Concussions

Concussions have been a hot topic in the last couple years, as second impact syndrome has been a result of many sustained head traumas. On the field and off the field assessments are critical with a diagnosis of a concussion. This article at no time will make you an expert on diagnosing concussions. This is an effort to supply data on some of the top concussion assessments, and provide my medical opinion.

First let's do a scared straight tactic:

• Between 1.7 and 3 million concussion occur each each
• 300,000 of those concussions come from football
• Number 2 sport with concussions...Women's Soccer
• and in regards to my job: "SFM, a workers compensation insurer covering the Midwest says they’ve seen a 48% increase in reported concussions that caused employees to lose time from work in just the time from 2012 to 2014" (https://www.traumaticbraininjury.net/workplace-concussions-on-the-rise/)

Having an adequate concussion assessment is important to diagnoses. There is an initial traumatic injury checklist when you are on the field (work field and/or sports field). If you are on the scene, check to see if the person is conscious. If the person is unconscious, immediately go into your emergency preparedness, checking for pulse, breathing etc. By the way, if a person hits their head an they are unconscious you have a concussion unless deemed otherwise. I see too many time they have no other symptoms besides initial temporary unconsciousness and they are sent back to the field. The body is protecting itself by going unconsciousness. It is an immediate defense mechanism. Now that we got that out of the way let's focus on different on field assessments:

SCAT (standardized concussion assessment tool)

The SCAT was developed to assess on the field and off the field assessments. I have provided the link to the Olympic SCAT card below. The initial loss of consciousness question is provided on the top, as well an other serious factors. The questionnaire then provides memory testing , cognitive testing, and neurological testing. The card provides a standard return to play protocol if a concussion is suspected.

The SCAT tool fails to provide more objective symptoms such as battle sign. Also, orthopedic test can get for balance issues (including rhombergs, heel to toe, and single leg stance). The SCAT card focuses mostly on the subjective findings. A simple symptom of a headache, according to the SCAT score, allows for the medical professional to diagnosis a concussion. Headaches can have multiple causes such as dehydration, low blood sugar. I think the idea of headache equals concussions has to be subject to the medical professional.

I have not found any other on the field concussion assessments that have been documented in literature. I am still searching and will update the article accordingly. My on the field assessment goes as follows:

• Assess the situation: What is involved (person to person), (person to machine)? Do you have to perform multiple triage?
• Is the person unconsciousness or conscious?
• The minute they sit up, look at their eyes. Do they have the "seeing right past you" stare?
• Check battle sign, raccoon eyes?
• First question I ask. Are you nauseous, have a headache, dizzy?
• Immediate pupil reaction test

In maybe minute I cleared all the immediate concerns of a possible concussion. From there I bring the athlete to the sidelines for further assessment.

I have researched a couple different off the field concussion protocols:

IMpact testing:

A baseline has to be established. The computerized test focuses on memory, cognition, and reaction skills to develop a score. That score is compared to baseline to determine if a concussion is suspected and the severity of the concussion is determined. This is a useful tool in determining the initial stage of a concussion, but obviously with the computerized test and the baseline assessment, it is time consuming. The test is excellent with providing a standardized tool to assess a concussive patient.

SCAT

As mentioned before, the SCAT or the most recent SCAT3, is a test used to determine if a concussion is suspected.The SCAT3 provides the medical provider with the Maddock questionnaire which is similar to the questions I ask to immediately determine severity of the injury .

In my experience, symptoms to a concussion may be caused by other factors. This is not to say that you should not take a concussion seriously. If you do not have expertise in this field and suspect a concussion with a symptom as simple as a headache, send them for an evaluation. My off the field assessment starts with a stop watch. Within 10 minutes of the initial impact if your symptoms have not decreased I suspect a concussion. If the only symptom is a headache, further evaluate the type of headache. I would also evaluate the headache for other factors, like exertional activity. Balance and coordination issues may also be caused by exertional activity. After this you can perform your cognitive assessment. When the athlete is aymptomatic run them through a physical extertional drill to make sure the symptom don't come back.

Again, if you are not an expert in concussion assessment, assume a concussion until proven otherwise.

Dr. Daniel Eichner DC, LAT, ATC