BC Concussion Researchers Propose ‘Very Inconsistent’ Changes to How Brain Injuries Are Diagnosed

It’s hard for Meg Kerekes to remember what happened after she hit her head on the ice while playing hockey.

But the former Vancouver High School hockey player knows what that particular headache felt like — “like a one-pound weight being put where it hits.”

“I forgot if they put me out or made it through the rest of the game,” she said of the alleged concussion in September 2018 while playing amateur hockey while in high school in Vancouver. rice field. “I think we’re probably done with the game.”

Her coach, who also serves as safety officer, advised her to stop playing, citing the risk of concussion.

“I didn’t do anything to the doctor. They just didn’t let me play for two weeks,” said Kerekes, who hit his head again five months later after being hit by an opponent.

After the second incident, her mother took her to the hospital on the orders of her coach, where a suspected concussion was confirmed, and Kerekes missed 10 days of school. She returned to “light” hockey practice, but she had no games in three weeks.

Amateur sports coaches and other volunteers need to be more aware of the risk of concussion, Kerekes said. Kerekes still sometimes gets a mild headache when he shakes his head while listening to music.

‘Wide dissatisfaction with existing standards’

Recognizing and properly diagnosing concussion is also a clinical challenge. The Vancouver researchers hope that the new diagnostic criteria they helped develop will change that.

Noah Silverberg, an associate professor of psychology at the University of British Columbia, co-led the international committee’s effort to replace the “grossly inconsistent” definition of concussion.

Experts from North America, Europe, and Australia included emergency room physicians, neurosurgeons, pediatricians, and clinical scientists specializing in rehabilitation and sports medicine.

Silverberg’s paper outlining the new standardization criteria was co-authored by Grant Iverson, a neuropsychologist at Spalding Rehabilitation Hospital at Harvard University on behalf of the American Council on Rehabilitation Medicine (ACRM). published last week in a diary Physiotherapy and Rehabilitation Archives.

Silverberg said concussions have historically been downplayed as minor injuries that don’t require medical attention and are thought to heal on their own.

According to Silverberg, who focuses on concussion recovery and treatment, it’s because people often don’t get treatment immediately or at all, and potential mild traumatic brain injuries go undetected. said that means

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However, concussions may not be diagnosed in the emergency room, where the emphasis is usually on ruling out fatal injuries rather than diagnosing conditions that may involve persistent symptoms or disability. It is, he said.

There is also a long-standing concern that family physicians are missing signs and symptoms of concussion because they have little training in this field, which has advanced rapidly in the last few decades. According to Silverberg, there are also inconsistencies in how concussion clinics diagnose the condition.

The ACRM’s 1993 definition of mild traumatic brain injury is outdated, he said, and whether a patient is diagnosed with the condition depends on the specific criteria used.

He said concussions are difficult to diagnose because the symptoms can overlap with other symptoms, so health care workers should know how the injury occurred—for example, hitting the head while participating in sports or in a crash. He said he had to make a decision.

Two or more symptoms, such as headache and dizziness, meet the diagnostic criteria for concussion, but the clinician should consider observational symptoms such as slow response to patient questions, loss of balance, or lack of awareness of where one is. There should be more emphasis on symptoms, too, says Silverberg. He said.

Laboratory tests to check balance, memory, concentration and vision are also part of the new criteria, he said, adding that brain scans can also be ordered but do not always show signs of damage.

He points to a 2008 study in Australia that applied multiple criteria to 12,000 children aged 3 to 16 and found that the proportion of children diagnosed with mild concussions ranged from 7 percent to 99 percent. It was found to be in the range of Silverberg said such a wide range means there are significant barriers to reconciling the results of studies comparing ‘apples and oranges’.

“I think there is widespread dissatisfaction with existing standards among health care providers of all kinds. You can benefit.”

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Abuse victims ‘taken out of the conversation’

The new standards also emphasize the need to be aware of intimate partner violence.

“Partner assault is a surprisingly common form of injury,” Silverberg said. Most of the cases are owed,” he said. And until recently, they’ve been off the topic of brain injury research. “

Stacey Ashton, manager of shelter services and affordable housing at YW Calgary, said a facility that provides 21 days of shelter space for women recently had minor injuries that may have been caused by domestic violence. He said he had started testing for sexual brain injuries.

“The big challenge is also raising awareness of the potential for brain damage among women who are being beaten. I think this correlation is not well understood by many,” Ashton said. .

It usually takes years for new standards and clinical guidelines to be widely adopted as awareness grows, Silverberg said, but before insurers pay for a particular treatment, they have a validated diagnosis according to the latest definitions of the condition. If you request a diagnosis, it may come sooner in some cases, he said. .