How soon after a concussion should the first follow-up visit happen?

Most protocols call for an initial visit within 24-72 hours of injury, sooner if the patient was first seen in an emergency or urgent care setting, to confirm diagnosis, screen for red flags, and set initial activity guidance.

Is a 1-week follow-up visit always necessary?

It's common practice rather than a strict requirement. The 1-week visit is useful for assessing trajectory, starting return-to-learn planning, and doing a more detailed clinic exam (including VOMS) than is typically feasible on the sideline or in an ED.

When should a patient be referred for formal neuropsychological testing instead of continued routine follow-up?

Consider referral when symptoms persist beyond the expected window despite standard management, when cognitive complaints are out of proportion to physical symptoms, or when RTL/RTP decisions are complicated and an objective baseline-to-current comparison would help. See when to refer for neuropsych testing.

Does the follow-up schedule differ for youth athletes versus adults?

Yes. Pediatric recovery generally takes longer, and a larger proportion of youth patients have symptoms beyond four weeks compared with adults, which supports more active multidisciplinary management and closer follow-up once that four-week mark is reached.

Can follow-up visits be done by telehealth?

Routine interval visits — symptom review and RTL/RTP counseling — are generally appropriate for telehealth. Visits requiring balance, vestibulo-ocular, or cervical spine exams are better performed in person.

What Is a Typical Concussion Follow-Up Schedule?

A typical concussion follow-up schedule includes an initial visit within 24-72 hours of injury, a follow-up around 1 week to assess trajectory and begin return-to-learn planning, and a visit at 2-4 weeks to clear return-to-play or return-to-work. Symptoms persisting beyond 2-4 weeks warrant more frequent visits and multidisciplinary referral rather than continued routine monitoring alone.

Why There Is No Single Mandated Schedule

No consensus guideline — not the 6th International Conference on Concussion in Sport (Amsterdam, 2023), not CDC HEADS UP — prescribes a fixed number or timing of follow-up visits for every patient. Instead, cadence is driven by trajectory: patients recovering as expected need fewer, more widely spaced visits, while patients whose symptoms plateau or worsen need closer surveillance and earlier specialty involvement. The practice pattern below reflects common clinical usage across sports medicine, neurology, and primary care settings rather than a single binding rule.

The Common Visit Cadence

Initial visit (24-72 hours post-injury). Often the first formal clinical encounter after an ED, urgent care, or sideline evaluation using SCAT6 or Child SCAT6. This visit establishes diagnosis, screens for red flags that would warrant imaging, documents baseline symptom burden, and sets initial activity guidance — relative rest for the first 24-48 hours followed by symptom-guided, gradual return to light activity, per Amsterdam consensus.

~1 week follow-up. This visit assesses recovery trajectory against the expected curve, initiates return-to-learn (RTL) planning, and adds a more detailed clinic-based exam than is practical on the sideline — including cervical spine screening, oculomotor exam, and vestibulo-ocular motor screening (VOMS), often organized using the Amsterdam-endorsed SCOAT6 office assessment tool. VOMS findings and cervicogenic symptoms at this visit are among the more useful predictors of a longer recovery and can prompt an early vestibular rehab referral.

2-4 week follow-up. For patients tracking normally, this visit confirms symptom resolution and clears graduated return-to-play (RTP) or return-to-work. The RTP progression is a stepwise sequence — symptom-limited activity, light aerobic exercise, sport-specific exercise, non-contact drills, full-contact practice, then return to sport — with each step generally held at least 24 hours and a return to the prior step if symptoms recur. No athlete returns to play the same day as a suspected concussion.

Escalated cadence beyond 2-4 weeks. When symptoms persist past the expected window, visit frequency typically increases to biweekly or weekly, and care shifts from routine monitoring toward active multidisciplinary management — neuropsych testing, headache specialty care, behavioral health, and vestibular PT as indicated. Earlier specialty-clinic evaluation has been associated with shorter overall recovery in cohort data, which supports a lower threshold for early referral rather than a prolonged wait-and-see approach, particularly for patients with risk factors for delayed recovery.

Pediatric vs. Adult Cadence

Children and adolescents generally need a longer follow-up runway than adults. Most adults recover clinically within about two weeks; most pediatric concussions resolve within about four weeks, but a meaningfully larger share of youth patients have symptoms persisting beyond one month. The Amsterdam pediatric consensus paper recommends active multidisciplinary management — not continued watchful waiting — once a child's symptoms extend past four weeks. Pediatric protocols also place more weight on RTL before RTS, since impaired school function is often more immediately visible than impaired athletic function, and require ongoing coordination with parents/caregivers and school-based RTL teams.

What Happens at Each Visit

Follow-up visits are not just a symptom check-in. A well-structured visit typically covers: a structured symptom inventory (commonly tracked with the PCSS); a directed neuro and cervical spine exam; VOMS or oculomotor screening when dizziness or visual symptoms are present; mood/anxiety screening with PHQ-9 and GAD-7 given concussion's association with new or worsened depression and anxiety; and a sleep check, since sleep disturbance independently slows recovery. Risk factors worth flagging at every visit include prior concussion history, migraine/headache disorder, psychiatric history, learning disability or ADHD, high acute symptom burden, and early dizziness or vestibular symptoms.

When to Escalate Beyond the Standard Schedule

Move to more frequent visits and specialist referral when: symptoms have not meaningfully improved by 2-4 weeks (adult) or 4 weeks (pediatric); cognitive complaints are disproportionate to physical symptoms; a positive mood/anxiety screen appears; headache is escalating or refractory to first-line management; or RTL/RTP decisions are complicated by academic or occupational demands. Post-concussion syndrome — more precisely termed persistent post-concussive symptoms (PPCS) — describes this delayed-recovery pattern rather than a distinct diagnosis, and is best managed with a defined multidisciplinary pathway rather than open-ended primary care monitoring.

Telehealth's Role in the Schedule

Routine interval follow-up — symptom review, RTL/RTP progression counseling, general trajectory checks — is generally well suited to telehealth, and available comparative data has not shown it impairs treatment decisions relative to in-person visits. Balance testing, VOMS, and cervical spine exam are physical-exam-dependent and are better performed in person, though a hybrid model — in-person for the initial visit and any exam-heavy visit, telehealth for interval check-ins — is a common pragmatic approach, particularly where in-person access is limited.

How Kavera Handles This

The Kavera protocol is a follow-up schedule: first visit, two-week feedback visit, weekly digital check-ins with brain training, monthly telehealth or in-office follow-up, re-evaluation against baseline. Each step is scheduled in the platform and each one is documented for RTM and testing codes. Self-Serve practices run this with their own staff. On Managed, Juliet Mott's team runs it and bills it under your credentials.