Teamwork Best in Recognizing, Treating Concussion

About a quarter-million children and teens visit emergency departments in the United States every year with what looks like a concussion – technically, any bump, blow or other impact to the head significant enough to disrupt normal brain function.

No two concussions are alike, doctors say, either in how they occurred or how they play out in days, months and even years following the initial injury. 

Now, experts agree, it takes a team approach – from the coaches and athletic trainers on the sidelines to the doctors and nurses in the emergency department or clinic – to make sure patients get the best outcome.

"An individualized treatment plan with careful monitoring of the patient’s recovery is vital. This, in addition to having open lines of communication between all parties involved – high school athletic trainers, coaches, teachers, parents, etc. –  is imperative for treatment success," says Dr. Brandon Kakos, a sports medicine specialist with Mercy Health – Wellington Orthopaedic and Sports

Medicine in Eastgate.

Around the country, school systems and health networks, including most in the Tristate, are implementing new systems like the  ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) computerized concussion evaluation system.

Even a mild concussion can affect a person’s neuropsychiatric function – the way they remember, reason, behave and react. With the ImPACT system, athletes undergo a number of tests to establish their baseline levels on memory and cognitive measures, as well as physical measures, like balance and vision. Those results are stored in a database, and if an athlete suffers a concussion, new tests are taken and compared to the original readings.

The system lets doctors measure the degree of damage, and helps track how well post-concussion therapy is working, says Dr. Michael Barrow, co-medical director of the Sports Medicine Center at Premier Health’s Good Samaritan Hospital in Dayton.

It’s a big improvement over the old days, when healthcare providers were limited to X-rays and CT scans.

"Those are static tests. The problem with them is they don’t show how well the brain is functioning," Barrow says.

There’s also more focus on therapy after the initial injury, says Dr. John Brannan, a physiatry and rehabilitation medicine specialist with Beacon Orthopaedics and Sports Medicine in Sharonville. Options include speech and language therapy, which often helps with the language and memory issues that concussions can cause, as well as physical therapy.

Doctors have also learned that giving the brain a little "quiet time" after the injury – usually by taking away the teen’s access to their computer and smartphone – helps improve healing, Brannan says.

Most teens are symptom-free within two to three weeks after suffering a concussion, Barrow says, and using the baseline information stored in ImPACT helps confirm that.

It’s not always easy to recognize a concussion, even in an emergency room. UC Health, which operates the University of Cincinnati Medical Center and West Chester Hospital, has recently implemented new protocols for diagnosing and treating possible concussion, says Dr. Natalie Kreitzer, an emergency medicine and neurology/critical care specialist at West Chester Hospital, who helped develop the new practices.

"Within the emergency department, we now have an observation protocol that is dedicated to patients with mild traumatic brain injuries or patients who are having concussion symptoms," she says. "While patients are in the ED, they are able to have a cognitive evaluation, which is performed by speech therapists. They are able to recommend further treatment specifically tailored to the patient’s needs."

Kreitzer estimates she sees one concussion patient per shift in the ED, usually in adults.

Preventing concussion means finding ways to protect the brain from impact. Protective equipment, including helmets and neck braces, can only do so much,

Kakos says.

But some athletic organizations are taking steps to change the way many sports are played, including football and soccer, so that players – literally – don’t use their heads as much, Brannan says, and that will help. Requiring athletes to sit out until the initial concussion clears also reduces the risk of a second concussion that, in many cases, can cause more significant injury to the brain than the initial blow.

Improving training for athletic trainers and coaches and getting more health professionals on the sidelines during games also helps.

"Sports medicine has to start on the field," Brannan says. "Sports medicine doesn’t happen Monday morning. It doesn’t happen in the ED. It starts on the field."