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Dr. Waeckerle: Concussion diagnosis a summary of findings

NFL Health Playbook will feature a guest columnist every Wednesday, each with a different viewpoint of player health and safety from the youth level to pro football.

By Dr. Joseph F. Waeckerle, NFL Evolution columnist

A concussion is a brain injury caused by direct or indirect trauma to the head. Concussions can be caused by a wide range of traumatic incidents, which could include falls, auto and pedestrian accidents, recreational and sports injuries and altercations.

The actual number of concussions that occur in the U.S. each year isn't known. There are about 2.5 million people who go to the emergency room each year to be evaluated for a head injury. However, health authorities think that it is possible that three to five times as many people actually suffer a concussion but don't report it or seek care. Some people don't understand the significance of the injury and want to simply "tough it out." Some believe they will get better without care and some have difficulty getting access to medical assistance for a variety of reasons. Health professionals are now, more than ever, aware of the gravity of concussions but diagnosis and management remains a challenge.

Concussions are different in each person. Just like each human is unique, a concussion is different in each person who suffers one. While there are general symptoms that suggest a concussion, there is "individual variability" in the presentation of the injury. The trauma that causes a concussion affects the brain cells and thus brain function. While health care professionals ask patients with suspected concussions about their symptoms, they also perform a complete exam evaluating four major neurological areas:

-- The history and mechanism of injury with associated symptoms

-- Physical exam including a detailed neurological exam

-- Balance testing (Modified Balance Error Scoring System Test)

-- Cognitive testing

The optimal concussion exam aids the knowledgeable and experienced health care professional in concluding that a person has suffered a concussion. There is no specific test that absolutely diagnoses a concussion with absolute reliability. In other words, there is no "gold standard" when it comes to diagnosis. It is made by the summary findings of a concussion evaluation consisting of a neurological exam and any other appropriate tests.

Concluding that an individual has suffered from a concussion is therefore based on "clinical criteria," so it is a criteria-based diagnosis made by a health care professional knowledgeable and experienced in concussion care. Unfortunately, there can be short-term and long-term complications from concussions if proper care is not obtained and maintained. Seeking a health care professional competent in concussion care after suffering a head injury is very important.

Dr. Joseph F. Waeckerle is clinical professor of emergency medicine at the University of Missouri-Kansas City School of Medicine. He also is editor emeritus of Annals of Emergency Medicine. He has practiced Emergency Medicine and Sports Medicine and has been a team physician at the grade school, high school, college, and profession level for over 30 years. He currently serves on the NFL Head, Neck, and Spine Injury Committee and the Mackey White Brain Injury Committee of the NFL Players Association.

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