Saturday, August 27, 2016

7 Concussion Myths

As the country is focusing more on concussions, I've seen a lot more kids come in after head injuries, many of which are concussions. Even some kids who went to an ER after a head injury get incorrect information about return to play sometimes.

Source: CDC Heads Up

Common myths and misinformation about concussions:

1. A normal head CT means no concussion and a full return to play is okay.
Concussions are not diagnosed by CT. Brain bleeds and masses can be seen on CT, but the damage done to the brain during a concussion is not seen on a CT. Concussions are diagnosed based on symptoms, such as headache, confusion, lack of coordination, memory loss, nausea, vomiting, dizziness, ringing in the ears, sleepiness, and excessive fatigue. Not all symptoms need to be present to make the diagnosis. Some symptoms develop over time and are not present at the time of injury.
A CT scan is usually not needed with head injuries. They involve radiation so are not without risk themselves. Unless there are signs of a possible bleed in the brain, skull fracture, or the type of injury suggests the need for a CT, a CT scan is not needed in the evaluation for concussion.
2. A minor hit to the head never causes concussions.
The force of a hit does not determine the severity of the injury. Some people with more significant problems initially also seem to heal more quickly than others with more mild injury. It is very hard to predict how long it will be until all symptoms are resolved. The most important thing is that if you have symptoms of a concussion, your brain needs rest.

3. After two weeks you can return to play without further testing.
Sadly I've had more than one patient who was given this advice from a medical professional, whether on the sideline at a game or in an emergency room or urgent care. Although most concussions resolve within 2 weeks, not all do and returning to play before the brain is healed can lead to a more serious condition called "second impact syndrome." Second impact syndrome is a very rare condition in which a second concussion occurs before a first concussion has properly healed, causing rapid and severe brain swelling and often catastrophic results, including death.
After a concussion clearance to return to play should only happen when the child, teen, or adult is re-examined and found to be symptom free. Returning to play is done in a stepwise fashion, with each step lasting at least one day and only progressing to the next step if symptoms don't resume. This starts with light exercise when there are no symptoms at rest, then progresses to moderate activity followed by heavy activity without contact, then full practice with contact (if the sport is a contact sport) and finally full competitive play if each step can be done without return of symptoms. If symptoms return, you back up to lighter activity.
Returning to play too quickly can prolong healing time and even lead to long term consequences. Do not return to any activity that causes symptoms to worsen!
4. If a coach doesn't recognize the concussion, it's minor enough to return to play.
Coaches cannot see everything that happens on a field. If you had a head injury, tell your coach. Even if you are the star player. Really. You will do your team a favor if you take time to heal and can play again versus stay in the game and get more severely injured and are out for good. See these real stories of concussion survivors.
Someone who is trained in concussion evaluation should do a sideline evaluation. If there is any chance of concussion, you should not return to play at all that day or until you are cleared by a doctor who understands concussions.

5. IMPACT testing is necessary.
IMPACT testing is a computerized test that measures neurocognitive functioning. Ideally a baseline is done prior to the season (or at least every 2 years) and then testing is repeated if a concussion is suspected. The results of the current test are compared to the person's baseline and can be repeated at intervals until the person is back to baseline and able to be cleared to return to play. It is one tool to help manage concussions and determine when it is safe to return to play, but at this time concussions are diagnosed based on symptoms and physical exam.
6. Complete bed rest until all symptoms are gone is best.

Bed rest for the first day or two can help enforce brain rest and allow healing, but may not be required and prolonged bed rest is specifically not recommended. Prolonged bed rest can increase stress in children who miss substantial amounts of school. This stress is thought to possibly prolong healing. Depression is more common if bed rest is enforced beyond 48 hours. Socialization with friends and family can help provide emotional benefits that aid in healing. This does not mean that people should participate in all social settings. They will likely need relative quiet, so even going to a sporting event to watch can lead to return of symptoms.
7. Concussions only impact sports.
Concussions take kids out of play, but other activities should also be limited until they are tolerated. Lights, sounds and even smells can trigger symptoms after a concussion. If anything leads to worsening of symptoms, it should be avoided. Things that take focus or a lot of brain work may cause symptoms to worsen. These include reading, watching television, or playing video games. Initially a child might need total restriction from these activities, and then can slowly add them back in small increments as tolerated. Many kids need to have breaks during school, a decreased work load, and shouldn't take standardized tests until they can focus for a prolonged time. If computers are used for school, it might be necessary to use paper books and worksheets and to limit computer use until it can be tolerated.

For more information:

  • Heads Up is a free resource for parents, athletes, coaches, and medical professionals
  • Acute Concussion Evaluation (ACE) Care Plan has all the typical symptoms of a concussion, general guidelines to healing, plus return to school and sport templates
  • Dr. Mike Evans has two great concussion videos:

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