Athletic Concussions (Part 1) by Michael Stump, MD, Blanchard Valley Orthopedics & Sports Medicine
Concussions in sports have been in the news and on social media frequently over the last few years. Over that same time period, there has also been an increase in research on concussions, and this new knowledge has changed many aspects of concussion treatment. The depth of this topic calls for a two-part column, and this week’s column will discuss what research has taught us about the initial evaluation and management of concussions.
A concussion is defined as a disturbance in brain function that occurs following some trauma to the head. Animal research has helped us understand what happens during a concussion at the cellular level. Basically, the brain is not working properly because communication between brain cells is disrupted. This disruption results in the common signs and symptoms of a concussion, such as headache, confusion and difficulties with memory, concentration, dizziness and/or balance. Contrary to popular belief, most athletes with concussions do not experience a loss of consciousness.
The most frequent questions about concussions that occur during sports include, “What should I do if I suspect my child has a concussion?” and “Should I bring my son/daughter with a concussion to the emergency room?” The first important step in managing a concussion is to remove the individual from the practice or game immediately. Recent studies have shown that if an athlete is allowed to continue participating instead of being removed from play, even if they do not sustain another blow to the head, the risk for a prolonged recovery over one month is doubled. In answer to the emergency room question, while all patients with a suspected concussion should see a physician, in most cases it is not necessary to be seen immediately. Red flags that indicate the need for the athlete to be seen in the emergency room include a loss of consciousness lasting for over one minute, severe vomiting, unequal pupils, seizure, rapidly progressive headache or any other symptoms that worsen over time. If none of these are present, observe the individual for any worsening symptoms and see a physician within two to three days.
In the past, it was standard practice to wake patients with concussions every one to two hours to make sure their symptoms were not worsening. However, recent research has shown that frequent waking actually slows recovery, since proper sleep is important to recovery from concussions. Instead, providers recommend monitoring the injured athlete for at least three hours to make sure he or she is not showing any of the warning signs mentioned above, then allowing him or her to sleep.
There have been many studies attempting to develop a test that can more accurately determine if an athlete has a concussion. A number of blood tests and imaging studies, such as computerized tomography (CT) or magnetic resonance imaging (MRI) scans have been reviewed, but none have been found to be useful. You may have heard about the “concussion blood test” that was in the media recently, but this test is only positive if a patient has bleeding in the brain; by definition, a concussion does not have any brain bleeding. Therefore, this test cannot distinguish between patients with a concussion and those without. While some modifications to MRIs have been shown to be positive in patients with concussions, these tests currently are not ready to be used in evaluation of patients. Despite all this research, at this time, most athletes with concussions do not need any testing, and providers continue to make concussion diagnoses based on the patient’s history and examination.
Be sure to check back tomorrow for a discussion on how the latest research has changed the management of concussions.