OPSC 56 th Annual Convention CONCUSSIONS: DIAGNOSIS. Alan Shahtaji, DO CAQ-SM February 17, 2017

Transcription

1 OPSC 56 th Annual Convention CONCUSSIONS: DIAGNOSIS Alan Shahtaji, DO CAQ-SM February 17, 2017

2 How will this improve and/or change your practice? 1. Recognize a concussion on the sideline or acute setting 2. Understand when to image and refer patients with head injury 3. Develop a system and/or improve efficiency of concussion assessment in the office 4. Perform a Vestibular Ocular Motor Screen (VOMS) when appropriate 5. Properly advise athletes and parents regarding prevention and equipment

3 Outline Epidemiology Pathophysiology and Definition Clinical Examination Common Questions & Prevention Management 3

4 4 Park, A. (2016, September). Concussion Diagnoses in Teens Hit a Record High Time, Retrieved from

5 From: Point of Health Care Entry for Youth With Concussion Within a Large Pediatric Care Network JAMA Pediatr. Published online May 31, 2016.e doi: /jamapediatrics Figure Legend: Proportion of Concussion Visits by Initial Point of Health Care Entry Over Time Among The Children s Hospital of Philadelphia Primary Care Patients (N = 8083)Q indicates quarter. Date of download: 6/1/2016 Copyright 2016 American Medical Association. All rights reserved.

6 By James Heilman, MD - Own work, CC BY-SA 3.0,

7 Definition NO grading Zurich 2012* Brain Injury Concussion is a brain injury and is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces. Several common features that incorporate clinical, pathologic and biomechanical injury constructs that may be utilized in defining the nature of a concussive head injury include: Impulsive 1. Concussion may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.

8 Jello > Egg Stanford Football Player 8

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12 Ryan Mason and Gary Cahill 1/22/17

13 Clinical Evaluation Sports Concussion Assessment Tool (SCAT) 3 VOMS

14 SCAT3 page 1 14

15 SCAT3 Page 1 15

16 SCAT3 PAGE 1 16

17 SCAT3 Page 2 17

18 SCAT3 Page 2 18

19 SCAT3 Page 2 19

20 SCAT3 Page 4 20

21 SCAT3 Page 4 21

22 SCAT3 Page 3 22

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24 OPSC

25 OPSC

26 estibular dysfunction Ocular Motor Pursuits: H-Test Example of Saccades Testing from UPMC Saccades: Horizontal Saccades: Vertical Vestibular/Ocular Gaze Stability: Horizontal,VerticalGazeti Convergence Balance Screening

27 Definition slide 2. Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, symptoms and signs may evolve over a number of minutes to hours.

28 When in doubt, sit it out

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30 Remove from Play Removal From Play After Concussion and Recovery Time Elbin R, Sufrinko A, Schatz P, et al. Pediatrics. 2016;138(3):e What This Study Adds: Athletes who were not removed from play took longer to recover and demonstrated worse neurocognitive and symptom outcomes after a sport-related concussion. Removal from play status is a new predictor for protracted recovery and supports consensus guidelines

31 SECOND IMPACT SYNDROME (SIS) Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was high (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown

32 Prevention and Rule Changes What can we do to protect our athletes?

33 Has external helmet padding been shown to decrease risk for concussion? A.True B.False 50% 50% 33 True False

34 A properly fit mouth guard decreases risk for concussion by lessening force transmission to the brain A.True B.False 50% 50% 34 True False

35 Soccer headgear (i.e. headband) when worn during games reduces risk for concussion A.True B.False 50% 50% 35 True False

36 Virginia Tech Helmet Ratings Star rating system (5 stars, 4 stars, etc ) 36

37 Mouthguard Myth Does not prevent concussions Use to prevent dental and mouth injuries 37

38 Soccer Headbands No prospective evidence Gladiator effect 38

39 RULE CHANGES Penalizing players who lead with their elbow during headers Yellow or even red cards Head injury evals during FIFA Matches Allowing 3 minutes of on-field assessment Recommendations for when to begin heading AYSO: 10 years old Never force a young player Proper balls 39

40 Assembly Bill 2127 California Concussion Law Limit Contact Practice None in off-season 2/week in-season Neither lasting >90 minutes Return-to-Play Minimum of 7 days Licensed healthcare professional 40

41 Los Angeles Times November 28,

42 How will this improve and/or change your practice? 1. Recognize a concussion on the sideline or acute setting 2. Understand when to image and refer patients with head injury 3. Develop a system and/or improve efficiency of concussion assessment in the office 4. Perform a Vestibular Ocular Motor Screen (VOMS) when appropriate 5. Properly advise athletes and parents regarding prevention and equipment

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44 Thank You 844 DR SPORT Kingscrown80 (Twitter) 44