Monday, December 26, 2011
While the NFL season continues its march to the playoffs, there is another football battle that is unfolding. The concussion issue is heading to the courts as former players are suing the league arguing that the long term risk of head injury was minimized by league officials and the medical personnel charged with the wellbeing of the players. Regardless of the outcome, it is a given that the physical nature of many sports including football, hockey and soccer, head injuries are inevitable and it is important to have a strategy to increase recognition and diagnosis.
This is a harder task than it appears since concussions can be very difficult to assess. Here are some interesting tidbits:
• Being knocked out for a few seconds does not mean that there was a significant concussion. Based on the guidelines from the International Conference on Concussion in Sport suggest that it matters only if there was prolonged loss of consciousness greater than 1 minute.
• Having a seizure after getting hit in the head is usually no big deal. A short seizure or jerking is not uncommon and does not need specific treatment other than what is provided to the care of the concussion itself.
• CT scans and MRIs are not useful in assessing the patient with a concussion. There is not usually a structural problem with the brain and the scans should be done only if there is concern that there is bleeding in the brain. This leads to a whole other subject that has been addressed by researchers in Ottawa and New Orleans who have developed guidelines to decide who needs a CT scan after sustaining a minor head injury.
• Concussion symptoms may not be readily apparent and could take hours to be recognized. Subtle signs can include change in sleep patterns, irritability, difficulty concentrating, headache and subtle changes in personality.
• Return to play on the same day is not recommended and the same guidelines should be used for both elite and recreational athletes. While elite athletes may have more people watching over them, the extra tests and hovering do not make the brain heal itself any faster.
• Since there is no magic test to make the diagnosis, there is similarly no one test that can say when the brain is ready to go. Return to play is a trial and error process that takes the player through exercise and workouts, gradually increasing their intensity. The player graduates from one level to the next only if the increased workload does not induce the return of concussion symptoms. It usually takes a week to pass this test but sometimes the player fails repeated and is done for the season and sometimes the injury is career ending.
About half of NFL players recently interviewed by the Associated Press said that they would hide the symptoms of a concussion fearing that it would end their ability to play. They would do so knowing the risk of short and long term complications including increased risk of suicide and dementia. The same players also wanted neurologists on the sideline but there lies the conundrum, and it is the same as for many other medical illnesses. Patients can’t be treated if they don’t show up for their appointment, be it in the clinic or the twenty yard line.