The lack of concussion awareness in the medical field

With all the media attention to concussion these days, most people are familiar with the term “concussion” and know what it means. If you’re not involved in the medical field, and you never watch CNN or ESPN, fine. You might not be in the loop. But it is extremely alarming when we still see the lack of awareness in the medical field.

I don’t mean to speak ill of other specialties, but because I am familiar with the long-term consequences of trying to play through concussions, I tend to get a little fired up about this. The following is a quote from a pediatric neurologist regarding an 11-year old boy who was slow to recover from his symptoms after concussion: “(Patient name) was said to have a concussion, if this is true, it must have been extraordinarily mild since there was no LOC (loss of consciousness) and he could walk to the nurse’s office after the incident.”

Seriously? If you’re not picking up on why I’m so exasperated by this, let me explain. First of all, we know that an athlete does not have to lose consciousness in order for the injury to be diagnosed as a concussion. Only about 10% of concussions involve loss of consciousness. We have known this for years. Next, “he could walk to the nurse’s office after the incident.” As opposed to what? Not being able to walk after a concussion? This reasoning is totally lost on me. One might argue that a pediatric neurologist might not be on the up and up when it comes to concussion issues. However, the most recent guidelines on concussion assessment and management have been published in multiple clinical journals, and as I pointed out before, it’s all over the media. If you’re seeing kids on a daily basis, you need to know about concussions.

Unfortunately, I have heard similar stories coming out of the emergency department. A kid will go to the ER after getting hit, a head CT will be ordered, which will be negative, and the kid is cleared to go back to football (or soccer, what have you). I can’t tell you how frustrating this is. Again, I will explain. Concussion is a functional disturbance, not a structural one, which is why imaging of the head or brain is unlikely to reveal anything. Unfortunately, there are some emergency department practitioners who do not understand this, and they don’t understand that negative imaging doesn’t necessarily mean the athlete is ready to return to play. The athlete should not be cleared for return to sport at the emergency room visit. The need for rest, symptom resolution, and a gradual return to play should be, but is not, explained to the patient or his/her parents.

Again, my intention is not to point fingers but to make the reader aware that a concussion is a complicated matter that not everyone fully understands. I’m not trying to generalize or stereotype any specialty. God knows how hard we have all trained to get where we are.

The bottom line is this: if you or a family member suffers a concussion, please see a sports medicine specialist to be evaluated. He or she will understand the symptoms and be able to guide you through treatment and an appropriate return to play protocol. The health of the athlete should always come first.

Mandy Huggins is a sports medicine physician who blogs on her self-titled site, Dr. Mandy Huggins.

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  • Anonymous

    You should really read about DTI research – we can see mild brain trauma with DTI FAI mapping.  The only problem with this type of imaging is the cost.  At our facility it is 500 dollars plus 500 FAI fiber tracking.  1000 dollars total on a 3T MRI 32 channel scanner.  I think you will find this is the cheapest in the world.

  • GPZ

    Reliance on CT scans instead of observation and serial neurological exams is also to blame. The average physician in north America is losing the ability to evaluate a patient with a H&P without giving the final say to imaging. CT scans are overused for medicolegal reasons and common sense evaluations are underutilized. The ED is a big culprit, but even sports med docs are beginning to rely on imaging instead of 24h observation and follow-up…while concurrently keeping them from going back to their sports.

  • Seung Oh

    I think you raise a great point…  however, you didn’t state what signs and symptoms to look for in a concussion.  Can you tell us certain signs and symptoms and ways we can assess concussion?

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