Concussion in Canada redefined by a researcher. Will the government follow?

VANCOUVER-

Remembering what happened after she hit her head on the ice while playing hockey is hard for Meg Kerekes, but she knows how that particular headache felt – “like a weight of a pound at the place which was hit”.

“I forget if they took me out or if I finished the rest of the game. I think maybe I would have finished the game,” she said of the alleged concussion. in September 2018 while playing amateur hockey during her high school days in Vancouver.

Her coach, who was also in charge of safety, suggested she stop playing and mentioned that she might have a concussion.

“I didn’t go to a doctor or anything. They just wouldn’t let me play for two weeks,” said Kerekes, who suffered another blow to the head five months later when a opposing player hit it.

Her mother took her to the hospital after the second incident on the coach’s orders, where a suspected concussion was confirmed and Kerekes was absent from school for 10 days. She returned to “light” hockey practice, but no games, three weeks later.

Coaches and other amateur sports volunteers need to be more aware of concussion risks, said Kerekes, who still gets a mild headache sometimes just from shaking her head while listening to music.

Correctly recognizing and diagnosing concussions has also been a problem in clinical settings. A Canadian researcher hopes that will change with a new diagnostic standard he helped develop.

Noah Silverberg, an associate professor of psychology at the University of British Columbia, co-led an international panel effort to replace “wildly inconsistent” definitions of concussion. North American, European and Australian experts included clinician-researchers such as emergency physicians, neurosurgeons, pediatricians and rehabilitation and sports medicine specialists.

Silverberg’s paper outlining the new standardized criteria, co-authored by neuropsychologist Grant Iverson of Harvard University-affiliated Spaulding Rehabilitation Hospital on behalf of the American Congress of Rehabilitation Medicine (ACRM), was published last week. in Archives of Physical Medicine and Rehabilitation.

Silverberg said the concussion has always been downplayed as a minor injury that doesn’t require medical attention and is thought to get better on its own.

This often means people don’t seek medical treatment immediately, if at all, so a possible mild traumatic brain injury goes undetected, said Silverberg, who focuses on concussion recovery and treatment. cerebral.

However, a concussion may go undiagnosed in an emergency room, where the focus is usually on ruling out catastrophic injuries rather than diagnosing a condition that could involve persistent symptoms and disability. did he declare.

There has also long been concern that family physicians miss the signs and symptoms of concussion due to little training in a field that has advanced rapidly in recent decades. There are also inconsistencies in how the disease is diagnosed in concussion clinics, Silverberg said.

A definition of mild traumatic brain injury published by the ACRM in 1993 is outdated, he said, and whether a patient is diagnosed with the disease depends on the particular criteria used.

He said diagnosing concussions is tricky because symptoms can overlap with other conditions. Health care providers must therefore determine how a person was injured, for example by being hit on the head while playing sports or in an accident.

Two or more symptoms, such as a headache and dizziness, would meet the diagnostic criteria for a concussion, but clinicians should also rely more on observational signs such as a patient responding slowly to questions, being off balance or not knowing where he is, Silverberg said. .

A clinical examination that tests balance, memory, concentration and vision is also among the new criteria, he said, adding that a brain scan could also be ordered but does not always show signs of injury. .

He pointed to a 2008 study in Australia that applied multiple sets of criteria to 12,000 children aged 3 to 16 and found that the proportion of those diagnosed with a mild concussion ranged from 7% to 99%. Silverberg said such a wide range means there is a huge barrier to harmonizing the results of studies comparing “apples and oranges”.

“I think there has been widespread dissatisfaction with the existing criteria among healthcare providers of all kinds. Different settings all have a vested interest in adopting these unified, evidence-based, consensus-based criteria. .”

The new criteria also underscore the need for awareness of intimate partner violence.

“Being mugged by your partner is an alarming way to hurt yourself,” Silverberg said. “These are mostly female victims and have not a single injury, but multiple injuries with repeated assaults over months or even years. And they have been excluded from the conversation about brain injury research until ‘to fairly recently.”

Stacey Ashton, manager of residential services and affordable housing at YW Calgary, said the facility that provides women with residential space for 21 days recently began screening for mild traumatic brain injuries that may have occurred due to domestic violence.

“The big piece, too, will be to make women who experience violence aware that they could have potential brain damage. I think that correlation is misunderstood by a lot of people,” Ashton said.

New criteria or clinical guidelines generally take several years to be universally adopted as awareness increases, but this could happen more quickly in some cases if insurance companies require a verified diagnosis according to the last definition of a condition before to pay for specific treatment, Silverberg said.

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This report from The Canadian Press was first published on May 25, 2023.

Canadian Press health coverage is supported through a partnership with the Canadian Medical Association.