Concussion Management: Q&A With Dr. Samuel Browd
Dr. Samuel Browd, a neurosurgeon at Seattle Children’s and medical director of the Seattle Sports Concussion Program, addresses questions about concussion management.
Thank you to Dr. Wendy Sue Swanson, a pediatrician at The Everett Clinic in Mill Creek, a member of Children’s medical staff and author of the Seattle Mama Doc blog, for submitting these questions.
Q: We hear a lot about evolving concussion management through the media and continuing medical education. What resources would you recommend?
A: The Centers for Disease Control (CDC) provides comprehensive information about concussion management for pediatricians and families. The CDC bases its material on consensus guidelines from the International Conference on Concussion in Sports held in Zurich in 2012. Much of the peer-reviewed literature points to those guidelines.
Families and providers can also find useful information and links on the Seattle Children’s website by visiting the Seattle Sports Concussion Program page and the hospital’s Sports Concussions page.
Q: When should children be referred to a specialist for management or co-management of a concussion?
A: If a child’s symptoms are mild and begin to improve in a few days, they probably don’t need to be referred. However, if symptoms are severe, recurrent and/or last more than a week without improvement, children should be referred for a more extensive examination.
Children should always be referred if they have previously sustained a concussion, even if symptoms are mild. Children with chronic headaches, learning disabilities, and other modifiers should also be referred.
Q: How should we use the Sports Concussion Program at Seattle Children’s?
A: The program is a multidisciplinary clinic for children who need specialized evaluation and management based on the severity and duration of their symptoms, a history of concussions and other neurological issues.
Concussion experts from Seattle Children’s, UW Medicine and Harborview Medical Center developed the program in response to the 2009 Washington State Lystedt law that requires written approval from a licensed healthcare provider before a child who sustains a concussion can return to play.
Our team of approximately 30 specialists includes neurologists, neuropsychologists, neurosurgeons, sports medicine specialists, rehabilitation medicine specialists, physical therapists and others who work together to create a plan to help children recover and return safely to their regular activities. We can see patients at Seattle Children’s main campus, our Bellevue Clinic and Surgery Center or our Federal Way clinic. In addition to referring patients to the program, you can call the program at 206-987-2109 for advice on patients you’re managing.
Q: What is the number one mistake pediatricians make when caring for children with sports-related concussions?
A: The biggest potential mistake is underestimating the severity of a concussion. Many kids can be cleared quickly and management is straightforward, but we believe more children should be referred to specialty care.
People used to think of concussions as part of playing sports and growing up. The mindset was you got clocked, were told to walk it off and it was a sign of weakness to show you were hurt. Athletes would try to hide it. But a concussion is a mild traumatic brain injury with serious potential consequences — especially if someone sustains more than one concussion.
One management challenge is that kids want to return to their sport as soon as possible. Many parents share their eagerness. That can create a lot of pressure to clear a child to play sooner rather than later — especially when a child is competing for an athletic scholarship.
Telling a child and family the child can’t play the sport they love for several weeks — or never if the risks are too high — is a tough conversation. Through a referral to Seattle Children’s Sports Concussion Program, we can assist in employing the best science and medical practices and educate families about strategies for returning athletes to play.
We hold a concussion board monthly to review the most complex cases. We decide how to manage them as a team and communicate directly with referring physicians as we look to partner in the patient’s management. A team recommendation can often mitigate a high-pressure situation regarding return to play or — in rare instances — the need to “retire” a player who has sustained multiple concussions.
Q: Are there gender differences in the frequency, diagnosis and recommended treatment of concussion?
A: Yes. A recent review by our colleagues at the University of Washington suggests that girls sustain more concussions than boys when playing sports with similar rules. Girls also experience a greater number and severity of symptoms and take longer to recover than boys.1
It’s a new dawn in the recognition of concussion as a true mild traumatic brain injury. Medical science is taking a harder look at concussions as we hear more about the problems athletes have later in life — especially after sustaining multiple concussions. We are at the beginning of an evolution toward more empirical management of concussion.
- Harmon KG, et al. American Medical Society for Sports Medicine position statement: concussion in sports. Clinical Journal of Sport Medicine 2013 Jan;23(1):1-18.
