The incidence of brain trauma has been rising in recent years. According to the Centers for Disease Control and Prevention (CDC), emergency department visits related to traumatic brain injury (TBI) increased by 53 percent in the U.S. from 2006 to 2014. For 2014 alone, the CDC reported about 2.87 million TBI-related visits, hospitalizations, and deaths. Reports of concussions in high school athletes have also increased in recent years.
One factor in this rise may be the increasing diagnosis of concussions. Brain trauma is more on the radar today, partly due to findings on the association between repeated concussions and early-onset dementia in professional football players. Autopsies of a number of high-profile NFL players have revealed evidence of chronic traumatic encephalopathy (CTE), a degenerative brain condition associated with prizefighters.
When getting treatment for a concussion, it’s very important to be selective since brain trauma can have long-term consequences. Unfortunately, not all concussion treatment centers or individual practitioners who treat brain trauma meet the quality standards necessary for appropriate care.
Case in point: Recently, a man I know asked for my opinion on a health care practitioner that his wife chose to treat their son’s concussions. The practitioner had offered a package of treatment sessions for a fee. I checked out his website and learned that he’s a chiropractor whose therapies are largely unproven for treating concussion. It wasn’t clear that he had any specific training for treating conditions of the head.
Another person called me about an inpatient concussion treatment center in Los Angeles where he had taken a family member suffering from concussions and PTSD due to war experience. The center claimed to be affiliated with Stanford University. My review of that center’s website revealed that no doctors from Stanford were on staff there. I also found it suspicious that there was no logo for the university anywhere on the website.
The dominance of the internet in our daily lives has, unfortunately, made it too easy for questionable health care practitioners and concussion treatment centers to dazzle us with fancy websites and claims that may or may not be legitimate. Some treatment centers offer therapies that sound great but lack credibility. Others cite impressive statistics without showing where the data came from.
Practitioners who treat concussion must be knowledgeable about not just initial treatment, but also about risk factors that may lead to persistent symptoms and what should be done for post-concussion care. They need to have the experience to provide a program customized to a patient’s specific condition and overall health.
Before you select treatment providers for concussion or other types of brain trauma, you should make sure they have the right experience, credibility, and proof of success. Of course, recommendations from family, friends, and other health care providers are valuable. But you should always keep the following things in mind before you make your choice:
Evidence-based treatments. Make sure the provider’s treatments are based on findings in rigorous clinical studies published in reputable journals. You should also request to see outcomes data for the provider’s own treatment experience. (If the provider’s website cites published findings, you can review the studies on PubMed.)
Good reviews for the center and doctors. Websites such as Healthgrades and Vitals feature patient reviews of doctors based on a five-point scale, where five is best. These sites also tell you if a doctor has received any awards, or been sued for malpractice. Keep in mind the number of reviews. If a doctor has an average of rating of five, for example, it doesn’t mean much if there are only two reviews. A 4.5 average for 40 reviews would be more impressive.
Ongoing coordination of services. An effective treatment plan may require involvement of a doctor as well as a physical therapist, psychologist, or other practitioners. Your provider or treatment center should have this type of network in place. Medical treatment may not be enough; the patient may also need help coping with stressors in his or her life, and that should be addressed in the overall plan.
Red flags for concussion treatment centers. Here are five things to watch out for before committing time and money to concussion treatment centers:
- Care provider only has anecdotal evidence. All treatments should be based on proven effectiveness in clinical studies published in reputable medical journals. Anecdotal data may be impressive, but it only shows success in some cases. It doesn’t provide enough proof that it will work across a range of patients.
- No academic affiliation. Some treatment centers may imply an affiliation with a university because they follow a protocol similar to one followed by the institution. You need to confirm that the university actually endorses the center and has an ongoing involvement with it. At least one university doctor should be cited as either a practitioner or consultant for the center.
- Lack of accreditation. There should be certification from an accepted medical authority, such as the American Medical Association or the American Academy of Neurology. Otherwise, the center is not obligated to meet any official standard of care. You can also check to see if any doctors at the center are listed on the Castle Connolly website, which cites top physicians by specialty in different states based on a comprehensive review and screening process.
- Doctors not listed, or not there. If you can’t review the staff, how can you know the quality of their care? Medical specialists are a critical part of the treatment equation, so rule the center out if it only has physical therapists and chiropractors.
- Few “legitimate” testimonials or reviews. If you can’t see any reviews on the website, chances are they are not good.
Remember, any kind of brain trauma requires care of the highest order. Be very selective when choosing among concussion treatment centers. Your choice may determine a patient’s entire future.
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