Concussion Label Sends Wrong Message: Study

Does labeling a child's head injury as a "concussion" convey the wrong message to parents, athletes and athletic trainers about its seriousness?

Perhaps, say the authors of a Canadian study reported in the February 2010 issue of the journal Pediatrics. Instead, they suggest that to encourage full reporting of head injuries in sports and to allow adequate management and recovery time the term "mild traumatic brain injury" (MTBI) be used in its place.

Researchers at McMaster Children's Hospital in Hamilton, Ontario, Canada, studied 268 children admitted with head injuries who had computed-tomography (CT) scan results.

Among their key findings:

• During the process of recruiting study participants, both parents and clinicians were frequently heard expressing the opinion that the use of the term "concussion" implied the exclusion of brain injury, with both parents and medical staff frequently heard expressing the opinion that "he doesn't have a head injury, he has a concussion."

• A normal CT scan result was the greatest predictor of receiving label of concussion, with the group of children most likely to be receive the diagnosis being those with a normal CT scan and some loss of consciousness;

• Loss of consciousness was the next most important predictor of whether a child would receive the concussion label if the CT results were normal, even though LOC is no longer a requisite for the diagnosis of concussion.

• The danger is that a "normal CT result likely implies to parents that their child has no brain injury." (emphasis supplied).

• A concussion diagnosis was strongly predictive of an earlier discharge from the hospital; the odds of being discharged were 1.5 times higher for those children who were diagnosed as having suffered a concussion.

• Children diagnosed with concussion also were allowed to return to school significantly sooner (i.e. fewer days until school return); after discharge, the odds of a return to school sooner after discharge were 2.4 times higher for children with concussion.

The study authors questioned the use of the concussion label as being reflective of mild injury and found that its use supports the existence of continued confusion about what a concussion really is and how the term should best be used in the care of children.

The negative consequences of the use of the concussion label, they noted, may be especially pronounced in the context of sports-related concussion, perhaps explaining the underreporting of head injuries by young athletes and their trainers as being due in part to the still-common belief that a concussion does not need to be treated seriously.

The findings, both in the return-to-school data and the phenomenon experienced during recruitment (in which both parents and clinicians may use the term to imply the exclusion of brain injury) suggests that if a child is given a diagnosis of concussion, then the family is less likely to consider it as a brain injury.

The authors suggest that "[i]f we want to encourage full reporting with subsequent adequate management and convalescence, perhaps we should use the term "MTBI."

Source: Pediatrics, Volume 125, No. 2, February 2010

Created: January 27, 2010