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Concussion Testing


A bump on the head (what doctors call "minor head trauma") gets taken seriously today, given what scientists now know about the after-effects of concussion. Whether from a fall, sports injury or accident, a blunt trauma to the head can cause a brain injury in a person of any age. 

“When somebody comes in to the emergency department with a minor head trauma, the big questions are: Is it truly minor or is it more serious?” says Ted Melnick, MD, a Yale Medicine emergency medicine physician. “A clinician will determine whether they have any red flag signs or symptoms that might require hospitalization or surgery.”

What causes minor head trauma?

Minor head trauma is a term that describes the way an injury that could result in brain injury occurs. “There’s a lot of confusion around this terminology,” says Dr. Melnick, offering this clarification: "The best way to tease it out is that minor head trauma is how patients hurt themselves, whereas the traumatic brain injury is what happens to their brain.”

Scientists have learned that two main types of accidents are likely to raise the risk of a more serious brain injury: Being hit by or ejected from a moving vehicle, and falling from a distance of three feet or more (or down five stairs). 

Also, regardless of how the injury happens, any person age 65 or older should treat a fall that results in minor head trauma as a medical emergency and see a doctor as soon as possible.

How can you tell if a visit to the emergency room is necessary after a minor head trauma?

Dr. Melnick says it's never a bad idea to go to the emergency room after a minor head trauma, but says it's only really necessary if you notice any "red flag" symptoms as listed below.  

“We don’t want to discourage people from coming in," he says. "If they’re concerned, we’re always happy to see them and evaluate them. But if they don’t have those red flag symptoms like prolonged amnesia, loss of consciousness, the mechanisms I mentioned, signs of a skull fracture, repeated vomiting, or advanced age, they can probably be in touch with their doctor and not have to rush in.”

What are the symptoms of minor head trauma?

A person who has had a minor head trauma may have any number of symptoms that vary in severity and duration. These may include: 

  • Confusion
  • Vomiting
  • Loss of consciousness
  • Amnesia
  • Headache
  • Drowsiness
  • Slurred speech
  • Weakness or numbness
  • Balance or coordination problems
  • Behavior changes

The following list describes "red flag" symptoms that should be considered more serious and require immediate attention. These include:

  • Severe confusion
  • Sustained vomiting (two or more times)
  • Prolonged memory loss or amnesia
  • Extended loss of consciousness
  • Severe drowsiness
  • Worsening or continuous headache
  • Trouble walking or talking
  • Weakness or numbness on one side of the body
  • Seizures or convulsions

And here are two more types of "red flags":

  • A person taking blood thinners like aspirin, Plavix, Coumadin, Eliquis and Xarelto is likelier to have internal bleeding and should be seen by a doctor.
  • Signs of a skull fracture, including bruising around the eyes and clear fluid leaking from the nose or ears, indicates an immediate need for medical attention.

How do doctors evaluate minor head trauma?

If a person comes to the emergency department with a minor head trauma, doctors will determine if he or she needs to be closely observed or requires treatment. 

To evaluate for mild traumatic brain injury (what doctors call MTBI) or concussion, a healthcare practitioner will conduct a physical exam, gather information about the trauma and how it occurred, and ask about resulting symptoms. This assessment provides information about what to do next. 

If there are no "red flag symptoms," the patient may be sent home or kept in the hospital for observation. 

If red flag symptoms are present, the doctor might order a computerized tomography (CT) scan or another kind of imaging test to rule-out higher risk conditions, such as bleeding in or around the brain, contusions (bruises) on the brain, swelling, or a diffuse axonal injury, which results in tears of tissue in or around the brain.

“If they get a CT scan, we’re going to be looking for those more serious injuries, like bleeding in or around the brain, that would require hospitalization or even a neurosurgical intervention,” says Dr. Melnick. 

How is minor head trauma treated?

In the absence of a more serious injury that might require hospitalization or surgery, little or no treatment is required beyond managing symptoms and giving the brain time to heal. 

Before you go home, however, you can expect your healthcare provider to provide some education on how to take care of yourself and what signs to look for that indicate you may need to get medical help. According to Dr. Melnick, this list will cover "things to look for to come back, things to do while your brain is healing, and who to follow up with in terms of additional evaluation and treatment if symptoms persist.”

Does minor head trauma affect people of different ages differently?

Minor head traumas can occur in people of all ages; those related to sports and other rigorous physical activities are less likely to affect the very young and the very old. 

One of the challenges of diagnosing brain injuries in children is their inability to articulate how they’re feeling. Yale Medicine doctors may refer young patients with minor head trauma to the Pediatric Concussion Clinic at Yale New Haven Children's Hospital.

In older people, the risk of falling increases generally, and the risk of more serious brain injury increases too. “The elderly are more at risk to have more serious injuries because of the way the brain ages,” says Dr. Melnick.  “They can have bleeding in the brain that would present more subtly. Although symptoms could be similar to a concussion, the actual brain injury could be more serious.”

Is concussion the same as minor head trauma?

Concussions can result from minor head trauma, but they are not the same thing. Concussion refers to the injury to the brain, while minor head trauma describes the way a patient was injured or, in medical terms, the “mechanism” of the injury. 

Dr. Melnick offers this general description of a person who has a concussion: "Somebody who has experienced minor head trauma and is exhibiting symptoms that are not severe enough to indicate a more serious, structural injury to the brain, like bleeding in or around the brain.”

Is there a relationship between drugs and alcohol and minor head trauma?

People under the influence of drugs and alcohol tend to be less inhibited and clumsier. They may do things that they wouldn’t do if they were sober. Substance use means people have less control over their motor skills and are likelier to hurt themselves.

Also, symptoms of minor head trauma can mirror common behaviors associated with intoxication, which presents special challenges. “If the person is drunk or intoxicated, you might not be able to identify that the symptoms are coming from the injury as opposed to the alcohol,” says Dr. Melnick. He notes that emergency room doctors frequently see this when a person who is intoxicated comes in with head trauma.

What makes Yale Medicine’s approach to minor head trauma stand out?

At Yale Medicine, doctors are trained to make a strong connection with patients who've experienced minor head trauma in order to perform a thorough evaluation. The interaction between patient and doctor is vital, allowing doctors to communicate with patients in a focused, thoughtful way so that they can offer more than just clinical care. 

“A big part of what we do isn’t just the evaluation, but the education, counseling and reassurance of patients with minor head trauma," explains Dr. Melnick. He adds that this is particularly important in patients who are anxious and uncertain about what to do and who don't know much about concussions. "The doctor-patient relationship is really important and almost sacred in this sort of situation," he emphasizes.