Uppercut to the jaw

Tuesday, April 29, 2008

Glass jaws are usually found in the boxing ring, but for umpire Kerwin Danley, he found his behind home plate. Dodgers’ pitcher Brad Penney threw a 96mph fastball that his catcher misjudged. The result was an uppercut to Danley’s jaw and he was out for the count, or at least for a couple seconds.

There is no doubt that being unconscious means Danley sustained a concussion,
but if Danley’s injury hadn’t been on a national stage, would he have needed an ambulance ride to the hospital and what should have happened once he arrived?

Lots of research has been done to decide who needs to be evaluated after a concussion, when that evaluation needs to take place and whether a CT scan needs to be done to look for bleeding in the brain. In a person who is wide awake after injury, opportunity exists to go a little slower. Studies from the University of Ottawa published in 2001 and then verified in other research developed the Canadian head CT rules for minor head trauma.

If the medical exam shows a patient who is wide awake, has no evidence of a skull fracture, has no vomiting and no or minimal amnesia, then a CT scan may not be necessary. Actually, these guidelines may miss an occasional minor brain injury but none that needed surgery.

So who cares? While pro sports have access to the latest and greatest medical tools and can use them indiscriminately, people in the real world don’t want the extra radiation and expense of tests that won’t make a difference in their care.

The doctor’s decision to order a CT scan is often made by reflex. A patient comes in with a head injury and the test gets ordered. It may be that patients need to be more assertive in asking why a test is being done. Sometimes, it’s the patient who wants the test and perhaps they need to ask themselves the same question.

In concussion, the big question is when a person can go back to work or play. When the brain is injured, it takes time to recover so it can tolerate another hit. Common wisdom says that repeated concussions are bad and the brain should be back to normal before being put into potential danger. Technology is entering the decision making process, as computer program that measure brain function and reflexes are becoming available (see www.impacttest.com). Instead of the gut feeling that it’s OK to go back onto the field, objective evidence is slowly becoming available.

Being decked by major league fastball has got to hurt .Umpires are at the mercy of the pitcher and catcher to be on the same page as to which pitch is being thrown and where it’s being caught. It’s amazing that umpires don’t get hit more often. It must be a testament to the skill of the catcher or the reflexes of the umpire. Kerwin Danley will get his oil and lubed before he steps behind the plate.

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