogeneity. Frequently examined
red flags were emotional symptoms, memory deficits, postural instability, vestibulo-ocular reflex
dysfunction and visual disturbances and instruments included the Graded Symptom Checklist,
SCAT, BESS, SOT, ImPACT, ANAM, SDMT, VOMS, and KDT. Conclusions: Evidence supports
a multimodal strategy that blends subjective symptom inventories with objective performance
measures to flag concussion. Although many tools have international validation, none is culturally
adapted for Portuguese-speaking populations, and none is universally adopted within any
domain, limiting comparability across studies. Data on long-term outcomes and return-to-play
decisions remain sparse. Physiotherapists are well positioned for early triage, but validated,
context-specific tools are needed to optimise care pathways. Future research should prioritise
cultural adaptation, psychometric validation, and integration of domain-specific assessments into
physiotherapy-led concussion management
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Palavras-chave
Concussion Red-flag indicators