Canadian researcher helps define new standards for diagnosing concussions

VANCOUVER — Remembering what happened after she hit her head on the ice while playing hockey is hard for Meg Kerekes, but she knows what that particular headache felt like: “like a pound on the spot where the bang”.

VANCOUVER — Remembering what happened after she hit her head on the ice while playing hockey is hard for Meg Kerekes, but she knows what that particular headache felt like: “like a pound on the spot where the bang”.

“I forgot if I got taken out or if I finished the rest of the game. I think I could have finished the game,” he said of the alleged concussion in September 2018 when he played amateur hockey during his high school years in Vancouver. .

His coach, who served as the person in charge of safety, suggested that he stop playing, mentioning that he might have a concussion.

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

Her mother took her to the hospital after the second incident on the coach’s orders, where a suspicion of concussion was confirmed and Kerekes was out of school for 10 days. She returned to “light” hockey practice, but not games, three weeks later.

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

Properly 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’s efforts to replace “wildly inconsistent” definitions of concussion. The North American, European and Australian experts included clinical scientists such as emergency physicians, neurosurgeons, paediatricians, and specialists in rehabilitation and sports medicine.

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

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

That often means people don’t seek medical treatment right away, or at all, so a possible mild traumatic brain injury goes unnoticed, said Silverberg, who focuses on concussion recovery and treatment.

However, a concussion may not be diagnosed in an emergency room, where the focus is typically on ruling out catastrophic injuries rather than diagnosing a condition that could involve persistent symptoms and disability, he said.

There is also long-standing concern about family doctors missing the signs and symptoms of a concussion due to poor training in a field that has advanced rapidly in recent decades. There are also inconsistencies in how the condition is diagnosed at 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 condition depends on the particular criteria used.

He said diagnosing concussions is tricky because symptoms can overlap with other conditions, so health care providers must determine how someone was injured, such as by being hit in the head while participating in sports or in an accident. .

Two or more symptoms, such as headache and dizziness, would meet the criteria for diagnosing a concussion, but doctors also need to rely more on observational signs, such as the patient responding slowly to questions, losing balance, or not knowing where it is, said Silverberg. .

A clinical exam that tests balance, memory, concentration and vision is also part of the new criteria, he said, adding that a brain scan might also be ordered, but it doesn’t always show signs of injury.

He pointed to a 2008 study in Australia that applied multiple sets of criteria to 12,000 children ages three to 16 and found that the proportion of those diagnosed with a mild concussion ranged from seven to 99 percent. Silverberg said such a wide range means there’s a big barrier to harmonizing the findings from studies comparing “apples and oranges.”

“I think there has been widespread discontent with the existing criteria among healthcare providers of all types. All different settings will benefit from joining this unified, evidence-based, consensus-based criteria.”

The new criteria also emphasize the need to raise awareness about intimate partner violence.

“Being assaulted by your partner is an alarmingly common way to hurt yourself,” Silverberg said. “These are predominantly female victims and they predominantly have not a single injury, but multiple injuries with repeated assaults over months or years. And they have been left out of the brain injury research conversation until very recently.”

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

“The big piece will also be raising awareness among women who experience violence that they may have a potential brain injury. I think a lot of people don’t quite understand that correlation,” Ashton said.

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

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

Canadian Press health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Camille Bains, The Canadian Press