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Optometry’s role in mTBI care will grow
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As I write this editorial, the National Football League’s regular season is winding down, providing some clarity to the much-anticipated post-season and who will vie for the coveted Lombardi Trophy.
While professional football has evolved into a game of strategy and analytics, each contest still hinges on an element of execution ... and physicality. Players are ever bigger, stronger and quicker; collisions are more violent; and injuries come fast and furious. Interestingly, in recent years, things like torn ACLs [anterior cruciate ligaments] and high ankle sprains are giving way to a different sort of injury: Concussion. Every team recognizes it is one helmet-to-helmet collision away from losing a key player ... and a chance of a Super Bowl victory.
NFL aside, concussion, or mild traumatic brain injury (mTBI), has become a huge concern for everyone. The CDC reports that the number of TBI-related emergency department visits soared from 420 per 100,000 population in 2001 to 715 per 100,000 in 2010. Factor in those mTBIs that are undiagnosed or managed in outpatient care facilities, and the total number likely exceeds 3 million annually.
While all mTBIs are reason for concern, perhaps none are more important than those involving children. The University of Pittsburgh Medical Center estimates that 1.7 to 3 million student athletes suffer from sports- and recreational-related concussions annually, with as many as 50% undiagnosed.
The challenge of concussion – and virtually all matters involving the brain – lies in the uniqueness and complexity of each presentation. Concussions, especially mTBIs, can be difficult to diagnose, prognosticate, monitor and manage. Recognizing the challenges and lack of consensus within health care, the CDC’s National Center for Injury Prevention & Control commissioned a work group with the task of providing much-needed guidance for mTBIs. Employing a modified Delphi approach and sifting through 25 years of peer-reviewed literature, the work group created the CDC Pediatric Mild TBI Guideline.
Published just a few months ago in JAMA Pediatrics, the guideline provides clarity on assessing and managing kids with suspected mTBI. It stressed five key considerations: Routine imaging is not essential for diagnosis, validated (age-appropriate) symptom scales are critical for diagnosis, evidence-based risk factors should be considered in predicting prolonged recovery, return to activity instructions should be customized for each patient, and patients should gradually return to non-sports related activities after 2 to 3 days of rest.
While it’s important that all optometrists familiarize themselves with the guideline, it should be viewed with perspective. Like all guidelines, this is a living document with future revisions inevitable. It did not consider the plethora of emerging research on what is undoubtedly a rapidly evolving area of medicine. Likewise, while acknowledging the significance of vestibulo-oculomotor dysfunction in mTBI, it did not specifically identify optometry as an integral care giver. I am confident the optometrist’s impactful role will be reflected in future guideline revisions.
Suffice it to say, optometrists will offer even more to mTBI patients, whether sharing prevention education, communicating with fellow care givers or providing treatment. Our mandate – like that of other mTBI providers – is to embrace current guidelines, stay abreast of emerging research and, above all, see each mTBI patient as a unique presentation.
- References:
- CDC. TBI data and statistics. www.cdc.gov/TraumaticBrainInjury/data/index.html. Updated January 22, 2016. Accessed December 27, 2018.
- UPMC Sports Medicine. Concussion facts and statistics. https://www.upmc.com/services/sports-medicine/services/concussion/about/facts-statistics. Accessed December 27, 2018.