I appreciate there are many recent blogs on Brain Impact Apnoea and others on how to manage severe head injuries, but what about minor head injuries?
I thought I’d write a short post on rugby players and head injury, as it’s been in the news recently. Last friday night, during the opening game of the 2015 rugby 6 nations between Wales Vs England, this happened:
Now imagine you are working in an Urgent Care Centre (UCC) or minor injury unit (MIU) on a saturday afternoon. Jonny a 17 yr old school rugby player comes in with his school teacher after sustaining a “concussion” on the pitch. You examine and there is no external signs of head injury or any focal neurological deficit. He is safe to be discharged home.
On the way out Jonny turns around and asks “Excuse me Doc, I will be alright to play in the schools cup final in 2 weeks time at Twickenham, won’t I? It’s just that there will be some premiership team scouts there watching….”
What do you tell him? Are there any guidelines out there to help us? We have come a long way from the advice given to us in the nursery rhyme “Jack and Jill went up the hill…” where the second verse reads:
“Up Jack got and home did trot,
As fast as he could caper;
And went to bed and bound his head
With vinegar and brown paper…“
Concussion: A disturbance in brain function caused by a direct or indirect force to the head. Pre-hospitally the Rugby Football Union (RFU) advise medical and healthcare professionals to use the Sports Concussion Assessment Tool (SCAT) (hence the title of this post….) to diagnose concussion. It goes through the an assessment process involving GCS, memory recall, symptom and cognitive evaluation, balance and coordination evaluation and neck examination.
Here is a link to the NICE ED Head Injury assessment guidelines. (Just to refresh ourselves!) Now let’s concentrate on Jonny. There is advice from the English RFU on when players can return to play (RTP).
So Jonny needs to be rested and symptom free for 2 weeks then have a graduated RTP (GRTP) programme. Jonny must be symptom free for 48hrs per activity stage before moving onto the next stage as he is U19. The Earliest RTP is 23 days for U19s, so unfortunately he will have to miss out on playing at twickenham. For adults over 19yrs old, the earliest RTP is 19 days. Professional clubs can have a shortened rehabilitation period as they have club doctors trained in traumatic brain injuries and concussion.
Hope this is useful to know about especially the next time you see a rugby player on a saturday afternoon in UCC! Oh and remember Jonny, who couldn’t play at twickenham?….. Well he may well end up winning England that World Cup….. (Note: “Jonny” in this post is a fictions patient!) :o)