Four (4) Critical  Parts of a Comprehensive Concussion Assessment Program

Four (4) Critical Parts of a Comprehensive Concussion Assessment Program

By R. Eugene Bailey, MD, Daniel Rancier, MD, Mark Powell MS ATC CSCS


Every year 3.8M concussions occur, but only 16% of them get diagnosed. Therefore each year about 3.1M concussions go untreated. Untreated concussions can lead to permanent brain damage and even death. Our goal at Total Concussion Management LLC is to help increase the number of concussion treatments by making assessments easier and more accurate.

When a concussion occurs on the field, one of four things can happen:

  • No assessment or misdiagnosis occurs. No treatment occurs. Although brain function impairment can occur with the initial injury, subsequent concussive forces to the brain cause further damage, including possible permanent injury or death when the brain is not allowed to recover fully from the initial injury.
  • Poor Assessment occurs,  the athlete does not fully disclose the extent of the injury or the evaluator does not perform a thorough enough evaluation.  Poorly done assessments can occur due to the athlete wanting to get back in the game or the evaluator not having the knowledge, the tools, or the time to perform a comprehensive evaluation. This misdiagnosis can lead to damage that can be inflicted by an undiagnosed and therefore untreated concussion.
  • No record generated for an otherwise accurate assessment. Past assessments are the foundation of current and future concussion recommendations.
  • The ideal accurate assessment with the proper treatment. That includes rest and stepwise return to play protocol followed, and all results are stored in a permanent secure database for recall when needed.

No Assessment or Misdiagnosis Can Lead to Brain Damage or Death

Cam’ron Matthews told his teammates he “felt woozy”  in the huddle one Friday night. Shortly afterward the 16-year-old junior collapsed on the sidelines in East Texas. A day later, he died[1].  

The “woozy feeling” is often a symptom of a concussion. In Cam’ron’s case, they didn’t treat it, and the second hit probably caused his death.

According to Wikipedia “Second-impact syndrome (SIS) occurs when the brain swells rapidly, and catastrophically, after a person suffers a second concussion before symptoms from an earlier one have subsided. This second blow may occur minutes, days or weeks after an initial concussion,[1] and even the mildest grade of concussion can lead to SIS.[2] The condition is often fatal, and almost everyone else is severely disabled. The cause of SIS is uncertain, but they think the brain’s arterioles lose their ability to regulate their diameter, and therefore lose control over cerebral blood flow, causing massive cerebral edema.

Concussion Misinformation

Confusion results from conflicting information. What you don’t want is for that confusion to manifest itself while trying to take care of an injured student. The results can be a student giving false information during an assessment os he/she can stay in the game, or a parent taking their student out of the game needlessly.

Arguments between stakeholders can result in lost time during a critical assessment and delay in treatment.

Successful Concussion Assessment

What components make a powerful concussion assessment program?   First, let us tell you who we are and why you should believe us.

We have a worked in sports medicine for decades.

Mark is an Athletic Trainer at a large High School in upstate New York where he administers all aspects sports medicine program. During his tenure, Mark established various injury management, injury prevention and safety rules for the school district including policies about concussion management,  return to play and return to learn protocols. Mark is also the conditioning coach for a professional hockey team.

Dr. Daniel Rancier MD has been a board-certified Family Physician for over twenty years. He has also served as a school physician for nearly two decades. Dan has worked at the sidelines for over 150 football games treating all manner of injuries, including concussion.

Dr. Eugene Bailey MD is a family practice physician, a professor at SUNY Upstate Medical University and team physician for a professional hockey team, school physician and team physician for a junior hockey team.

We have seen and treated numerous concussion over decades in Central New York. Together we saw a need for a better approach for assessing concussions in student-athletes and set out to do just that.

Computer Aided Concussion Assessment 

We’ve tried many methods of assessing concussion, including local best practices, paper and pencil, ad hoc assessments, desktop programs and mobile apps.   As a result,  we conclude that a comprehensive solution includes these four parts:

  1. Use of a Recognized, Standardized Assessment Protocol
  2. Mobile and Desktop Computer Aided Assessment
  3. Training and Re-training with Verification for Students, Faculty, and Parents
  4. Assessment Tracking in a Permanent Electronic Record Storage

An Internationally Recognized Protocol – SCAT 5

Every four years an international consortium of medical professionals gather to update a standardized tool for evaluating injured athletes for concussion Know as  “Sports Concussion Assessment Tool (SCAT).” Currently, they are in their 4th edition, and they call it SCAT5.

Mobile and Desktop Computer Aided Concussion Assessment

Yes, you can assess a concussion using paper and pencil, but to do so, you will need to have the protocol forms, a place to write and supplies. Additionally, you will need to keep track of those assessments in a file so you can prove accountability for years into the future. While not impossible, you can make your life easier with a computer.

The reason for using a phone app or computer SW tool is to make your life easier and to make your assessment faster. With a phone app, all you need is your phone. Open the app, start a new assessment, get and enter a recommendation then save it and therefore all your records for as long as they are needed. You did it. You helped a student in distress, and now you can go back to the game totally accountable and responsible.

Training and Re-Training for Faculty, Students, and Parents

One of our school physicians encountered a case where a “star” athlete received a concussion during a football match. It was evident that I should remove the student from the game.But the parents resisted the decision.

“Did you know that my son is probably the best player on his team?” the dad barked. He was of the opinion that his son wasn’t that injured and should be on the field.

This attitude happens a lot. Uninformed parents often want their athlete to excel in the game but don’t realize the dangers. Secondarily, head injuries can sometimes be fatal and if left untreated concussions can cause permanent brain damage and disability.  Parents, athletes, and coaches need to understand and be reminded that a concussion is a BRAIN INJURY and that it should be treated as such.

“He has had a concussion and isn’t going back into the game”  was the calm reply from the school doctor. Not realizing the importance of proper concussion assessment and treatment caused a conflict between the parent and the medical personnel.  The conflict wasted time that would have been better used to get the student to the emergency room.

It is important that all the stakeholders including coaches, students, parents, and school medical staff are all operating from the same set of information. The best way to accomplish this is through training. Since most of us are fallible, we need training and retraining. In most states, coaches are mandated by state law to regularly train in concussion evaluation.  Schools should mandate training for students and parents before the athlete’s first practice.

Assessment Tracking – Documentation

School systems are responsible for taking the full and proper action when a potential concussion occurs while under their accountability. Therefore it is critical that the school can show what was done by whom and what was the recommendation. If a concussion is diagnosed, they must show a  proper medical release before returning to the athletic field.

Multiple Assessment Resulting in Return to Play

If you make a proper concussion assessment and relay the information to the right channels, you can treat the current injury better, and future evaluations can be more accurate. The result is greater safety and potential reduction in lost time.

After removing an athlete from play, they should not return without proper medical approval. The law mandates this standardized concussion protocol.

So, Bring Standardization, Accountability, Speed and Ease to Your Concussion Management

Concussions are important to you, your school system, your athletes, and their parents. The responsibility begins with you to prepare and obtain the most comprehensive means available to manage concussions at your organization.

[1]    http://www.motherjones.com/media/2015/10/high-school-football-death-camron-matthews

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