Talk:Concussion

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	Concussion has been listed as one of the Natural sciences good articles under the good article criteria. If you can improve it further, please do. If it no longer meets these criteria, you can delist it, or ask for a reassessment.
Article milestones Date Process Result February 4, 2008 Peer review Reviewed March 7, 2008 Good article nominee Listed Current Status: Good article

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	This article is within the scope of WikiProject Neurology. Please visit the project page for details or ask questions at the talk page.
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To-do:	edit · history · watch · refresh
Find better image for upper right Find a head trauma expert to vet for accuracy Copyedit Add section on social consequences and costs Add secondary sources, replace primary sources per WP:MEDRS Replace sports examples Find single source for sentence with mid-sentence citations

Contents 1 TV Medicine 2 Missing Citation? 3 Move to concussion 4 Other symptoms 5 Requested move 5.1 Survey 5.1.1 Survey - in support of the move 5.1.2 Survey - in opposition to the move 5.2 Discussion 5.3 What about seizures related to concussion? 6 MTBI and the CDC 7 Prevention 8 Tables 9 Images? 10 Concussion#Other guidelines 11 Citation cleanup 12 DOI help 13 URL's to abstracts 14 Spinning out grades section 15 Move to Mild TBI? 16 Review of the first few sections 17 PTSD post concussion 18 Good Article nomination 19 New source re microhemorrages in boxing

[edit] TV Medicine

Why would a person who has a concussion have to stay conscious? For example, a person falls in an icy cave and struggles through the episode to stay awake until help arrives. Does this have any basis in medicine? --Orthografer 20:34, 3 December 2005 (UTC)

The only basis I can think of is that staying awake faciliates ongoing assessment. Staying awake when in a cave is useful because one can call help to come closer when it arrives. Otherwise, there's little to it. JFW | T@lk 01:57, 4 December 2005 (UTC)

There's that, and the fact that the parents of a child who has had a head injury are often instructed to "wake him up every hour through the night" when they take him home - the purpose being to check that he's ok, but the instructions being mistaken as treatment rather than an aid to diagnosis. For Orthografer, the point of the exercise is to be sure that the person is still capable of consciousness (and get medical assistance if he is not), rather than to keep him conscious. - Nunh-huh 02:00, 4 December 2005 (UTC)

Ok - TV makes it seem like physical harm follows from loss of consciousness due to concussion. Thanks! --Orthografer 02:42, 6 December 2005 (UTC)

Orthografer is correct. In television and movies, it is said that a person should not fall asleep after a concussion because he\she will (might) die. PrometheusX303 23:42, 1 March 2006 (UTC)

[edit] Missing Citation?

Compare 1st para under Pathophysiology to description from Mayo clinic concussion article at http://www.mayoclinic.com/health/concussion/DS00320 : "Your brain floats within your skull surrounded by cerebrospinal fluid (CSF). One of the functions of CSF is to cushion the brain from light bounces of everyday movement. However, the fluid may not be able to absorb the force of a sudden hard blow or a quick stop."

Should this be referenced? Vandersluism 04:12, 31 May 2006 (UTC)

Excellent catch. I just rewrote it to The brain floats within the skull surrounded by cerebrospinal fluid (CSF), one of the functions of which is to protect the brain from normal light "trauma", e.g., being jostled in the skull by walking, jumping, etc., as well as mild head impacts. More severe impacts or the forces associated with rapid acceleration/deceleration may not be absorbed by this cushion. I'm not sure that's not enough to avoid any copyright violation, but it's a start. —Ryan McDaniel 01:31, 20 July 2006 (UTC)

[edit] Move to concussion

Does anyone really say "concussion of the brain"? Top google hits are wikipedia and mirrors. Is there any reason that having the article at Concussion would be confusing? I suggest that we move it. Any objections? If not I'll go ahead in a couple days. delldot | talk 06:02, 8 January 2007 (UTC)

Well, no objections, so I'm going to list it at WP:RM. The new section for discussion of the requested move is below. delldot | talk 02:15, 1 February 2007 (UTC)

[edit] Other symptoms

A friend of mine has just been asking me for advice. She had a bump to the head two days ago. Yesterday evening she was complaining of inability to walk, numbness and heaviness in her legs. Can these be symptoms of concussion? (As an aside, I've urged her to contact a doctor ASAP rather than rely on unqualified advice.) 89.241.180.143 20:56, 29 January 2007 (UTC)

Good job advising her to get professional help (We can't give medical advice at Wikipedia). But those symptoms sound like something more serious than a concussion, and you're right that she should get medical treatment right away. delldot | talk 02:15, 1 February 2007 (UTC)

[edit] Requested move

RVD

[edit] What about seizures related to concussion?

