Subjective evaluation

When I was young I remember that my cousin, Jim, got a concussion. I don’t remember how it happened, but I remember that everyone was worried. It was the first time I’d heard about concussions and because of it, and until quite recently, thought that concussions were A BIG DEAL. I didn’t realize that there were degrees of concussions. Some were mild, some severe. Some life threatening.

A few years ago one of Andrew’s friends and rugby teammates, Eddie, suffered his second concussion and had to quit playing rugby. I talked to him recently and he still cannot play — although he helps the team out now and then by coaching a game or two. He’s replaced rugby with skiing (and according to an article in the school newspaper, cliff jumping).

A few months ago I heard a broadcast about concussions on National Public Radio. It was around the time a Washington Redskins player (I think it was a Washington Redskin) decided to give up his football career because of concussions. The broadcast discussed new research that had been published about concussions and that they were more dangerous than previously thought.

Nearly 3 weeks ago Andrew suffered a mild concussion playing rugby. Apparently he was playing a position he usually doesn’t play, tackled someone, fell backwards with the person he tackled falling on top of him. Or so that’s what people told him what happened. He didn’t remember any of it. He also was “out of it” for the rest of the game as he watched from the sidelines.

We took him to the ER as soon as his friend drove him home. He was sleepy for a day and stayed home from school, but went to school the next day. By Thursday he seemed fine. I’d taken him to his pediatrician on Monday because I was worried about his sleepiness and the doctor suggested that Andrew be checked out by Children’s Hospital’s SCORE program before he return to sports because Andrew tends to like sports that can result in concussions.

I took him to a 3 hour-long appointment at Children’s yesterday. We were both asked verbal and written questions about the incident, questions about before and after the incident and questions about how Andrew feels now. I answered that everything seems to be back to normal. Andrew did too, except he mentioned that he felt a little tired. Not normally, but that he felt tired that morning. He didn’t mention that he’d spent the previous day out with friends, got to bed late and got up earlier than usual for the appointment.

At the end of the appointment we were brought into the doctor’s office (technically a post-doc student) and told that Andrew was almost completely recovered but since he was reporting fatigue (tired that day?) that they still didn’t want him to participate in sports until he was 100% better and that he needed a professional sports rehab facility to ease him back into sports and then have another session at Children’s in a week.

While I don’t dispute the new research about concussions and I do believe that they are more dangerous than previously thought, I do think that much of what we did yesterday was completely subjective. His CT Scan, right after the concussion was fine. He’s been fine for two weeks — not acting tired at all. The tests he took yesterday were all fine. The only abnormality is that he reported being tired yesterday.

This leads me to wonder if this is standard procedure. A kid who had a concussion comes in for an appointment and no matter what the answers, they set up another appointment and refer them to a sports rehab facility. If so, then I think patients should be told this. We might have tried to get an earlier appointment with the SCORE program if that was the case.

I guess I should be glad that someone is concerned about my son and his brain. I only wish that the evaluations were less subjective. There are so many variables. While the bottom line is the health of the child, I know that my child is itching to get back to sports.

11 thoughts on “Subjective evaluation

  1. I sincerely hope your son is okay. I would be concerned if it were one of my kids too. But I can’t help thinking that, especially since the tests were normal, the docs are over-reacting a bit. Maybe in fear of malpractice? A couple years ago, I managed to put a sewing machine needle right through one of my fingers. I’d have pulled it out myself but it had broken off and I couldn’t get a grip on it. So, I took myself to the “urgent care” a couple blocks away. I was there for two hours (the place was practically empty). Even though I wasn’t even in pain, they went through all the usual rigamarole, gave me two x-rays and a prescription for an antibiotic (which I didn’t fill and didn’t need). A few weeks later I got a “nasty” letter from the insurance company asking me a bunch of stupid questions about where my accident had happened and had I contacted a lawyer. (!!!) I couldn’t help thinking that if this incident had happened 2 or 3 decades ago, I’d’ve gone to my no-nonsense doctor-uncle and he’d have just yanked it out without ceremony. Obviously this was an extremely trivial incident that doesn’t begin to compare to a concussion but it got me thinking.

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  2. When Maeve had her first (and so far only) febrile seizure, it resulted in an EEG and an MRI…which were fine. I have a feeling they are fine most of the time. Perhaps a high percentage of the time. And when it was all fine, it was done and over with. If the tests are good…that's frustrating that there is that much easing back in. In many cases (like kayakwoman's example) we are over tested because that's how doctors are paid.

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  3. Hmmm. I know a practicing pediatrician–I wonder what his thoughts would be. Ligitation always is an issue these days and it is just in the medical field. A sad sign of our times I think.

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  4. I dunno. I'd far rather a Dr was cautious about concussion than not.Today it's been announced that a former top All Black retired from rugby. He hasn't played for 10 months since a bad concussion last year. That was about his 5th (that I know of) serious concussion. Once he had his first, he seemed to have more and more.

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  5. I agree, Mali. I just wish there were more objective tests to determine when he can go back to sports. He's actually exhibiting one of the “symptoms” of concussion because he cannot play sports (irritability).

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  6. I heard that scary broadcast on NPR–but I seem to remember that they were talking about people who have repeated concussions. Plus, there are concussions and then there are concussions. I think that your awareness of Andrew's activities the night before is an important variable, but if you mention “fatigue” in the context of “concussion” it sets off a whole chain of medical interventions. Kind of like if you mention the word “pain” anywhere near the words “left arm.” Next thing you know, you're hooked to an EKG.

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  7. You're right Lali. And in the long run a week or so of missing sports is better than long-term effects of repeated concussions. He's got an appointment this afternoon to check if he can go back to sports, then another on Tuesday. Fingers and toes crossed that everything checks out ok.

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