From Our 2010 Archives
Concussions Not Taken Seriously
Study: Parents Not as Alarmed by Diagnosis of Concussion as They Should Be
Reviewed By Louise Chang, MD
Jan. 19, 2010 -- Parents may not be as concerned as they should be when their children are diagnosed with concussions, but the term "mild traumatic brain injury" may be more accurate and should be used more often, new research suggests.
In a report in the February issue of Pediatrics, published online on Jan. 18, researchers say some doctors and parents may not be as concerned as they should be by a diagnosis of concussion, which could lead to serious problems.
Concussion vs. Brain Injury
The research, by scientists at McMaster University, say doctors consider traumatic brain injury and concussion as two separate diagnostic categories, when in truth, both reflect brain injury.
The diagnosis of concussion is strongly associated with earlier discharge from the hospital and earlier return to school activities, the researchers say.
But in light of a current re-examination of brain injuries and return to activities, including sports such as hockey and football, the researchers recommend that more specific descriptions of concussion and brain injury should be used.
"Even children with quite serious injuries can be labeled as having a concussion," study researcher Carol A. DeMatteo, MSC, says in a news release. "Concussion seems to be less alarming than 'mild brain injury,' so it may be used to convey an injury that should have a good outcome, does not have structural brain damage and symptoms that will pass."
But that's not necessarily true, because a concussion could have serious consequences, the researchers report.
The researchers analyzed the medical records of 434 children admitted over a two-year period to McMaster Children's Hospital in Hamilton, Canada with the diagnosis of acquired brain injury. Of the 341 with traumatic brain injury, 32% had received a diagnosis of concussion, the researchers say.
Despite the severity of the injury, children said to have a concussion stayed fewer days in the hospital and the term was a strong predictor of earlier discharge. And they were more than twice as likely to go back to school sooner following hospital discharge.
"Our study suggests that if a child is given a diagnosis of a concussion, the family is less likely to consider it an actual injury to the brain," DeMatteo says in the news release. "These children may be sent back to school or allowed to return to activity sooner, and maybe before they should. This puts them at greater risk for a second injury, poor school performance, and wondering what is wrong with them."
Using the term "mild traumatic brain injury" rather than "concussion" might help people better understand what they are dealing with and improve decisions about what the children should be allowed to do, DeMatteo and her colleagues contend.
How Is Concussion Defined?
There are no universally accepted guidelines for using a diagnosis of concussion in children, so more specific descriptors ought to be used, for both clinical and research purposes, the researchers say.
Clinicians might use the concussion diagnosis because it alarms parents less than "mild brain injury," implying the injury will soon pass and that is has no long-term health consequences, the researchers write.
"There are currently at least eight difference scales for concussion, with no universal agreement on the definition or grades of concussion," the researchers write. "But there is a lack of scientific evidence to support any of the concussion-grading systems."
This is true even though a diagnosis of concussion could range from mild, with prolonged loss of consciousness, to severe, with no return to consciousness and potentially death, the researchers write.
SOURCES: DeMatteo, C. Pediatrics, February 2010; vol 125.