Bringing Home Lessons on Concussion Treatment

During my nearly 17 years as a primary care physician, I’ve seen the knowledge around concussion grow, picking up steam in the last few years. I jumped at the chance to be a “Concussion Champion” last spring when The Children’s Hospital of Philadelphia offered special training to primary care physicians in the CHOP Care Network as part of the Minds Matter Concussion Program effort. We learned an evidence-based approach to diagnose and treat concussion. It prepared me to handle the influx of patients I’d see after Pennsylvania’s law requiring kids who suffered a concussion to get a doctor’s approval before they could return to sports went into effect in July 2012.

In the months since, I treated several patients with concussion, including a young girl who hit her head while riding a bus. But nothing brings home a lesson like dealing with it in your own backyard. I mean that literally.

My 13-year-old son, Jack Kurtz, was playing football with a friend in our backyard and hit his head, hard, on the ground after being tackled. When the pain went away after a few minutes, he didn’t mention it to me that day and went to school the next day. He didn’t tell his teachers or the school nurse that he was dizzy, had a headache and couldn’t concentrate, but he fessed up that evening.

After giving him the new physical exam, it was clear he had suffered a concussion. He was out of school for a week —sleeping as much as 15 hours a day and staying clear of TV, video games and even homework—as his symptoms decreased. Since he had taken the computerized ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) evaluation a few months prior to his injury, we had a baseline score to compare when he took ImPACT again. He scored higher than his baseline (probably because he wanted to get out of the house) and returned to school. Despite his protests, I waited three weeks longer before allowing him to return to lacrosse because his balance and eye-hand coordination were still off.

As hard as it can be to deny an eager child’s desire to get back to his “pre-concussion” life, as physicians we must instill patience in our patients and their families—even when the doctor is also the mom.