Those of us on the front line in the concussion world and certainly all injured people would like to know if it will take a few hours, or days, or if the debilitating symptoms of concussion are likely to persist. For some recovery can take many months. For some life is never quite the same. Ever.
A fascinating if somewhat disheartening study was published online this week showing us just how much we really don’t know about concussions.
In the revamped JAMA Pediatrics journal online, Drs. Zemek and others from Canada published their ambitious review of the literature to see if they could define the predictors (or “prognosticators”) of prolonged recovery from concussion in pediatric (ages 2-18) patients. The murkiness starts with the fact that there is not a consistent definition of concussion, post-concussion syndrome (PCS) or full recovery. So with these limitations in mind, the researchers did their best to determine what we know about predicting.
They culled fifteen studies that met strict criteria after a review of over 500 published papers in the world literature. In sum their findings show that in large studies the risk of PCS (defined as more than a month of symptoms following injury) was increased in older children who had sustained loss of consciousness, headache and/or nausea/vomiting. In smaller studies there appeared to be some correlation between initial dizziness after the injury and prolonged recovery (PCS).
Another soft finding from the review that many “feel” is true is that certain conditions predispose to prolonged recovery. Those include children and teens who have had a previous head injury, learning difficulties, or behavioral problems. However, none of these associations with prolonged recovery were strong predictors.
The authors conclude that “because there is no method to predict which children will experience prolonged symptoms vs which will have a rapid recovery, clinicians must continue to recommend conservative management including both cognitive and physical rest, followed by a stepwise return to activities for all children.”
We remain without a good “test” or means to determine whether a concussion is mild, moderate or severe until we see how long the process of recovery will take. No estimation of severity can be made at the time of the injury. We still do not have a clue about who will recover when.
But we have a fantastic opportunity to do some good research to try to find out. Now that the majority of the states in the US have mandated some sort of concussion protocol and management program at the middle and high school levels, there is a tremendous opportunity to collect solid data. And we also need to keep looking for and tracking markers (biological or behavioral tests) that might help predict who will play the next season and who cannot.
image from curebird.com via Googleimages