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In the Clinic |


Christina L. Master, MD; Laura Balcer, MD; and Michael Collins, PhD
[+] Article, Author, and Disclosure Information

CME Objective: To review current evidence for prevention, diagnosis, treatment, and prognosis of concussion.

Funding Source: American College of Physicians.

Disclosures: Dr. Master, ACP Contributing Author, has disclosed the following conflicts of interest: Payment for manuscript preparation: American College of Physicians. Dr. Balcer, ACP Contributing Author, has disclosed the following conflicts of interest: Consulting fee or honoraria: Biogen-Idec, Vaccinex, Questcor, and Acorda. Dr. Collins, ACP Contributing Author, has disclosed the following conflicts of interest: Board membership: ImPACT Applications; Consultancy: ImPACT Applications; Stock/stock options: ImPACT Applications. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0497.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.

With the assistance of additional physician writers, Annals of Internal Medicine editors develop In the Clinic using resources of the American College of Physicians, including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program).

Ann Intern Med. 2014;160(3):ITC2-1. doi:10.7326/0003-4819-160-3-201402040-01002
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As many as 3.8 million mild traumatic brain injuries occur annually in the United States. Many of them are sports- and recreation-related, and more than 800 000 Americans seek outpatient care for this injury each year (1). With more than 40 million children participating in organized sports annually (2), children and adolescents represent a large proportion of injured persons.

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Submit a Comment/Letter
What is "concussion"?
Posted on February 10, 2014
Thomas E. Finucane, MD
Johns Hopkins University
Conflict of Interest: None Declared
The “In the Clinic” review of concussion lacks a definition of concussion. Its first sentence refers to mild traumatic brain injuries. Later, “historically, concussion has been defined as a constellation of subjective symptoms (sic) after head injury without any objective radiologic or physical examination findings”. “Concussion is a clinical diagnosis that is made once more significant injuries have been excluded.” The Patient Information page answers the question “What is concussion?” by saying simply “a serious injury that damages the brain”.

The review does describe symptoms that are “indications that a concussion has occurred” and proposes that “Historically, concussion has been a radiologic diagnosis of exclusion: signs and symptoms consistent with concussion with normal imaging studies.” What the diagnostic criteria are, however, is not given.

Head injuries can be extremely serious and their effects (especially cumulative and chronic) are not yet fully understood. A clear diagnosis seems necessary in order to provide evidence about diagnosis, treatment, prognosis, and epidemiology. A burgeoning industry has now developed. People are taken for “further testing” to see if they have had a concussion. Lawsuits and foundations proliferate. Athletes become patients if they play hard and have a headache. A serious scientific definition would provide a strong basis for study.
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Summary for Patients

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The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


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