My brother fell off the monkey bars at school and had a seziure before blacking out. He went to the hospital and had a catscan. Point of this is, it was caused by a concussion, they(the doctors there)concluded. Yet, no where on this page does it mention seziures, nor does the 'types of sezuires' page note concussion as a cause.(If it does, someone needs to tell me) I'm not ready to go listing things just yet, thought I'd get someone else's two cents. 67.171.167.106 04:15, 10 August 2007 (UTC)

[edit] MTBI and the CDC

The CDC has started a campaign to increase awareness of and to optimise the care of MTBI, see here. JFW | T@lk 00:16, 22 August 2007 (UTC)

Thanks! I looked through it and added some stuff from it. delldot talk 10:14, 19 January 2008 (UTC)

[edit] Prevention

Any reason there isn't a prevention section in this article? Many if not most concussions could have been prevented with the use of proper precautions. Helmets: Consider the design changes to NFL helmets (they used to have hard exteriors, now resilient). Construction, hockey, bicycle and motorcycle helmets have become nearly universal. There must be some good epidemiological studies out there. LeadSongDog 15:18, 28 September 2007 (UTC)

I actually wondered about this too. I say go ahead if you can find sources for it! delldot talk 04:51, 9 January 2008 (UTC)

I've started a small stubbly section. Please add! delldot talk 22:36, 9 January 2008 (UTC)

[edit] Tables

So what do people think, are the tables in Concussion#Grades helpful or annoying? Should we leave the text as well as the tables that say the same thing, or pare or remove one or the other? delldot talk 04:51, 9 January 2008 (UTC)

[edit] Images?

I think it would be nice if this article had images, but I can't find any free ones, and aside from graphs and so on, can't make them myself. Anyone have any ideas for what to use and where to get some? delldot on a public computer talk 10:30, 12 January 2008 (UTC)

[edit] Concussion#Other guidelines

I'm going to remove this section for a couple reasons: I'm concerned that the grades section is disproportionately detailed. Plus, I've only seen a reference to it in the Shepherd article cited, and it doesn't say what the system is called or why it's more special than any of the other 16 systems (whereas the other three systems mentioned are called the three most widely accepted in one source). I do think, though, that Concussion grading systems or some such could be a fine article, if someone wanted to research them.

Since not too many people are active on this article, and since I'm the one that added that text in the first place, I'm going to assume no one will mind my removing it. As always, though, let me know if there's a problem. delldot on a public computer talk 11:06, 12 January 2008 (UTC)

[edit] Citation cleanup

Much better now, still many missing pmid and doi. LeadSongDog (talk) 21:06, 23 January 2008 (UTC)

Thanks for the hard work, Dog. I've been through and found all PMID's that I could, the rest apparently couldn't be found. I'll look for doi's for the rest. Apparently the {{cite journal}} template is case sensitive, i.e. you have to have lower case pmid= and issn= for it to work. delldot talk 21:48, 23 January 2008 (UTC)

[edit] DOI help

I can't get the doi to work for this article. It's listed there as 10.1136/jnnp.2006.106583, but it's a dead link if you add it to the template. A little help? delldot talk 22:05, 23 January 2008 (UTC)

Seems to be a malformed doi, even at source, common to all the Pract Neurol articles I could find.LeadSongDog (talk) 22:30, 24 January 2008 (UTC)

Hrrmm, do you think it can be fixed, or is that it? delldot talk 03:10, 25 January 2008 (UTC)

Argh! Now it seems to work.LeadSongDog (talk) 01:56, 28 January 2008 (UTC)

Argh, indeed. It's still not working for me.  :-( delldot on a public computer talk 02:01, 28 January 2008 (UTC)

My mistake, I clicked on the url, not the doi. It points to the author's archived pdf, not the journal. As the error message says, "If you believe you have requested a DOI that should be found, you may report this error to doi-help@doi.org. Please include information regarding where you found the DOI in your message: http://en.wikipedia.org/wiki/Concussion "LeadSongDog (talk) 04:23, 28 January 2008 (UTC)

Thanks! I sent the email, hopefully they'll fix it! delldot talk 08:59, 29 January 2008 (UTC)

