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0
1
2
Age of patient
5 to <8 years
8 to <13 years
13 to <18 years
Sex of patient
Male
Female
How long did the patient’s previous concussion last?
No previous concussion or Recovery in less than 1 week
Recovery took 1 week or longer
Does the patient have a history of migraines?
No
Yes
Did the patient answer questions more slowly than normal as compared to before the injury?
No
Yes
On the BESS Tandem stance balance testing, how many errors did the patient have in 20 seconds?
0-3 errors
4 or more errors, or could not complete the balance testing
Does the patient have a headache?
No
Yes
Does the patient have sensitivity to noise?
No
Yes
Is the patient more fatigued?
No
Yes
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