The Seriousness Of Concussions

This is a guest post from J. Forrest Bennett, an ARNP at Seattle Children’s and Dr Samuel Browd (@DrBrowd) a neurosurgeon who, together with their team, care for children after concussions. Clearly, we’ve all heard more about concussion these past few years. Not just because of pro-football tragedies and lawsuits but also because of the increasing expertise the medical community is acquiring around how to care for children and young adults after getting hit in the head. We’re also learning how to prevent head injuries in the first place. Forrest and I first started discussing this last spring when I began to see his passion in getting great information out to families. He’s convinced the more we parents (and community physicians) know about what to do with head injuries the less children suffer. In some cases what we do in minute 1 or day 1 after an injury can really change how a child recovers. Take a peek at this awesome post and please post comments/questions if you have them. More content will also be published later this week.

---

There is an ongoing debate about how we should best assess, manage and prevent head injuries in sports. Given the complexity of the injury and the effects that a concussion can have on an individual there is no room for the outdated and dismissive terms such as “getting your bell rung” or a “ding to the head.” Being dismissive of head injuries can lead to premature return to play and can end tragically. These injuries really matter.
This isn’t to say that kids shouldn’t play sports of course. Sports promote cardiovascular health and play a crucial role in the character development of children and adolescents. Parents must balance the risk with the benefits of sports to promote healthy decision-making. I like to talk about an active risk-reduction lifestyle. Through outreach and education we can prevent debilitating injuries, identify concussions early, and provide care plans that stem from evidence to limit the impact injuries have on kids.

What Every Parent Should Know About Concussions

• Helmets do NOT protect against all concussions
  • Helmets provide crucial protection against skull fractures and more severe brain injuries but you can still suffer a concussion even with all of the proper protective equipment.
•  There is a right way to play sports
  • Teach your kids safe ways to play sports and adhere to the rules of the game. For example: no tackling in soccer and no head tohead contact in football. HEADS UP trained coaches teach actively safe participation in sports.
  • The majority of sport rules are intended to maintain a level playing field and enjoyable experience. Head to head contact in football is just one example of improper and unsafe play that has recently drawn national attention in increasing ones risk for injury.

Because injuries happen, a group of experts developed the Standardized Concussion Assessment tool- 3rd edition (SCAT 3). This tool can help guide trained coaching staff, athletic trainers and medical providers in the initial assessment, triaging, and monitoring of these injuries. Many concussions can be handled through the expertise of your pediatrician or primary care provider. Concussions with prolonged symptoms (lasting weeks to months) and\or more severe injuries frequently benefit from a team approach.

Act Fast If Worried About A Head Injury

First things first – act fast. If you think your child has a concussion immediately remove them from play/danger, and get them evaluated by a medical professional. The timeline and quality of care your child receive following a head injury can have an impact on the outcome. If a concussion is suspected, your child should never return to play a sport or participate on the same day of your injury. Seek timely care, within 24-48 hours, and escalate care (ask to see someone specializing in concussions) if you are concerned. Given the complexity of these injuries there are often a number of treatments that can help manage the symptoms and speed up the rate of recovery.

5 Things To Do If  Your Child Has A Concussion:

1. Know when to go to the emergency department.

• If your child has a prolonged loss of consciousness, vomits after being hit in the head, or gets progressively worse take them to the emergency department. These symptoms could indicate a more severe injury such as increased pressure or blood on the brain and warrants timely evaluation by a trained clinician to determine if further evaluation and/or imaging (a CT scan or MRI) is indicated.
• If your child doesn’t have these symptoms, but complains of a headache, dizziness, confusion, sensitivity to light, or doesn’t feel well, call your pediatrician. While time and rest is the foundation of initial concussion management, timely evaluation\management following an injury can decrease the severity of the injury.

2. The younger the child the longer the potential recovery may take.

• It’s true that developing brains appear to be more susceptible to injuries then developed brains. The brain is still developing until the early 20’s! We see this reflected in prolonged recovery rates in younger athletes (school-age) compared to high school and college athletes. Even though young kids “bounce back quickly” know that young children may need the most time out from activities after a head injury.
• Partner: parents should determine how long to delay reentry to sports for younger children along with their pediatrician, ARNP or family doc.

3.  Pain is not gain

• Research indicates that if your child tries to push through a concussion by going back to school too soon or over exerting themselves, they can delay recovery by weeks to months. Tell this to your children!

4. Mental rest should be part of the plan

• Cognitive and physical rest can be beneficial for up to 7-10 days following a concussion. This means no sports, running or high intensity physical activity. Cognitive rest means potentially taking a break from school and recreational mental activity (reading, movies, computers, video games and even cellphones) immediately following an injury. Once symptoms improve pacing your return to mental activity can avoid flares in symptoms. With conservative management and rest many of these injuries improve within that time frame. If after 10 days you’re not seeing improvement in your child’s symptoms the head injury may be more complex and may benefit from additional evaluation by your pediatrician or a concussion specialist.
• While both the extent and amount of “brain rest” continues to be debated, some cognitive rest following a concussion remains the standard of care.

5. Escalate care when appropriate

• Loss of consciousness or being “knocked out”  doesn’t always happen with concussions and is not necessary for the diagnosis of concussion.
• Your instinct is important: If things don’t feel right get evaluated. Subtle complaints such as “feeling in a fog”, difficulty concentrating, or fatigue can linger beyond when the obvious signs of concussion such as headache and dizziness resolve.
• Timing: If your child isn’t getting better within two to three weeks while being followed by your primary care provider, consider seeing a specialist. The concussion program at Seattle Children’s Hospital, Harborview Medical Center and the University of Washington are examples of local specialty concussion clinics in the Pacific Northwest that offer comprehensive care of head injuries such as concussion.

In my clinic at Seattle Children’s I perform a comprehensive history and physical exam. While aspects of my assessment may mirror the initial intake evaluation performed by your pediatrician, my focus is on a thorough neurological examination to quantify and address the constellation of post-concussive symptoms. Part of the evaluation may include getting an MRI, to help rule out other potential causes for prolonged symptoms. Overall goals of the visit are to identify barriers to recovery and work closely with a comprehensive team of providers(rehab psychologists, physical therapists, and additional specialties depending on individual patients needs.) In many ways I act as the concussion quarterback of care, tracking symptoms, partnering with patient and the families and making a good play to expedite recovery.
Care doesn’t stop when symptoms do. Once recovery is complete, parents and I have an in-depth conversation about risk factors. We promote a risk-reduction lifestyle with the goal of avoiding future injuries. After I clear someone from their injury I transfer ongoing care back to your pediatrician, whose role is crucial in maintaining and promoting long term health.
More from these experts in the next blog post…what questions do you have?