View Online Schedules for Regional Clinics
You can now view online schedules listing the providers and specialties available at Seattle Children’s regional clinics in Everett, Mill Creek and Olympia.
Online regional clinic schedules will be added for Federal Way, Tri-Cities, Wenatchee and Bellevue in the coming months. To learn more, visit www.seattlechildrens.org/regionalschedule.
Seattle Children’s Provides Influenza Vaccinations to Patients, Household Contacts
Seattle Children’s is providing influenza vaccinations to inpatients, outpatients and their household contacts again this year, beginning Sept. 15. All inpatients, except hematology/oncology patients, will be screened for eligibility. Outpatients will be offered the vaccination when they come to Children’s for clinic visits. Children’s will also offer the vaccination to Emergency Department (ED) patients.
Children’s bills the insurance of patients and siblings under age 21 for their vaccinations, but continues to provide vaccinations free of charge to adults age 21 years and older who live with a patient in an effort to protect patients. All vaccinations given to children are documented in the Child Profile Immunization Registry.
Children’s efforts to vaccinate patients are in accordance with recommendations from the Centers for Disease Control and Prevention to increase access to the vaccine in healthcare settings.
For questions about flu vaccinations at Children’s, email Dr. Matthew Kronman, infectious diseases specialist.
The Good, the Fad and the Ugly: Hot Trends in Nutrition – 6th Annual Nutrition Symposium
Saturday, Nov. 1 at Seattle Children’s Hospital (main campus)
View the brochure and register online
Upcoming Pediatric Advanced Life Support (PALS) Courses
Register for an upcoming course:
Learn more and see a calendar of all PALS courses.
Grand Rounds for September 2014 (CME Credit Available)
Upcoming Grand Rounds
- Practice Points of Ophthalmology Every Pediatrician Should Know, Sept. 11
- Working with the Latino Community to Address Youth Violence, Sept. 18
- No Grand Rounds on Sept. 25 (Rosh Hashanah)
- See all upcoming grand rounds.
Watch Past Grand Rounds Online
New Medical Staff, September 2014
Trevor Adams, MD, Seattle Children’s, Anesthesiology and Pain Medicine
Alireza Anissipour, DO, Harborview Medical Center, Orthopedics and Sports Medicine
Arjun Bansal, MD, Seattle Children’s, Psychiatry and Behavioral Medicine
Jimmy Beck, MD, Seattle Children’s, Hospital Medicine
Scott Bevans, MD, University of Washington, Otolaryngology
Jesse Bledsoe, PhD, Seattle Children’s, Psychiatry and Behavioral Medicine
Brandi Chew, PhD, Seattle Children’s, Psychiatry and Behavioral Medicine
Jennie Collins, MD, Seattle Children’s, Neonatology
Meagan Dodge, MD, Seattle Children’s, Hospital Medicine
Diana Geisser, MD, Seattle Children’s, Critical Care Medicine
Jennifer Gerdts, PhD, Seattle Children’s, Psychiatry and Behavioral Medicine
Yi Guo, MD, University of Washington, Orthopedics and Sports Medicine
Silvia Hartmann, MD, Seattle Children’s, Critical Care Medicine
Matthew Hopperstad, MD, Seattle Children’s, Psychiatry
Maya Jones, MD, MPH, Seattle Children’s, Emergency Medicine
Dale Lee, MD, MSCE, Seattle Children’s, Gastroenterology and Hepatology
Kasey Leger, MD, Seattle Children’s, Hematology-Oncology
Peony Liu, MD, Seattle Children’s, Hospital Medicine
Jonathan Lopez, MD, Seattle Children’s, Neurology
Najma Mehter, MD, Seattle Children’s, Anesthesiology and Pain Medicine
Eric Mosqueda, MD, Kadlec Regional Medical Center, Neonatology
Celeste Quitiquit, MD, Seattle Children’s, Orthopedics and Sports Medicine
Virginia Sanders, MD, MDiv, Seattle Children’s, Hospital Medicine
Alisa Van Cleave, MD, Seattle Children’s, Critical Care Medicine
R. Scott Watson, MD, MPH, Seattle Children’s, Critical Care Medicine
Joanna Wrede, MD, Seattle Children’s, Pulmonary and Sleep Medicine