Researchers recently released results from a study into the effect of educating parents about the difference between a concussion and a brain injury. The goal of the study was to see whether using the graphic illustration below changed the rate of head CT orders when parents bring their children to a provider for evaluation of a concussion or minor head injury.
As a parent, I know there’s a lot more education and public awareness about concussions and childhood sports, at least since I grew up and played basketball in the 1980s.
What is a concussion?
The dictionary includes one definition of concussion as “a violent shock as from a heavy blow.” Sometimes people use the word to describe the ground shaking after an explosion.
When it comes to head injuries, a concussion can happen in football, soccer, boxing, or just banging your head on something.
I like how the authors of the JAMA Neurology study described concussion as “brain movement within the skull.” That makes it pretty easy to understand. Something hits your head causing your brain to move within the bony confines of the skull.
Concussion symptoms may include some or all of the following:
· Difficulty concentrating
· Loss of consciousness
Typically, symptoms resolve in a time period of between several days to a few months and recovery is almost always complete.
Often, parents and emergency physicians discuss whether a CT scan is warranted. There’s a bit of tension in this decision-making because CT scanners expose patients to radiation and concussions cannot be seen on a CT scan. On the other hand, if the head injury is something more than a concussion—there is bleeding—it’s important to diagnose and treat it.
Is a concussion a brain injury?
Technically, a concussion is a type of mild traumatic brain injury caused by a mild blow to the head. Yet, most doctors use the word “brain injury” to describe head injury severe enough to cause bleeding in or around the brain.
Medical research shows that only 1 out of 100 children with a concussion or minor head injury will have a brain injury with bleeding. That means, of course, that 99 out of 100 will not.
A brain injury that includes bleeding in or around the brain is serious because there is only a limited amount of space in the bony cranial cavity. If bleeding doesn’t stop, it can compress the brain and even cause the brain to herniate, or squeeze down out the back of the cranial cavity (foramen magnum). Thus, these types of injuries may require hospitalization or even a surgery to stop the bleeding.
Different types of brain bleeding include epidural hematoma, subdural hematoma, subarachnoid hemorrhage, or intracerebral hemorrhage.
Wondering about the study results?
The JAMA Neurology study concluded that a graphic decision aid like the one shown in the illustration had no impact on the number of CT scans ordered. On the other hand, it made decision-making a bit easier. I think any time a physician is better able to communicate facts, findings, and options to the patient or parent, it’s a good idea.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2018, by H Texas as one of Houston’s top lawyers. Also, in 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.