Young patients are seen almost daily in our emergency units after they have a head injury and exhibit symptoms that indicate they have some degree of concussion. Most of these patients are observed shortly in the emergency unit and, if they show no further symptoms, are discharged with information about the circumstances in which they should return to the hospital immediately. Few of these patients show up again, but what happens to the rest of those patients? Do we really know how they perform in the longer term?
Research has been done to analyze the outcomes of concussion in younger athletes. According to some reports, as many as 15% of young athletes who sustain a sport-related concussion develop severe outcomes like chronic headache, cognitive defects and changes in personality. With such information, follow-up programs should be mandatory for all younger patients who sustain a head injury that leads to the suspicion of concussion and who come to the emergency unit for any reason after that injury. The goal of the program is to identify, as early as possible, any symptoms related to the head injury.
Some will question the need for a program like this and perhaps discuss whether an initiative like this possibly “induces” concussion-like symptoms, thus leading to over-diagnosing and over-treating the condition. That may be possible, but we must minimize the effects of concussion. A follow-up program will minimize concussion risk in the hands of the right health care professionals.
We need to diagnose and support younger patients with sports concussion. Without proper follow-up, these individuals may not be aware that what they attribute to an adolescent personality change may be related to an earlier head injury from which they quickly recovered. A head injury sustained when they are young that goes untreated can cause problems in the future with jobs, family and other interactions with people.
Although head injuries, especially diagnostics, follow-up and later outcomes, are mostly handled by neurosurgeons and neurologists, we as orthopaedic surgeons must also have appropriate knowledge of these injuries. In several European emergency units, an orthopaedic surgeon, or his or her younger trainee, is the frontline health care professional dealing with adolescents with head injuries. Sometimes, this is the first and only physician to examine and observe the individual. Guidelines to observe, further examine and follow-up head-injured younger patients should be available to orthopaedic surgeons. For the best results, it is preferable that these guidelines and follow-up programs be standardized, as well as based on proven international criteria.
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- Per Kjaersgaard-Andersen, MD, is Chief Medical Editor of Orthopaedics Today Europe. He can be reached at Orthopaedics Today Europe, 6900 Grove Rd., Thorofare, NJ 08086, USA; email: firstname.lastname@example.org.
Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.