[edit] URL's to abstracts

I'm not really worried about it either way, but about URL's to abstracts, I had actually asked about this at WT:MEDMOS#Citing journal articles. Colin replied there that a URL to an abstract should only be given if there's no doi or PMID, and it should be linked as (abstract). Like I said, I'm not concerned either way, but I'd argue for taking them out entirely when we have doi's or PMID's (unless the URL adds something, like if the doi takes you to an intermediate page and the url takes you right to the abstract), and including the link with "abstract" in parentheses when we don't. delldot on a public computer talk 06:43, 9 February 2008 (UTC)

[edit] Spinning out grades section

I had an idea to move most of the grades section to a new article, maybe concussion grading systems, leaving a summary here. I'm excited about the idea for a few reasons. The article is stupidly long (my fault), plus, moving this to its own article will help with some of the sports-heaviness brought up in the peer review. Hope no one objects (doubt they will, I'm the one that added the material anyway). I think I'll go ahead in a bit, if there are any problems, we can of course discuss as usual. delldot on a public computer talk 03:52, 15 February 2008 (UTC)

[edit] Move to Mild TBI?

My progress with this article is stalling because I can't find any non-sports-related info on concussion per se -- all journals use "mild traumatic brain injury" rather than "concussion", except in sports medicine. Should the name of the article be changed? It's a problem because "MTBI" and "concussion" are sometimes considered the same thing and sometimes not, and no one can agree on the definition of either one. But at least most people consider concussion to be subsumed under MTBI. However, changing the name would require a big rewrite. And more laypeople are familiar with the term "concussion". Should they be two separate articles?

I'm really not sure what to do. Any input would be much appreciated. delldot talk 19:13, 22 February 2008 (UTC)

If there is a complete overlap between the concepts (i.e. all MTBI = concussion) then leave it at "concussion" with a clear emphasis on the MTBI concept. If there is an incomplete overlap, make it clear that this is the case (e.g. very mild concussion is not termed MTBI but ****). JFW | T@lk 09:56, 24 February 2008 (UTC)

Since I was one of the people that recommended an attempt to incorportate more medical literature from outside the sports domain, I guess I should add my two cents. I think that the distinction between the two (MTBI and concussion) is made fairly clear in the lead, and makes clear that MTBI is a broader concept that includes concussion. Perhaps in both the lead, and the diagnosis section it might be worth making clear that concussion has traditionally be used in a sports-related context, while MTBI is used in a broader medical context. One way to do so would be to find the first reference to MTBI in the medical literature, and clarify that concussion is also an older (generic) term, while MTBI is a more recently introduced, technical term. The first reference to MTBI (although there is used as "minor traumatic brain injury") that I find in the pubmed database is 1992 [1]. There is an earlier 1982 reference, but it seems to have nothing to do with traumatic brain injury. Based on this, and the fact that most readers will look for concussion, and not MTBI (which currently redirects here) I would keep it as is. Edhubbard (talk) 15:03, 24 February 2008 (UTC)

Thanks much to both of you. It sounds like maybe it should be left at "concussion" but the distinctions and uses made clearer, right? Good idea about finding the original use of MTBI, Edhubbard, maybe I can even find the original statement where the term was proposed or something. Thanks again, delldot talk 21:44, 25 February 2008 (UTC)

[edit] Review of the first few sections

Well, I thought delldot was going to go for GAN, so I started reviewing...then got the message saying not yet. Anywhere, here's the review I did...basically just the first few sections of the article. Hope you find it useful!

• "may be used interchangeably with concussion,[2][3] but" - I think the "with concussion" is implied and thus not necessary, and the "but" would work better as an "although"
  • Reworded slightly delldot talk 05:49, 7 March 2008 (UTC)
• "'Concussion', an older term, has been used for centuries" - this doesn't read too well IMO
  • Reworded slightly delldot talk 05:49, 7 March 2008 (UTC)
• I'm not aware of the referencing standards for articles in this area (it sure aint music or video games!), but should it be said on ref 5 that registration is needed?
  • Having it this way was a suggestion at Wikipedia:Peer review/Concussion/archive1#Colin. It doesn't matter to me how we link it though, if there's an established way I'm glad to change it. delldot talk 05:49, 7 March 2008 (UTC)
• "however it may be more than 600 per 100,000 people" - why not just say a percentage?
  • It's a standard way of writing incidence, maybe because the person years thing. Tourette syndrome has it in per 1,000, which may be logical (since they're both divisible by 100...), so I'll change it to that for now. delldot talk 08:42, 7 March 2008 (UTC)
    • OK, sounds good. As I said, I have no idea what consensus in this area is. :) dihydrogen monoxide (H₂0) 08:50, 7 March 2008 (UTC)
• In reading the last para of the lead I felt that it sort of ended too soon, as if something was missing...although as the discussion is ongoing I'm not sure what I'm leading it! :)
  • Added a little and reworded, how is it now? delldot talk 08:42, 7 March 2008 (UTC)
• "In 2001, a group of concussion experts" - you might want to say who they were, how they were chosen, etc. just to display potential POV in their definition (oooh, conspiracy theory!)
  • Done, but it might be too bulky now... delldot talk 08:57, 7 March 2008 (UTC)
• "may have helped make them more" - rather than "may have" can't you find a source that says that they did?
  • I doubt a source would say that it did help (too committal), but I made the wording a little more specific, hopefully this will clarify why the source expected it to. delldot talk 09:26, 7 March 2008 (UTC)

