Continuing with our football quarterback analogy about the difference between confusion and amnesia, lets also focus on another material area where the brain injured athlete gets better diagnostic methods directed towards them than the average member of the public: serial follow-up exams. A little over a decade ago, the Brain Injury Association of the U.S.A. in working with the American Academy of Neurology developed the first set of the “sport and concussion guidelines.” That first set did several really important things, the most notable was that it clarified that a loss of consciousness was not necessary acute event for a diagnosis of a concussion. The Sport and Concussion guidelines were not the first time that was clarified, but it was the first time it came from the Neurological national association.
From a long term standpoint, the most important thing those guidelines did was to create return to play guidelines. If an athlete who was not knocked out ceased to be symptomatic within 15 minutes of the concussion, then that athlete could return to the game. If they continued to be symptomatic after 15 minutes, then they could not return to a game for seven days after they ceased to be symptomatic. As this rule created a waiting period from the time they ceased to have brain injury symptoms, it required the training staff and or team doctors, to continue to do followup exams, every day after the injury. If you franchise quarterback can’t go back in the game for seven days after apparent recovery, you will make sure they get checked out every day.
Sadly, no non-athlete gets that kind of serial followup. Since no one sees any serious risk of harm for returning to work too soon, no one really makes any effort to determine whether the symptoms are occurring on day two, day three. That is so tragic, because there is really no doubt that if we did evaluate mild traumatic brain injury survivors at 24 hours, 48 hours and 72 hours, that we would probably be able to distinguish between almost all of those who were at risk for long term disability.
In our next blog, we will discuss why it can take up to 72 hours to be able to tell how serious a concussion or mild traumatic brain injury is.