For Scott Ramsay, seeing children with concussions suffering from migraines, tension headaches and other complex symptoms when he was working as a nurse at BC Children’s Hospital in Vancouver was like a flashback.
The former professional hockey player, who suffered four concussions as a teenager, recalled that, like him, many of those young patients weren’t sent to the hospital until months after their initial diagnosis.
“It seemed as though, because kids were referred to us too late, their symptoms had become much more complex and harder to manage,” said Dr. Ramsay, who graduated last week with a PhD in nursing from the University of British Columbia.
He also realized that in B.C. there is no educational intervention or post-concussion follow-up for children under the age of 12. There’s also little research on interventions for that demographic, he added.
Those kids, and his personal experience, prompted him to launch a study of 23,000 children and youth in B.C. who had been identified with concussions, focusing on their experiences in the province’s health care system. His PhD thesis is the largest study to date of its kind in British Columbia.
He found that most concussed children and youth do not have follow-up visits.
Based on Ontario Neurotrauma Foundation guidelines, a first follow-up visit should occur within four weeks of an initial concussion diagnosis. But Dr. Ramsay found that only 19 per cent had a timely follow-up.
He also found a higher incidence of residual health outcomes for cases with delayed follow-up visits, with young patients significantly more likely to develop persistent post-concussive symptoms such as migraines, nausea and photophobia, he said. “But also anxiety and depression and behavioural issues.”
Dr. Ramsay, 32, said multiple factors may contribute to the problem. He said some family physicians may not have sufficient knowledge about concussions and may be unaware of the clinical guidelines or policies. Kids and parents often do not take concussions seriously because it’s an “invisible injury,” unlike a broken arm or sprained ankle, he said.
The issue is not limited to B.C., he said. A similar study published in 2017 showed that more than two-thirds of children and youth in Ontario did not seek a medical follow-up or clearance, as recommended by the current concussion guidelines. A paper published in January suggests that only 13 per cent of young patients in Alberta received follow-up care during the study period.
Dr. Ramsay, who is Métis, said his study subjects reminded him of his own experiences. He sustained his first concussion when he was 15. He suffered three more in the span of 13 months when he was 18 and 19.
One occurred while he was attending an NHL training camp with the Anaheim Ducks. He was sent back to his junior hockey team but experienced acute symptoms that included vertigo and nausea for a few weeks. He was then put back on the ice before recovering fully.
“Even though I had told the physician that I was experiencing the symptoms, they had basically convinced me that I was good enough to play,” he said.
Five months later, the teenager incurred yet another concussion after falling headfirst onto the ice during a fight. That caused a long period of post-concussion symptoms that eventually led to his decision to retire from hockey.
“It was one of the hardest things I’ve ever had to do,” he said, adding that if he had been informed by health professionals just how serious his injuries were, his post-concussion syndrome could have been prevented.
Dr. Ramsay said he plans to continue postdoctoral research in this area and advocate for services and for changes in policy, practice and better education for health care providers, as well as for children and their families.
He was a finalist for the UBC faculty of applied science’s “Rising Star” award. His nomination lauded his work mentoring Indigenous nursing students and as a senior teaching assistant in the 2021-2022 academic year.
He said getting through nursing school can be very daunting – particularly so for Indigenous students, who may have to leave their communities and attend school without normal supports.
“So there needs to be people who do understand that can support students – and not only their learning, but mentoring and providing guidance on how to navigate those situations,” he said.
“Essentially … we want the nursing work force to be representative of the population.”