Whats up, doc?

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August 2024

 

Concussion has become a diagnosis that provokes fear in parents and unnecessary restrictions on the patient.

 

1) A review article, WHAT’S NEW WITH PEDIATRIC SPORT CONCUSSIONS? y Mark E. Halstead, MD, FAAP appeared in PEDIATRICS vol 153, nu.1. January 2024, pg. 61. I feel it gives a very clear view of this topic.

 

The author points out that the days of keeping the patient in a darkened environment with decreased stimulus are gone. He states that it not only lacks benefit but may slow recovery.

 

The current recommendation is for light activity that does not provoke increased symptoms as soon as 48 hours after the injury.

 

Regular athletic activity should not be resumed until all symptoms are gone as activity is increased. 50% of the patients may achieve this in 7-10 days with 30% taking much longer. Returning to sports activity should be decided by the physician experienced in concussion recovery; not the coach, parent and certainly not the patient.

 

The article lists risk factors that might indicate a prolonged recovery:

  1. Serious initial symptoms present

  2. Continuing play immediately after the concussion.

  3. Delay in medical care.

  4. Little follow-up rest after the event in physical and cognitive activity.

  5. Females with migraines.

 

What should the informed parent take away from this article?

  1. We don’t have to keep a patient in a non-stimulus environment for a prolonged amount of time.

  2. Unless the risk factors are present the usual recovery is 7-10 days before the patient can return to sports activity.

  3. “Sports activity” means any physical risk activity; i.e. skate boarding, bicycle riding, “backyard” sports, etc.

  4. The decision to return to full sports activity is to be made by an experienced physician in concussion observation’ not a coach, trainer, parent and never the patient.

 

In my practice it has always amazed me that we take better care of our lap tops or I -phones than our brains; the most spectacular ”computers” on this planet.

 

We marvel at “A.I.” which pales in significance to the human brain. Remember, we can get another computer but we cannot get another brain. Provide it with the same care we give to our man-make electronic devices.