Concussions have become so commonplace that people diagnosed with the condition tend not to take the brain injury seriously, a new study concludes.
It's a tendency that could lead to increased damage - especially in children - a team of Canadian researchers warn. So they are recommending that cases of concussion be referred to more precisely, as "mild traumatic brain injury," or MTBI for short.
"It comes down to language and the implications of language," said Carol DeMatteo, an occupational therapist, associate clinical professor and associate member of the CanChild Centre for Childhood Disability Research at McMaster University in Hamilton, Ont.
"People will take it more seriously if they realize the injury is to their brain, not their head," she said.
The research, published in Monday's edition of the medical journal Pediatrics, was prompted by an off-handed comment from a parent who said: "My child doesn't have a brain injury; he only has a concussion."
Prof. DeMatteo was flustered by the statement, but also wondered whether it was a common perception and, if so, what impact that might have on the treatment and recovery of patients.
The research team examined the medical records of 300 children who'd been admitted to McMaster Children's Hospital with traumatic brain injuries. Thirty-two per cent of them, 102 in total, were diagnosed with a concussion.
The study revealed that the children who were told they had a concussion spent fewer days in hospital than their counterparts who were told they had a mild traumatic brain injury (or some other descriptor). They also returned to school sooner and resumed playing sports more quickly.
More importantly, all of this occurred regardless of the severity of the injury, the research showed.
Seventy-three per cent of the children in the study had a low score on the Glascow coma scale (a series of tests that measures neurological function), indicating mild injuries. The rest were ranked as moderate or severe.
However, 38 per cent of those with mild traumatic brain injury were diagnosed with a concussion; so were 24 per cent of those with a moderate or severe traumatic brain injury.
In every instance, Prof. DeMatteo said, the diagnosis of concussion seemed to leave children and their parents with the impression the injury wasn't too serious.
"Our study suggests that if a child is given a diagnosis of concussion, the family is less likely to consider it an actual injury to the brain," she said.
That is problematic, Prof. DeMatteo said, because without adequate recovery time the risk of further concussions is far greater, and so is the risk of permanent brain damage.
"Kids have only one brain, so we have to take care of it," she said. "So we have to watch our language."
While concussions are commonplace, there is little consensus on when the diagnosis should be given, particularly in children.
For example, it was long assumed that a person always lost consciousness when they suffered a concussion, but that's no longer the case.
One thing clinicians can agree on, though, is that a concussion-like injury is temporary. In other words, there is no structural damage to the brain.
But even that causes confusion. The new study found that the best predictor of who was diagnosed with a concussion was a patient who suffered loss of consciousness but had a normal CT scan.
"A normal CT doesn't mean there wasn't any damage," Prof. DeMatteo said. "The brain gets shaken around a lot and it needs time to heal."
André Picard