Concussion Testing: Early Diagnosis Is Critical. Yet Often Missed

Not only the symptoms were similar, their Head CT Scans and Head MRI’s esp. functional MRI’s of the head showed similar areas of damage that had been missed in the time immediately after the concussive injury.  The Dept. of Defense funded several studies and protocols and as it stands today, all US Defense Forces have access to these EEG Based Concussion Testing as a means to risk stratify and identify functional brain trauma.

In the general community however, in spite of research and new modalities for early concussion diagnosis & concussion testing after head injury or head trauma, the majority of brain injuries remain un-diagnosed. Part of the challenge is the habit of going to an ER.  Pediatricians do it for kids after soccer or basketball injuries, general practitioners refer patients after a motor vehicular accident or a fall at home or a head injury at work.

And it is standard practice in almost all ER’s to order a CT Head as the immediate next diagnostic test.  The purpose of the CT head in cases of head trauma after a fall or a car accident or a head injury during sports or at work is simply to identify patients that need admission to the hospital for observation on a neurosurgical ICU or immediate surgery to remove the blood that is accumulating inside the skull (either outside the brain tissue compressing the brain or inside the brain tissue) causing damage from pressure to neighboring brain tissue.  A CT Head is never testing for functional brain injury and it is the disruption in electrical circuits that is the best predictor of long term effects from such brain injury.

It has become amply clear that there is more to head injury than just the presence or absence of bleeding inside the skull.   The CT Scan of the head can only identify structural changes.  The brain however is an electrical tissue with circuits that can get stunned and take time to recover.  Only EEG based concussion testing protocols can pick these up.  Standard EEG tests do not.

It remains standard ER procedure to send home all patients with a normal Head CT or Head MRI.  This is a missed opportunity for several reasons.

1.  An EEG based concussion testing in patients aged 18-85 years old; within 72 hours of injury; would detect patients with specific areas of the brain that have concussive injury.  These patients need to follow a different protocol before their brains can recover fully.  If not done, these patients will develop long term brain injury called Chronic Traumatic Encephalopathy (CTE) or Traumatic Brain Injury (TBI).  If identified early and managed properly, they would go on to full recovery instead of having memory issues and dementia in later life.

2.  Statcare’s specialized EEG testing for concussion helps risk stratify patients for ALL levels.  This means that patients with head injury who undergo EEG concussion Testing can be separated into several groups – those that need a CT Head for evidence of structural damage on EEG (Blood in the brain affects electrical activity even in small amounts) and those that do not need CT Head or MRI.  This can be done with an extremely high degree of confidence.  It is the third group, however that majority of the patients fall into which is picked up by EEG Concussion Testing.  This group is one that does not have a need for CT Head but has enough evidence of EEG detected electrical disturbance in brain circuits that need to be managed carefully.  These are exactly the patients that would be sent home from the ER today; and still suffer symptoms of concussion and eventually have CTE or TBI or neurological symptoms such as memory issues decades later.  Currently these patients are sent home without monitoring, without re-testing for recovery and without any instructions on how to protect their brain from more stress.  Sending such patients back to their work or school or having them use their brains for stress activities only progresses the damage and prolongs recovery.

3.  Unnecessary ER visits can be avoided and unnecessary exposure to radiation from CT Scan can be avoided as well.

4.  Early diagnosis of electrical injury and management of the brain trauma, prevents long-term CTE and TBI.

Sending people back to work or back to school without detecting underlying brain injury from head trauma or risk stratifying high risk patients for Chronic Traumatic Encephalopathy (CTE) is a missed opportunity.  This care plan misses a critical point where a proper evaluation and testing of brain function in every patient with head injury through EEG diagnosed electrical injury patterns had to be performed and risk stratification of the patient done.  An appropriate intervention based on the seriousness of the initial brain injury pattern on concussion testing as well as its evolution over time while the brain is actively being protected from further stresses (like TV, Home work etc.) has to been undertaken.

How you evaluate concussive injury with EEG concussion tests in this period can make the difference.

Performing a CT or an MRI Scan of the Brain only seeks to look for physical and structural damage to the brain after head trauma.  The functional damage to electrical circuits in the brain, however, remain un-diagnosed as these testing modalities cannot detect functional issues.  EEG based concussion testing does. These cases can be high risk for developing Traumatic Brain Injury (TBI) and CTE and can be identified by computer assisted cutting edge EEG concussion diagnostic tests performed at Statcare.

Why is it important to diagnose the electrical trauma to the brain with specific EEG concussion tests?

There are many reasons to do so.  Most importantly, a brain already suffering from an functional trauma (as can be seen in the injury pattern recorded through EEG concussion testing done at Statcare) has to be protected from further stress such as watching TV or playing video games or having to learn new information in the school.  Too often, Pediatricians, ER Physicians and many other medical professional release children “back to school” without quantifying the injury through appropriate concussion tests or making an adequate recovery plan from a concussion related brain injury.  Read on to see how Statcare can help.  Remember, your Concussion Screening Tests at Statcare are covered by most Insurance plans.  These concussion tests have been validated by research and are extremely good at predicting brain injury.

Don’t wait! Call us at (917) 310-3371 to get your child the concussion testing he or she deserves!