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Trauma- concussion

Primary Care Corner with Geoffrey Modest MD: Need for safe, sustainable sports

9 Sep, 14 | by EBM

study from boston children’s hosp looking at kids aged 11-22 coming into ER with acute concussion¬†(see doi.org/10.1542/peds.2014-0158#sthash.y90mwnqy.dpuf). assessed duration and course of post-concussive symptoms. not much info in the literature previously about the time-course of symptoms. all pts had blunt head trauma with either alteration of mental status or new symptoms of headache, nausea, vomiting, dizziness, fatigue, drowsiness, blurred vision, memory or concentration difficulty, and no evidence of intracranial hemorrhage. exclusion criteria included glascow coma score <13, skull/long bone fracture, coexisting abdominal/thoracic injury, too much cognitive disability to fill out the questionnaire. Rivermead Post-concussion symptoms questionnaires were given in ER and at 1,2,4,6,8,12 weeks after ER visit. ¬†results:

–235 patients completed at least 1 follow-up questionnaire. mean age 14, 60% male, 22% with loss-of-consciousness, ¬†34% had concussion from collision, 41% from fall, 19% struck by object, 64% from playing sports. 23% had imaging done

–headache (85%), fatigue (64%), dizziness (61%) and taking longer to think (58%), poor concentration (52%) were most common presenting symptoms

–sleep disturbance, frustration, forgetfulness and fatigue were most common symptoms during follow-up:

–at day 7: 77% with some symptoms, with 69% having headache, 60% fatigue, 57% poor concentration, 54% taking longer to think, 44% light sensitivity, 44% forgetfulness, 43% noise sensitivity, and 30+% with restlessness, irritability, frustration, nausea, blurry vision

–at day 28: 32% with some symptoms, with 25% having headache, 22% fatigue 18% taking longer to think, and 10+% with dizziness, light sensitivity, frustration, irritability, restlessness, forgetfulness, dizziness, noise sensitivity, sleep disturbance

–at day 90: 15% with some symptoms, with 3+% with dizziness, fatigue, headache, poor concentration, taking longer to think.

–median days of symptoms: most of above lasted 10-12 days. longest were: fatigue 13d, light sensitivity 13d, sleep disturbance 16d, poor concentration 14d, taking longer to think 13d, frustration 14d, irritability 16d, and restlessness 12d

–physical symptoms mostly improved over time, but cognitive/emotional ones increased by day 7, then declined. 18% reported worse school performance after the concussion and only 8% returned to full athletic activity (64% reporting no athletic activity at all, except walking)

so, there are clear limitations to this study (self-reported symptoms, lack of control group), but pretty impressive how long the symptoms last. especially an issue for school-aged kids. as a firm believer in the importance of exercise, i find it unfortunate on both sides of the picture: first the high incidence of concussions (numbers are difficult to know, with definitional and reporting problems, but cited as high as 20+% of high schoolers who participate in sports), with the attendant long-lasting physical and cognitive/emotional problems); and second the finding that after a concussion, a significant majority reported no real athletic activity (at least for the 90-day mark). all of this speaks to the need for safe, sustainable sports through high school, with modifications to reduce the rather high risk of concussion and its sequelae (including the low likelihood, in this study, of returning to athletic activity).

geoff

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