4 responses to “Gaps in recognizing, treating and managing concussions”

  1. The authors note that concussions occur by the millions and are a leading cause of death and disability. They suggest that early treatment is essential (“Without proper recognition and treatment early symptoms may progress”) and reference a 15 y.o. paper (Ref 3) that finds that “early single session treatment can prevent the syndrome as effectively as traditional outpatient therapy.”

    They note that “Concussions are the most common form of brain injury in British Columbia,” that “they can occur without loss of consciousness and initial symptoms can be subtle and may not show up for the first few hours or days,” and that “85% of concussions usually resolve with out complications if treated properly.”

    I would find this paper much more useful if it defined the condition it was discussing and then gave evidence-based evidence about treatments that are useful.

  2. The video clip of Drs. Tator and Taunton seems unfortunate, to me. It lacks scientific rigor and is more akin to scare-mongering around this important and complex topic. I found it rather off-putting, since it suggested to me that the module for medical education provided may provide a similar un-nuanced, emotional and simplistic approach.

  3. While there may be significant morbidity from concussions, I was unaware they are a leading cause of death. Most traumatic brain injury deaths occur at the more severe end of the spectrum than concussion. An intracranial bleed or a coma is not a concussion. Even the feared “second impact syndrome” death is such an exceedingly rare event that it’s existence is debated by some and has only case series level evidence at best.
    The hyperbole linking death to concussion is misguided and creating unnecessary fear.
    Even less forgivable is the cited reference #1 that links concussion to death must be a typo or a mistake. It seems unlikely the authors of “The salutary effects of DHA dietary supplementation on cognition, neuroplasticity, and membrane homeostasis after brain trauma. J Neurotrauma. 2011;28(10):2113-2122” are discussing concussion death rates.
    Warren Thirsk, MD, FRCPC, Dip Sport Med (CASEM)

  4. Thank you for your comments. Sorry for the confusion and we will revise the opening line to say “Traumatic brain injuries are….”. In the literature, the terminology around the word concussions, mild TBIs, TBIs, head injury, etc. are used interchangeably and concussions are considered a traumatic brain injury, albeit mild in most (approx. 85%) of cases. Second impact syndrome is rare but does occur as recently seen with the death of Rowan Stringer in Ontario which has led to the discussion around a national concussions strategy to avoid unnecessary deaths. It was not our intention to create fear by any means but to simply say that concussions are a brain injury and should be taken seriously. In terms of the reference, I have appended the first couple of sentences taken from the article. Again we will make the suggested change outlined above.

    Traumatic brain injury (TBI) is one of the most common causes of death and disability in the United States, with
    220,000 hospitalizations, 52,000 deaths from head trauma, and 80,000–90,000 patients suffering from permanent disability
    each year. The total costs of TBI in the U.S. are about $44 billion each year (Sosin et al., 1995;Waxweiler et al., 1995).

    Dr. Alexander Moll: Thank you for your comment. The videos of Drs. Taunton and Tator by no means were meant to be a scare tactic but to provide commentary by world renowned experts in the field. The tool is built and based on the Consensus Statement of Concussion in Sport held every four years (last one in Zurich ) as well as new and emerging evidence. It was built to provide medical professionals a site for up-to-date guidelines as well as resources with ease.

    Tom Finucane: Thank you for your comment. The referenced paper (#3) outlines symptoms that can progress if initial physical and cognitive rest aren’t followed, which is still the case today. Concussions are a precarious injury with individuals responding very differently. One may recover in the normal course of 2 weeks while another may still be recovering months later. Given the lack of concrete diagnostic tools for diagnosis, concussion diagnosis is based on history, symptoms, cognitive and balance testing, with no treatment but immediate cognitive and physical rest to allow the brain to heal, followed by slow integration back to activity as tolerated.

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