Behind The TRICORDRR (TRI Concussion Outcome Risk Determination & Rehab Recommendations)
Concussion CalculatorThis risk calculator was created using the Ontario Concussion Cohort to identify risk of development of persisting post-concussion symptoms early post injury
Details about the Ontario Concussion Cohort can be found here.
Science Behind the Calculator
All adults with concussion who had 2 years of follow-up health care information were included, representing 587 057 adults in total, and the team looked at premorbid health conditions like migraine, mental health and psychiatric conditions, neurological disorders, vestibular disorders, chronic pain, prior concussion, as well as demographic data and how often someone accessed their family medicine and/or walk-in clinic in the year before their injury. Using administrative health databases, the team then tracked how many saw a specialist physician like a neurologist, ENT, psychiatrist, ophthalmologist, physical medicine & rehab physician, or a neurosurgeon for concussion related treatment after in the 2 years after injury. Anyone that required 2 or more specialist visits for concussion related complaints more than 6 months after their injury were classified as having persisting post-concussion symptoms and the factors that increased the risk of requiring additional health care for concussion were determined. This calculator provides the absolute risk that an individual may have of requiring additional specialized health care for persisting post-concussion symptoms based upon the 5 factors identified.
How to use this Calculator
The calculator consists of 5 questions to ask your patient including age, mental health and psychiatric history and ranges for how frequently they see primary care physicians (including walk-in clinics) in a given year. The calculator will provide you with the percent risk of your patient developing prolonged concussion symptoms as well as best practice recommendations based upon your patient's risk.
When to use this Calculator
This calculator was designed to be used in the acute phase of a concussion, ideally right after injury. It can be used accurately within the first 6 months following a concussion.
Resources for Best practice Concussion Care
- ONF mTBI Guidelines
- Toronto Acquired Brain Injury Network
- Brain Injury Society of Toronto
- Persisting Symptoms Workshop
- Education and Support Workshop: 'When Symptoms of Single and Multiple Concussions Persist'
- Hull-Ellis Concussion & Research Clinic
- Patient Under 18?
- Holland-Bloorview Concussion Centre
Risk level description or popup once score is calculated:
- Low: This patient profile indicates LOW risk of developing persisting concussion symptoms. Provide education regarding recovery trajectory (up to 4 weeks), reassure patient of good recovery trajectory, encourage symptom threshold mediated return to activity (i.e. light aerobic exercise, work/ school work, etc.) as tolerated.
- Medium Risk: This patient profile indicates above average risk of developing persisting concussion symptoms. Refer to Section 5 of the ONF mTBI Treatment guidelines and provide education regarding concussion and encourage symptom threshold mediated return to activity (i.e. light aerobic exercise, work/ school work, etc.) as tolerated.
- Hight: This patient profile indicates high risk of developing persisting concussion symptoms. Refer to Section 5 and Section 8 of the ONF mTBI Treatment Guideline and make treating psychiatrist aware of concussion.
Meet the team behind the calculator
Laura Langer
Laura is a research analyst at KITE TRI and the lead researcher on the Ontario Concussion Cohort project. She has a background in molecular neurobiology, immunology, and biostatistics. Her research interests are in predictive disease modelling in neurological disorders like concussion, post traumatic headaches, and Multiple Sclerosis.
Dr. Mark Bayley
Dr. Bayley is the Program Medical Director of the Toronto Rehabilitation Institute, the Physiatrist-in-Chief of the University Heath Network, and Professor and the Saunderson Family Chair in Brain Injury Research in at the University of Toronto's Faculty of Medicine. Dr. Bayley's research focuses on understanding how to speed brain recoveries through exercise, virtual reality, telerehabilitation, and functional electrical stimulation. Importantly, he has bridged the know-do gap by making the best evidence available to clinicians through smartphone apps and Best Practices guidelines in stroke, concussion, multiple sclerosis and Brain Injury.
Mohammad Alavinia PhD
Dr. Alavinia is a Clinical Epidemiologist and Research Fellow in the Spinal Cord Rehab Program at TRI Lyndhurst.
Dr. David Lawrence
Dr. Lawrence is a sports and exercise medicine physician and the lead team primary care physician for the Toronto Blue Jays. His research interests include sports-related concussion and injury prevention.
Sarah Munce PhD
Dr Munce is a Scientist at KITE (Toronto Rehabilitation Institute-University Health Network) specializing in health services research and knowledge translation. Her program of research involves developing, implementing, and evaluating transitional care programs for individuals with neurological conditions.
Dr. Alice Kam
Dr. Kam specializes in Physical Medicine and Rehabilitation. She is involved in the inpatient brain injury unit, outpatient brain injury clinic, and concussion clinic at Toronto Rehabilitation Institute.
Dr. Alan Tam
Dr Tam is a Physical Medicine and Rehabilitation physician.
Dr. Lesley Ruttan
Dr Ruttan is a Clinical Neuropsychologist with the Brain Injury Rehab Program an TRI Rumsey and a Lecturer at the Graduate Department of Psychological Clinical Sciences at the University of Toronto, Scarborough.