*"where it is frequently used interchangeably with "MHI" and "MTBI", while the latter is more common in general clinical medical literature" - this doesn't read well. Perhaps "where it is frequently used interchangeably with "MHI" and "MTBI", the latter of which is also common in general clinical medical literature"

• Woah, 2 boxing images...and nothing from any other sport? I'm sure you could find a relevant Gridiron one, for instance
  • Other folks mentioned the sport-heaviness of the article in the peer review, so I replaced the image with an image of someone with a headache. Is this OK? delldot on a public computer talk 01:06, 8 March 2008 (UTC)

Cheers, dihydrogen monoxide (H₂0) 01:27, 7 March 2008 (UTC)

[edit] PTSD post concussion

I cut the following new para by User:Whipesq, as it was unreferenced:

However, PTSD is frequently over diagnosed in Post Concussion situations. Too many medical providers are using PTSD as a grab bag diagnosis to cover symptoms that appear to be more severe than the medical provider concludes they should be, based upon the verified evidence of concussion on the day of the event. Historically, PTSD is a syndrome that grew out of combat type stressors. Few, if any civilian injuries involve the same level of emotional shock (and hypervigilance) which accounts for the combat diagnosis. If, as discussed above, the concussion was under diagnosed on the day of the event, the symptoms may be consistent with a more severe injury than originally believed. The intersection of organic brain damage and emotional issue post concussion is a synergistic battleground within the mind, with both areas at risk for more severe symptoms, because of the interplay between the two. An area of study still in it's infancy is whether brain plasticity, which has for generations been credited with positive gains in brain recovery, may be partially responsible for the poor recovery from PCS. The hypothesis here would be that during the early PCS period, the combination of cognitive difficulties, synergistically interacting with the stress and frustration of adapting to the trauma, rewires the brain in destructive ways.

The account had just been registered and I wouldn't want to discourage a new editor. If someone can back it up with cites, some of it might be worth keeping. LeadSongDog (talk) 19:45, 7 March 2008 (UTC)

[edit] Good Article nomination

GA review (see here for criteria)

---

Overall, very good work. I made did minor MOS (in particular, images) work, but otherwise it definitely meets the GA criteria.

1. It is reasonably well written.

   a (prose): b (MoS):

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

   Especially nice job on providing adequate in-line citations, it is rare for me to not have to request a single one.

3. It is broad in its coverage.

   a (major aspects): b (focused):

4. It follows the neutral point of view policy.

   Fair representation without bias:

5. It is stable.

   No edit wars etc.:

6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):

7. Overall:

   Pass/Fail:

   Again, great work. Congratulations! Just as a side note: GA is currently enduring a hefty backlog of nominations. If anyone is willing, please consider reviewing at least one article. For those new to the process, there are mentors willing to guide you through the it. Thank you, VanTucky 03:20, 8 March 2008 (UTC)

Thanks a ton for the very quick review! delldot on a public computer talk 12:16, 8 March 2008 (UTC)

I hate to say I told you so! dihydrogen monoxide (H₂0) 10:15, 8 March 2008 (UTC)

Oh shut up. Just kidding XD Thanks much, H₂O, for giving me just enough of a, uh, kick in the pants to get around to nominating it :D delldot on a public computer talk 12:16, 8 March 2008 (UTC)

[edit] New source re microhemorrages in boxing

"How Dangerous is Boxing for the Brain? The 'Heidelberg Boxing Study' does not find any clear risks from amateur boxing / Publication in American Journal of Neuroradiology" (PDF). Press release. Opinions on this one?LeadSongDog (talk) 20:30, 31 March 2008 (UTC)