Why is Post-Concussion Syndrome Important (& the term problematic)?
The first action of the post-concussion syndrome working group was to consider an update to the terminology. The working group discussed how the PCS terminology may create a barrier to effective recovery - by conveying a sense of hopelessness and blaming the patient for not getting better. "Post-concussion syndrome" implies a constellation of symptoms that consistently occur together after an individual has sustained a concussion - which is not the case.
As neurobiological, psychological and social factors that drive symptom persistence are becoming better understood, the working group identified a need for a clinical term that emphasizes the importance of accurate diagnosis of specific symptoms that persist after the expected recovery period.
PCS as "Clinical Red Herring"
Misattribution of symptoms, diagnostic errors and misinformation by health care providers may lead to post-concussion syndrome (PCS) as a "clinical red herring." Symptoms that are misattributed to concussion results in inadequate evaluation and treatment - leaving treatable symptoms and conditions to go untreated. Many of these patients will also receive an "over-prescription" of cognitive and physical rest. Patients with persisting symptoms often have high levels of disability, reduced life satisfaction, and increased healthcare utilization.
Symptoms that are consistent with post-concussion syndromes are also consistent with normal life, depression/anxiety/other mental health disorders, chronic pain and symptoms reported by persons involved in personal injury litigation.
Persisting Symptoms after Concussion (PSaC)
The International Congress for Athlete Brain Health accepted the recommendation to update the term "post-concussion syndrome" to "persisting symptoms after concussion" - which places a focus on treatable symptoms.
Persisting is an active state vs. persistent may mean forever - this is an important distinction for the updated terminology. Persisting Symptoms after Concussion (PSaC) implies specific symptoms are persisting that require ongoing clinical management and emphasizes the importance of accurate diagnosis of specific symptoms that can persist after the expected recovery period.
PSaC calls for individualized evaluation and treatment, while communicating that symptoms experienced after concussion may not be due to concussion and uses active and optimistic language that implies symptoms are not permanent and thus treatable.
Persisting symptoms after concussion are characterized by the following:
not improving or are worsening in number and/or severity over days to weeks after injury
persisting beyond the period that can be explained by pre-morbid, co-morbid or resulting factors
may be related to issues directly resulting from the injury, but not the injury itself
cause distress or disability more days than not
interfere with partial or full return to typical activities such as school, work, sport, and/or social roles
Not all recoveries are the same...
“Sport-related concussion is a heterogeneous injury that is characterized by a myriad of symptoms, variable clinical presentations, and recovery trajectories.”
Collins, Kontos, Reynolds, Murawski, Fu (2014)
“The personal experience & reporting of post-concussion syndrome is likely individualized, representing the cumulative effect of multiple variables, such as genetics, mental health history, current life stress, medical problems, chronic pain, depression, personality factors, & other psychosocial & environmental factors.”
Wäljas, Iverson, Lange, et al. (2015)
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