Concussion Management Over 70% of Doctors Got It Wrong

Written By: Leah Concannon, MD; Stanley Herring, MD

Concussion Management

When asked how to manage a concussion case over 70% of doctors got the answer wrong. What does this mean? It means that the information is constantly changing and you can’t expect a primary care physician to know everything. They are constantly having to keep up with latest flu, rash, vaccine, antibiotic and a million other things. They cannot be expected to know everything about every topic. What you learn in school is only the current basis of information. What you know presently is based on what type of cases you see. The Urgent Care doctors know how to handle emergencies, life threatening situations. If you are not in immediate danger for them you are “fine”, because that is what they do.  Primary care physicians have a large breadth of knowledge but not necessarily depth of a knowledge with all subject matter. We certainly can’t expect them to have a depth of knowledge about everything, that’s why we have specialists. Most physicians will admit that they have a certain area of expertise and refer to colleagues for what is not in their “wheelhouse”, that’s a team approach to health care. We certainly can’t expect them to have Posturography, Videonystagmography, ImPACT testing and Interactive Metronome to assess brain function. But specialists, for example medical neurologists, are consulted only when the situation is really bad or a specific disease process needs to be managed. So what do we do about the thousands of cases of concussions? First you educate yourself, particularly if your child is in contact sports. Second you get baseline testing done, more the better. Thirdly you consult a doctor who has made the management and treatment of traumatic brain injury their only focus, a concussion specialist and you find this doctor before they are needed. The following is part one of a concussion scenario from Medscape. See if you get the correct answer. David Burns, DC ND DACNB FACFN

 

A Soccer Player With a Headache: Best Practices

Leah Concannon, MD; Stanley Herring, MD

Jamie, a 14-year-old girl, presents to your office complaining of headaches and difficulty concentrating in school. One week ago, she was playing soccer on the school team when she collided with another player while going for a header. She doesn’t think she lost consciousness, but her memory is a bit fuzzy regarding the minute or so after the hit. She continued playing, but by late in the second half, her headache was severe enough that she took herself out of the game.

She missed a few days of school owing to headaches and fatigue. She reports ongoing daily global headaches since that time; they are better in the morning and worse in the afternoon, particularly after eating lunch in the lunch hall. Reading and classes that require that she focus more are also reported to exacerbate her symptoms and have resulted in her having difficulty concentrating in school. Jamie’s parents report she is more moody than usual, and she finds it difficult to spend time with her friends owing to her symptoms. She has tried going to soccer practice but found that this too worsens her symptoms. She is sleeping well and denies nausea, vomiting, dizziness, photophobia, phonophobia, and other associated symptoms.

Jamie has always been healthy except for a few minor orthopedic injuries as a result of sports participation. She and her family deny any prior concussions. She plays year-round soccer for her select team and was excited to play for her high school this season. She was diagnosed with attention-deficit/hyperactivity disorder (ADHD) at 10 years of age, but doesn’t use medication because she doesn’t like the side effects. Her parents divorced 3 years ago; Jamie had some anxiety at that time but feels that it is under control now.

Her mother has a history of migraine headaches; her father is healthy.

TEST:

On the basis of your knowledge of concussion in teenage girls, you decide to:
  1. Monitor for another month, recognizing that because of the neuroplasticity typical of adolescents, Jamie can be expected to recover more quickly than an adult.
  2. Advise Jamie and her family that athletes with attention-deficit disorder/ADHD may recover more slowly from sports concussions.
  3. Allow Jamie to return to physical activities, such as running, but limit her to non-contact sports.

ANSWER:

See Part Two

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