Concussion

In this Article (Index)

• What is a Concussion?
• Traumatic Brain Injury
• Concussion Symptoms
• Concussion Signs
• Concussion Danger Signs
• How to care for a minor head injury
• How to Prevent Traumatic Brain Injury
• Risks at Home: children and the elderly
• Sports and concussion Risk

What is a Concussion?

While most head injuries are not serious, some may provoke concussion, a temporary brain injury which can last for a few weeks and have serious effects. Most concussions are considered a mild brain injury but you should get immediate medical help if any symptoms appear after a head injury (1).

The Centers for Disease Control and Prevention (CDC) defines a concussion as follows:

A concussion is a type of traumatic brain injury -or TBI- caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.
This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. CDC (2)

Traumatic Brain Injury

Concussion is the result of a mild Traumatic Brain Injury (TBI.) It is a major cause of death and disability and 60,000 people died in the U.S. in 2021 due to it.

Fall, firearm injury, assault and motor vehicle crash are the main causes of TBI.

People with a mild TBI (concussion) recover at home following a medical check-up.

Severe cases may require hospitalization. Falls provoke almost half of th TBI-related hospitalizations.

The elderly suffering from a TBI are often overlooked -because some symptoms overlap with conditions found in older adults, such as dementia (3).

Concussion Symptoms

If one or more of these symptoms appear after someone has received a blow or bump, or jolt to head or body it may mean that the person has concussion or some more serious traumatic brain injury. Seek immediate medical assistance.

Symptoms usually start within 24 hours after the injury, some can get worse as time passes, and sometimes symptoms may not appear for up to 3 weeks.

Concussion Signs

• Vomited since the injury. Nausea.
• Headache that does not go away with painkillers, "pressure" inside the head.
• Been knocked out, and lost conciousness, but woke up after a while. Even if blackout was brief.
• Behaviour, mood, personality changes (i.e. irritability or loss of interes in the surroundings -especially in small children). Unusual crying bouts (babies and young children).
• Memory problems, can't recall events before or after the injury. Forgets an instruction. Answers questions slowly.
• Clumsy movements, balance problems.
• Sensitive to light or noise.
• Appears dazed or stunned, confused, unsure of their surroundings.
• Reports being: dizzy, having blurred or double vission, sluggish, groggy, hazy, doesn't feel right.

If someone has suffered a head injury and has been taking drugs or drinking alcohol just before the injury or has been taking medication to thin the blood or has a blood clotting disorder, seek immediate medical assistance because bleeding in the brain after concussion may put a person at risk for more severe injury or death.

Concussion: Danger Signs

Situations that require immediate medical action

More sever symptoms may indicate that a dangerous collection of blood known as hematoma, has formed in the brain. This squeezes the brain against the skull, damaging it.

Call 911 immediately or take the patient to the emergency department if somebody with an injury to the head shows one or more of these danger signs:

• Loss of consciousness a blackout or passing out even if brief should be taken seriously.
• Difficulties in staying awake, drowsiness, cannot keep their eyes open, can't wake up.
• Vomiting, nausea, confulsions, a fit (seizure).
• A headache that gets worse.
• Vision and hearing problems, one pupil larger than the other.
• Vomiting, nausea
• Weakness or numbness of their body.
• Confusion, unusual behaviour, agitation, problems in understanding, balance, walking, speech, writing (slurred speech, lack of coordination).
• Black eye without direct eye injury, bleeding-fluids coming from the ears or nose, bruising behind the ears.

For babies and young children: they will not stop crying, will not nurse or eat.

Anyone who has fallen more than 3 feet (1 m) or 5 stair steps, has hit their head at speed such as being hit by a car, bike or suffering a car crash, bicycle accident or has a head wound should be taken immediately to an emergency room at the closest medical facility.

Continue to check for signs of concussion

Even if the initial symptoms seem mild, you should keep on checking for concussion symptoms over the next few hours and days. If they worsen seek immediate emergency room help.

How to care for a minor head injury

In mild or minor head injuries, those that don't require hospitalization, you can look after the patient at home.

Some concussion symptoms may last for up to two weeks, such as a slight headache, nausea or feeling dazed.

Do List

These are the things you should do:

• Rest, take it easy, avoid physical or mental stress.
• Treat headaches with painkillers (i.e. paracetamol).
• Apply cold to the area, ice pack or towel, for short periods of time during the first few days to reduce inflammation.
• In the case of children, an adult should stay with them at least for the first 24 hours.

