Thursday, September 20, 2018

Treating Concussions in Children

The CDC has just issued draft guidelines for treating concussions in children. Their first conclusion is that we should call them "mild traumatic brain injuries", mTBI, because too many people blow off a "concussion" as no big deal and they want people to take them seriously.

On the other hand they do not want people to take them too seriously. One of their recommendations is that most children should not receive CT scans, because that is so scary that the psychological danger is greater than the chance that something of medical importance will be learned. They dismiss MRIs altogether as not useful, and say the radiation damage from x-rays is also worse than any potential gain. Instead physicians should work from the usual template for assessing neurological trauma, examining pupil contraction, asking questions, observing neuromotor problems, and only if that examination suggests severe damage should more tests be ordered.

They also recommend against leaving children for too long in a darkened room. While the basic treatment for mild head injuries is "rest," and they advise a gradual return to a full schedule of activity, too much rest, especially in isolation, makes children anxious and depressed.

I don't really know anything about this type of medicine, but I am very glad to see the experts taking seriously the potential harm of treating children like something terrible has happened to them.

1 comment:

G. Verloren said...

I couldn't find anything freely available through the link that explains what age groups they're talking about. "Children" is just such an incredibly broad category.

I would imagine the considerations would be vastly different based on whether you're dealing with a 4 year old patient, an 8 year old, a 12 year old, et cetera. Even if we assume that "teenagers" are a separate category, that still leaves us with eleven year olds who shouldn't really be finding a CT scan "incredibly scary", and whose physiology should be far more than robust enough to handle a simple x-ray without any real concern.

(On average, medical scans account for only 15% of annual ionizing radiation exposure; 85% comes from simple natural background radiation, up to 100% if you don't get any scans during the year. In particular, it should be noted that x-rays themselves are incredibly benign compared to CT scans - and even the most intensive of CT scans barely creeps into the single digit milliseiverts. Unless you're literally getting dozens of CT chest scans per year, there will be no measurable effect. In contrast, a single CT head scan in the wake of a concussion is utterly insignificant.)

All of that said, perhaps they aren't trying to suggest that the radiation from a CT scan isn't, in fact, neglible? Perhaps they're simply emphasizing how little use such scans actually are in diagnosis and treatment of a concussion? That, at least, I could believe.