Hyperacusis? Photophobia?

Conern:
How many concussions go diagnosed?

Thought:
So, we have all this "new" technology that is supposed to be in place to help our athletes "prevent" a concussion. Well, wouldn't decreasing hits help decrease concussions? What about those individuals who get in a car accident during their season and have a closed head injury? Or get scared by their roommate and hit their head on their wooden bed in the dorm? How many of these kinds of incidents happen and nothing gets said?

Reality:
What can we do? Does reporting it really make that big of a deal? The sports medicine world is very (mostly/typically) all educated about the possiblity and severity of second impact syndrome and intercranial hemmoraging that can result from unadiagnosed concussions... but, is the rest of the population?

I watch football week by week (not always by choice/job ;) ) and I am blown away by the number of "unbelievable" hits... the ones that throw someone to the ground, helmet to helmet hits or the ones that knock the helmet right off an athlete. Do each of these result in mini concussions leading to the brain-injured retirees? Check out this concussion!

Upon doing some research for this post, I looked up some concussion articles on espn.com and came across this linke - http://espn.go.com/nfl/topics/_/page/concussions
I was interested to see this new "rule" instituted by the NHL and I think it's phenomenal. The line before it is what interests me the most, "The NFL currently requires players who show concussion symptoms to sit out the rest of a game or practice and be analyzed by a neurologist before returning."

Well, the individual who wrote this little law probably hasn't played or worked with collegiate football. It is unbelievable the amount of times individuals suffer a concussion and don't say anything. It isn't until they are on the field and looking confused - or that ((uncommon)) time a teammate comes up to the athletic trainer or coach and reports that someone is acting different. So, in the NFL do they really sit for the duration of the game/practice? Or do they just not say anything, predisposing themselves to second impact syndrome.

The rest of the link from ESPN is actually quite interesting... it sort of breaks down each sports concussion protocol. Which brings up another thought... why do they have to be different? Why can't it just be universal? If a person is showing signs and symptoms of a concussion (i.e. headache, dizzy, nausea, blurred vision, "spacey", ringing in ears, light sensitivity, sound sensitivity, etc.) why should they finish playing?

Reality is that if this was instituted, no one would want to report a concussion... therefore the number of second impact syndromes, aka death, increases immensely.

This brings me back to a personal example - my "big kid job"... away from school completely, on my own and responsible for making return to play decisions (well, underneath a physician's discretion, of course). I was working a Division 2 collegiate football game with a coworker of mine and a defensive tackle suffered a concussion early in the 2nd quarter. The individual was disoriented, dizzy, nauseous - among other things. I, responsibly, removed him from the game and monitored his symptoms.

Reportedly, his symptoms cleared up in 10 minutes. However, despite the yelling, throwing, and cursing that ensued, I removed him from the duration of the game. Not a pretty site.

At the end of the game, my coworker (who had been employed as an ATC for 7+ years) asked for my explanation for why I didn't allow him to return to play once his symptoms decreased as he just "got his bell rung". My response included: how do we know the symptoms haven't gone away? Isn't a "bell ringing" a concussion? Hasn't he had concussions in the past?
My co-worker completely supported my decision to not allow him to return to play, but did question it... I mean, why should someone be allowed to subject themself to more hits following an obvious concussion?

Side note: the athlete approached me a few days later and apologized for being so abrasive and also admitted that he shouldn't have gone back into the game.

I often think back to this example when I am treating concussions with other individuals. I know that I did the right thing in this case, as well as several others that I have dealt with. However, I have been wrong too and cleared individuals too early. That's the tricky thing about treating concussions - you can't feel the damage, you can't see the swelling/bleeding, you can't fully objectively examine them.

Question:
How do we know the right decision is being made? How can we make sure the right decision is being made?

Answer:
RESEARCH. research typically requires a CHANGE.