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The dangers of a concussion not to be underestimated

Rather be safe than sorry when it comes to a head injury, advises emergency medical practitioner

Tuesday, May 3 2016

Head injuries are one of the more common injuries attended to within the emergency departments of most hospitals. While a concussion is considered the least serious type of head injury, it can nevertheless cause serious long-term complications and suspected concussion cases should therefore be taken to a hospital for evaluation.

So cautions Dr Bianca Visser, a general emergency medicine practitioner who practises at the emergency departments of Netcare Alberlito and Netcare uMhlanga hospitals on the KwaZulu-Natal north coast. She says that common causes of head injuries include motor-vehicle accidents, falls, contact sports and injuries sustained in violent confrontations. According to Dr Visser the symptoms of a head injury can range from no symptoms whatsoever to severe disability.

A concussion can be serious
“Fortunately, minor head injuries are much more common and concussions are frequently diagnosed at emergency departments,” she adds. “Most experts agree, however, that all cases of possible concussions should be evaluated and managed appropriately. This is because the brain is more sensitive to damage after a concussion. An initial concussion does not usually cause permanent damage, but repeated injuries can result in long term neurological problems.”

Dr Visser describes a concussion as a type of traumatic brain injury which is caused by a blow to the head or by a fall, that ‘shakes’ the brain inside the skull. This results in short term disturbances in brain function.

“So while a child or an adult is recovering from a concussion, be sure that they avoid activities that might injure them again. If a person suffers a head injury or a suspected concussion during a sporting match, they should stop playing immediately,” she cautions.

Younger people and men at greater risk of concussion
According to Mande Toubkin, Netcare’s general manager emergency, trauma, transplant and corporate social investment, statistics from Netcare emergency departments around the country indicate that concussions are much more common among younger people than the elderly.

“Some 20.5% of persons seeking medical assistance at Netcare’s emergency departments for concussions in the third quarter of 2015 were 18 years old or younger, close on 20% were aged between 19 and 29 years and 23% were between 30 and 39 years old. These figures dropped to 14.5% in the age group 40 to 49 and just 4.69% in the 70 to 79 age group. Roughly twice as many males were treated for concussions than females,” says Toubkin.

“These statistics are not surprising as younger individuals tend to be more active than the elderly, and males tend to engage in more hazardous activities than women, including contact sports and fast driving,” points out Dr Visser. “However, we also see older adults at our emergency departments, usually as a result of falls. It should also be remembered that due to age-related shrinking of the brain, or medications commonly used by the older population, these patients have a higher risk for more severe head injury and bleeding in the brain.”

When to seek medical attention
Dr Visser says it is important to seek medical assistance after an injury which results in a period of unconsciousness or if the person displays any symptoms of a concussion. Doctors also need to check whether or not a more serious injury may have been suffered, such as a skull fracture, or bruising of, or bleeding in, the brain.

“It is not always easy to know if someone has suffered a concussion. However, if the person feels unwell or is acting strangely after even a minor bump, it is important to seek medical advice,” she observes. “Anyone taking blood-thinning medications, such as Warfarin or Xarelto, and has had a fall or a bump to the head should see a doctor right away, even if there are no symptoms of a concussion.”

Dr Visser recommends calling an emergency services provider, such as Netcare 911 (on 082 911), for assistance, or getting the person to an emergency department if they display any of the following wide range of symptoms:

  • A headache that gets worse or does not go away
  • Weakness, numbness, dizziness, or decreased coordination
  • Balance problems
  • Repeated vomiting or nausea
  • Slurred speech
  • Feeling tired or having no energy
  • Extreme drowsiness or deep sleep
  • Sleeping less than usual or trouble falling asleep
  • One pupil larger than the other
  • Convulsions or seizures
  • A problem recognising people or places
  • Increasing confusion, restlessness, or agitation
  • Loss of consciousness
  • Inability to think clearly and feeling sluggish
  • Inability to concentrate
  • Fuzzy or blurry vision
  • SENSitivity to light or noise
  • More emotional and moody (i.e. feelings of sadness, anxiety or nervousness)

According to Dr Visser, not all persons who sustain a concussion will lose consciousness. “Some people will have obvious symptoms such as passing out, or forgetting what happened before the injury, but others will not. Symptoms of a concussion range from mild to severe and can last for hours, days, weeks, or even months, so rather seek medical attention if you are in any doubt as to the seriousness of the injury. ”

Young children can have the same symptoms of a concussion as older children and adults. However, it can sometimes be hard to tell if a small child has a concussion, particularly as they may have difficulty expressing what is troubling them.

“Parents should take their child to an emergency department should they have any concerns regarding a possible head injury.

They should watch for any changes in behaviour such as more crying and distress than usual, feelings of sadness, lack of interest in activities and favourite toys, loss of new skills such as toilet training, trouble with attention, loss of appetite and/or loss of balance,” advises Dr Visser.

How is concussion diagnosed?
The patient’s blood pressure, pulse and other vital signs will be checked. During their examination, the doctor will ask questions to test responses and memory. Muscle power, balance and reflexes will also be checked. The individual will also be assessed for any signs of brain injury.

“Not all patients with a head injury will need an X-ray or brain scan using computerised tomography [CT] or magnetic resonance imaging [MRI] technology. Depending on your combination of symptoms and tests results, you might be admitted to hospital or sent home with advice on how best to manage your concussion, or a scan may be indicated at a later date,” says Dr Visser.

How is concussion treated?
The vast majority of patients are discharged home into the care of someone who can look after them for the next few days. They will be given advice on what to do and what not to do, as well as a prescription for pain medication. However, if they live alone they might be admitted to hospital for observation.

“With rest and appropriate care most people will recover completely from a concussion. Some people feel normal again within a few hours. Others may have symptoms for weeks or even months. It is very important to allow yourself time to rest and get better before slowly returning to your regular activities. If your symptoms start up again while you are doing an activity, stop and rest for another day. This may well be a sign that you are pushing yourself too hard,” concludes Dr Visser.

Additional concussion advice

Tips to help the concussion patient get better

  • Get plenty of sleep at night, and take it easy during the day. Take naps during the day.
  • Avoid alcohol and illegal drugs.
  • Only take medicines prescribed by your treating doctor.
  • Avoid activities that are physically or mentally demanding (including work and schoolwork).
  • Avoid TV, computers, video games, cell phones, texting, movies and loud environments.
  • Use ice or a cold pack on any swelling for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
  • Use pain medicine as directed.

How to reduce the chances of getting a concussion

  • Wear a seat belt every time you drive or ride in a car or other motor vehicle.
  • Never drive when you are under the influence of drugs or alcohol.
  • Make your home safer to prevent falls.
  • Wear a helmet for any activity that can cause a fall or impact to the head or neck. Examples include cycling, skateboarding and horseback riding. Helmets help protect the head from injury.

 Protecting children from head injury

  • Use child car seats and booster seats correctly and ensure that your child is correctly strapped in.
  • Teach your child bicycle safety.
  • Teach your child how to be safe around streets and cars.
  • Teach your child playground safety to minimise the risk of them falling from heights.
  • Educate your child on how they may prevent sports and other injuries.

Ends

Issued by: Martina Nicholson Associates (MNA) on behalf of Netcare
Contact: Martina Nicholson, Graeme Swinney, Meggan Saville or Devereaux Morkel
Telephone: (011) 469 3016
Email: martina@mnapr.co.za, graeme@mnapr.co.za, meggan@mnapr.co.za, or
devereaux@mnapr.co.za

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