Concussion management: Do’s and don’ts for treating concussion

While concussions are often associated with sports injuries, these tips from Tad D. Seifert, M.D., apply to treating patients regardless of how the head injury came about.

Concussion recognition, diagnosis and treatment have improved significantly in recent years. To further that progress (especially in pediatric patients), Tad D. Seifert, M.D. a neurologist and sports concussion specialist with Norton Neuroscience Institute Sports Neurology Center, offers some do’s and don’ts for primary care providers.

While concussions often are associated with sports injuries, Dr. Seifert’s tips apply to treating patients regardless of how the head injury was sustained.

One area that can lead providers astray is forgetting that not every neurologic symptom following exposure to mechanical force is due to concussion, Dr. Siefert said during a recent continuing medical education opportunity. For instance, a football player complaining of headache may have a history of migraines and happened to experience one during a game.

“I always have to be mindful, to look at any even potential injury situation through the lens of those preexisting comorbidities,” Dr. Seifert said.

Concussion treatment Do’s

Know your patients. Understanding their personalities before an injury helps assess their symptoms after.

“The better we know the patient, the better, because everybody responds differently after head trauma,” Dr. Seifert said.

Educate. Understanding concussion is important for the child, parents, school administrators, coaches, teammates and anyone else who may come in contact with someone who has sustained a head injury.

Review the video. If video is available, being able to review the mechanism of injury is helpful.

Know when to image. Being knowledgeable on when and where to collect imaging as well as understanding the appropriate threshold for pursuing imaging is a key element in forming a treatment plan.

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Concussion treatment Don’ts

Don’t ignore serial assessments. See patients regularly after a concussion — once a week for the first two or three weeks after the injury.

“I find it helpful if I can see that certain areas of their recovery are evolving nicely, but they’re still lagging in other respects,” Dr. Seifert said. “I’ve found it helpful to be able to provide a bit more of targeted treatment to that area that perhaps is lagging. I think that helps with recovery trajectories as well in a positive way.”

Don’t be pressured by return-to-play protocols. The gold standard still remains the Berlin consensus statement. The return-to-play guidelines broadly state removing an athlete from play, a brief time period of rest, and then progressive levels of increased levels of activity.

“Those protocols are not set in stone, and no two concussions are alike,” he said.

Younger patients may need more time on each stage before progressing, and some comorbidities may worsen in response to the concussion — attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), anxiety, depression and migraine all can be amplified by concussion.

Don’t disregard input from those who know the patient well. Listen for signs that they’ve noticed changes in the patient’s behavior, mood, activity level — anything that’s noticeably different since the injury.

Dr. Seifert, whose Twitter handle is @neurodoctad, makes himself available to providers who feel they need to refer a patient or talk through a case.

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