Is That a Concussion?

Concussion causes and whether one has one is difficult to pinpoint

(RxWiki News) The helmet on that athlete's head can only do so much. The short- and long-term problems from getting hit on the noggin have been laid out over the years, but diagnosing them has been a different story.

Research from a recently published study shows a number of reasons why it's difficult to define a concussion and say for sure when an athlete has one.

"Watch for any sign of dizziness or headaches."

Researchers, led by Ann-Christine Duhaime, MD, director of pediatric neurosurgery and of neurotrauma and intensive care in the neurosurgical service department of Massachusetts General Hospital, looked at which signs, symptoms and athletes' histories better define concussion in each player.

The study included 450 athletes who had almost half a million head impacts over two to four seasons of play between the fall of 2007 and spring of 2011.

Athletes were from three college football teams and four ice hockey teams, both male and female.

They were instructed to wear helmets designed to measure the acceleration and angle of the impact during both practices and games.

Researchers did not tell the teams' trainers and medical staff members how to define a concussion. The personnel relied instead on signs of a concussion already set by each university's athletic department.

The researchers then collected basic information and reevaluated players who were diagnosed with a concussion, looking at athletes' symptoms and cognition.

Evaluation at some of the schools included a balance test, gene sample and xrays of the brain.

They also looked at symptoms and other findings linked with the concussion, how impact related to the concussion, the time between the start of symptoms and diagnosis and how the athletes had their injury.

In 44 of the players, 48 concussions were diagnosed. Researchers found 31 of those concussions could be directly tied to a specific hit on the head.

A third of the concussions were not linked to an exact impact.

The diagnoses were made mainly by self-reports from athletes. Few were diagnosed by others.

Half of the athletes noted symptoms right away after they were hit. For many other athletes, symptoms occurred later.

Athletes most often reported headaches, dizziness and mental clouding. Only one person lost consciousness.

Researchers also found that concussion diagnoses from trainers were much more delayed. The diagnosis time was made on average 17 hours after the injury.

In only six cases did trainers diagnose a concussion immediately after the athlete hit his or her head.

Dan Clearfield, DO, a primary care sports medicine physician and dailyRx Contributing Expert, said that ultimately, concussions are "inevitably going to happen."

"The best thing we have been doing is educating the student athletes, coaches, athletic trainers, school personnel, and medical staffs so that these injuries can be prevented where possible, and they are appropriately recognized and managed," he said.

Researchers say it is difficult to identify the reasons that lead to problems as a result of sports-related head impacts. This is due to:

• a variety of signs and symptoms
• inexact timing of when the first symptom appeared and when the person was hit on the head
• lack of observed findings from other people, and
• a broad range of impact speed and where athletes were hit on the head

"By carefully characterizing exactly what we are talking about and by continued investigation,... neurosurgeons and others will be best positioned to offer effective treatments and to advocate knowledgeably for appropriate injury-prevention strategies," the authors said in a press release.

The authors note that they have a financial interest in the tools used to collect the data in their study.

The study, which was supported by the National Institute for Child Health and Human Development at the National Institutes of Health, was published online October 2 in the Journal of Neurosurgery.

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Review Date: 
October 3, 2012