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To be taken seriously: the chronic effects of concussion

Due to incorrect diagnosis and treatment: 4 in XNUMX children who have suffered a minor head injury may suffer from chronic post-concussion syndrome

A boy with a head injury. Photo:
A boy with a head injury and a concussion. Photo:

A new study by Tel Aviv University, Kaplan Medical Center and Shamir Medical Center (Assaf Harofeh) states that one in four children (25.3%) who were released from the emergency room after a minor head injury, are misdiagnosed and unknowingly continue to suffer for many years from chronic post-concussion syndrome ( persistent post-concussion syndrome). This syndrome includes chronic symptoms such as forgetfulness, memory problems, sensitivity to light and noise, attention and concentration disorders, and even mental problems. Instead of treating the syndrome, they are mistakenly diagnosed as suffering from attention disorders, sleep disorders, depression and more. The wrong diagnosis leads to treatment that is not adapted to the problem, and this creates great and prolonged suffering for the children.

The study was conducted under the leadership of Prof. Shay Efrati from the Segol Center for Hyperbaric Medicine and Research at Tel Aviv University as well as the Shamir Medical Center (Assaf Harofeh), Dr. Uri Bela and Dr. Eli Fried from the Kaplan Medical Center, and Prof. Eran Kotzer from the Shamir Medical Center. The results of the study were published in the journal Scientific Reports.

"The goal of our study was to determine how many children in Israel suffer from post-concussion syndrome," says Dr. Eli Fried from the Kaplan Medical Center. "The children in the study arrived at the emergency room with minor head traumas, and after staying overnight for observation, or being sent for a head CT scan, they were discharged home."

According to Prof. Shai Efrati from Tel Aviv University, "The post-concussion syndrome is a chronic syndrome that results from micro damage to the small blood vessels and nerves and which may appear even several months after the head injury, and therefore many times they are mistakenly diagnosed as suffering from attention disorders, sleep disorders, depression and more. There are cases where children report headaches and are diagnosed as suffering from migraines, or for example children who report difficulty concentrating, and the doctor prescribes Ritalin. Unfortunately, those children continue to suffer for many years from various disorders, and instead of treating the real problem, which is the syndrome, they receive treatments that usually do not solve the problem."

As part of the study, 200 children who suffered a head injury and who were released from the emergency room after denying the need for medical intervention were examined. The researchers followed the subjects for a period of between six months and three years after discharge, and found that one out of four children who were discharged from the emergency room suffered from the chronic syndrome.

Lifelong impact

"You have to understand that the consequences of a brain injury during childhood continue throughout life," says Dr. Uri Bella, director of the children's emergency room at the Kaplan Medical Center. "Loss of any brain function will prevent the child from realizing his potential in school, university and social life."

In contrast to damage to large arteries and significant damage to the brain tissue, in a mild head injury the damage is to the small blood vessels and neurons - and it is not detected in a normal head CT scan or MRI. The diagnosis of the syndrome requires long-term follow-up of the manifestations of the symptoms as well as the use of imaging and functional tests of the brain. According to the researchers, the alarming findings require the systems to change their approach in monitoring and treating these children.

"The goal of an emergency room diagnosis is to determine if the child is suffering from a serious brain injury that requires immediate medical intervention," adds Prof. Eran Kotzer, director of the emergency rooms at the Shamir Medical Center. "Unfortunately, in the way most medical systems operate today, we miss long-term effects and do not continue monitoring those children who left the emergency room without visible motor impairments."

"The treatment of a wide spectrum of disorders will be different if we know that the cause of the new difficulty is a brain injury," concludes Prof. Efrati. "Correct diagnosis of the cause is the first and most important step in providing adequate treatment for the problem."

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