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Identifying Concussions 101 for the Sideline Spectator

I was all set to board my flight home from the American Academy of Pediatrics (AAP) meeting in Chicago and write a compelling summary of my few days in the McCormick Convention Center walking shoulder to shoulder with some giants in the field of Pediatrics, when suddenly my message notification buzzed in the airport security line.

You guys know by now that I’m wild about all the #smartmommas who weigh in regularly on various topics on social media. The tremendous wisdom, keen insight, clever humor, and pointed questions add more to my professional satisfaction than I think I can adequately describe in words. Good stuff. But this time, on the other end of the notification was a #smartDAD. Not as many of those types seem to be speaking up in the DearDrChristina galaxy of health commentary. This guy shared a story about one of his children and suggested that I write a bit about how a non-medical person might recognize a concussion, given that Fall sports for kids are in full swing.  He’s a paramedic and a critical care transport nurse for children, so when he makes a topic suggestion, I listen up. He defines the term “finger on the pulse” in many different ways, as you can imagine.

text messaging screen shot

So let’s set the scene.

You’re at your 13 year old child’s soccer game on a Saturday. If you’re like me, you had to get up at the crack of dawn and you didn’t have enough time to shower because you picked coffee over shower so you might possibly look as though your hair has suffered an electrocution injury. You barely made it on time to the game because you forgot to get gas in your car the night before so you had to stop, and when you arrived you realized you don’t have your folding chair and blanket so you’re also cold. (How’s that for a compelling intro?)

And you’re standing on the sidelines. You see 2 kids go up for a ball in the air and their heads collide. They both go down and are lying on the field. One gets up quickly, appears ok. The other is still down, moving but clearly not 100%. The ref comes over and motions for the coach to come out, and they both get the player up. Clearly she looks like she’s gotten her bell rung: she’s dazed, stunned, and moving but not with the usual coordination of an athlete.

What’s going through your mind as you watch these events unfold?

Given the extensive amount of media coverage about concussion in the news, let’s not make this document a re-hash of any of THAT.  Let’s review a few quick important points and then just simply go through how YOU can help identify a kid who might be concussed, without making a career of it.

Recall that concussions can be tricky, because there’s no X-ray or CT scan that makes the diagnosis. It’s what we call a clinical diagnosis, made by astute clinicians and those trained to clue in to specific physical signs and symptoms. A concussion happens when the head sustains a blow and, for lack of a better word, the brain gets “shaken up a bit.” It’s a type of traumatic brain injury (TBI) that can cause injury to the brain cells and damaging chemical changes in the brain. It can be quite a serious injury because of the potential long term effects on the brain that manifest physically in vision problems and  chronic headaches, psychologically in learning and focusing problems, and emotionally with mood swings and other difficulties as well.

But you know this. I promised I wouldn’t repeat what has been already extensively covered.

via GIPHY/University of California

What I really think is useful here is to know about:

  1. The basic signs a non-clinician should look for, and
  2. Interesting breaking research news about this topic that I just learned for myself at the recent AAP meeting.

From the vignette above, you have a sense that something isn’t quite right, correct? Appearing dazed or stunned is one red flag. Vomiting or any loss of consciousness or “passing out,” even briefly, are also clear ones. A few other signs and symptoms that can sometimes be more subtle, but that I want you to look for are:

  1. Headache
  2. Light and/or noise sensitivity
  3. Answering questions slowly and unclearly
  4. No recall of the events right before or after the impact
  5. Confusion about what’s happening o
  6. Inability to follow directions
  7. Balance problems

You don’t have to be an athletic trainer or a doctor to notice when an athlete has some of these signs and symptoms after a head injury. You DO have to be a good observer, however.

So what do you do?

For a patient who is what we call “persistently altered,” which means that they are still acting confused and not improving, continuing to vomit, etc. those patients need to be evaluated urgently by a clinician just to make sure that no further immediate intervention is required.

For the others who are still a bit “woozy” but seem ok?

  1. They should NOT play that day, even if they feel better.
  2. Their parents should be encouraged to call their regular clinician to determine some time of follow up.

female soccer players are 5x more likely to return to play on the same day as sustaining a concussion than male soccer players.

That’s pretty straightforward.  I’m not asking you to do much; just simply recognize the subtle symptoms and speak up about sitting out, because….

A new study determined that female soccer players are five times more likely to return to play on the same day as sustaining a concussion than males. And girls sustain more concussions than boys overall, so they are especially at risk for serious long term brain injury. This data was presented at the AAP meeting; here’s the link describing it if you’re interested. Of the 87 soccer players with concussions who were studied, 2/3 were girls. Over half of them returned to play on the same day, compared with only 1/5 of boys who did. Sounds like we need to be more vigilant with our girls, friends.

The #smartDAD’s daughter described at the top of this entry sat out after her injury and sought care. She ended up being ok, thankfully, and I want all of yours to be OK, too. So tune in to those subtle signs and symptoms and speak up when you see them. (This) Doctor’s orders.


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