Don't List

This is what you shouldn't do:

• Do not go back to school or work until you have recovered.
• Do not drive a car or operate machinery.
• Do not play any contact sports for 3 weeks minimum. For children: avoid rough play for a few days.
• Do not take any drugs or alcohol until you have fully recovered. Don't take sleeping pills.

If the symptoms last more than two weeks, see your doctor.

After a Concussion

There may be complications, persisting symptoms (mood swings, problems with memory, fatigue, insomnia, etc). This is known as post-concussive syndrome.

Those suffering from it should avoid participating in activities that put them at risk for a repeated concussion and reconsider playing certain sports.

A second concussion before the first has recovered completely (Second Impact Syndrome) causes brain swelling and is often fatal. Sometimes the original concussion wasn't diagnosed prior to the fatal one (4).

How to Prevent Traumatic Brain Injury

The CDC has some helpful prevention tips to reduce the possibility of suffering a traumatic brain injury and concussion or worse! (3):

• Buckle up. Every time you drive or ride in a car, van, bus or in an aeroplane, buckle up your seat belt.
• Don't drive under the influence of drugs or alcohol or ride as a passenger of somebody under the influence.
• Obey all traffic signals when driving and look out for pedestrians and cyclists.
• Be aware of the traffic when you are riding a bike or skateboarding. Avoid rough, uneven, off-the road and unpaved trails.
• Wear a helmet when you (or your children) play sports:
  
  • Contact sports such as football, boxing, ice hockey, wrestling.
  • Ride a bicycle, use roller or ice skates, skateboard, ski on snow, or water, snowboard, paddle a kayak.
  • Ride an offroad vehicle: motorcycle, snowmobile, scooter, all-terrain vehicle (ATV).
  • Play baseball and softball (while batting).
  • Ride a horse.
• Headgear is recommended for many sports such as martial arts, pole vaulting, soccer.
• Don't dive in water if you don't know the depth, if it is less than 9 ft (3 m) deep or in above-ground swimming pools; follow the rules at water parks and swimming pools.
• Wear approriate gear for the sport, don't participate in sports if tired or ill. Replace damaged protective gear.
• Children should be supervised at all times and use sporting gear suitable for their age (including protective gear).

About Helmets

Not any old hardhat is safe or offers the necessary protection. Buy and use protective headgear or helmets that have been approved by the American Society for Testing and Materials (ASTM) for specific sports. Each sport has its special head protection gear.

Use the hedgear all the time you are playing the sport. Make sure it fits properly (4).

Risks at Home: children and the elderly

Make your home safer, remove hazards that could make you trip or fall. Items to check (3)(4):

• Loose power cords.
• Rugs, doormats.
• Safety gates for toddlers on the top and bottom of stairways. Window guards so they don't fall out of open windows.
• Grab bars and handrails for the elderly (bathtub).
• Soft flooring for children's playground.

Older Adults

Check with your physician your risk for falling. Review your all your medicine (OTC or prescription) to see if they could make you dizzy, unstable or sleepy.

Check your eyes and eyeglasses to have clear vision.

Exercise and keep fit to keep your core and legs strong and firm, and improve balance.(3)(4)

Sports and concussion Risk

A study by Zachary et al. (2019) looked into high school sports-related concussions during practice and competition and it pointed out the concussion rate per 10,000 athlete exposures (AE). Its findings are the following (5):

• The average rate of concussions was: 4.17 concussions per 10,000 AEs.
• In sex-comparable sports, the girls had a higer concussion rate thatn boys (3.35 vs. 1.51 per 10,000 AEs).
• Girls also had a larger proportion of recurring concussions than boys (9.3% vs. 6.4%).
• Ranking of highest concussion rates:
  
  • 10.40 per 10,000 AEs in boy's football.
  • 8.19 per 10,000 AEs in girl's soccer.
  • 7.69 per 10,000 AEs in boy's ice hockey.
  • 3.06 per 10,000 AEs in cheerleading.
  • 3.12 per 10,000 AEs in boy's wrestling.

Closing comments

Taking safety precautions to avoid falls at home, accidents in vehicles or while practicing sports, and using proper helmets and headgear can do a lot to prevent traumatic head injuries. The tips, do's and dont's the symptoms and danger signs described in this article will help you to take action promptly when you suspect that someone is suffering from concussion. Always seek medical assistance when danger signs appear, and remember that concussion can take several hours or days to become evident.