B.C. concussion researchers propose change to 'wildly inconsistent' way the brain injury is diagnosed

Remembering what happened after she hit her head on the ice while playing hockey is tough for Meg Kerekes.

But the former Vancouver high school hockey player knows how that particular headache felt — "like a one-pound weight on the spot that got hit.''

"I forget if they took me out or if I finished the rest of the game," she said of the suspected concussion in September 2018 when she was playing amateur hockey during her high school years in Vancouver. "I think I might have finished the game."

Her coach, who doubled as the person in charge of safety, suggested she stop playing and mentioned she might have a concussion.

"I didn't go to a doctor or anything. They just didn't let me play for two weeks,'' said Kerekes, who suffered another hit to the head five months later when an opposing player slammed into her.

Her mother took her to hospital after the second incident on the coach's orders, where a suspected concussion was confirmed, and Kerekes was out of school for 10 days. She returned to "light'' hockey practice but no games three weeks later.

Coaches and other volunteers in amateur sports need to be more aware of concussion risks, said Kerekes, who still gets a slight headache sometimes from just shaking her head while listening to music.

Recognizing and properly diagnosing concussions has also been an issue in clinical settings. A Vancouver researcher hopes that will change with a new diagnostic standard he helped develop.

Noah Silverberg, associate psychology professor at the University of British Columbia, co-led an international panel's efforts to replace "wildly inconsistent'' definitions of concussion.

The North American, European and Australian experts included clinician scientists such as emergency room doctors, neurosurgeons, pediatricians and those specializing in rehabilitation and sports medicine.

Silverberg's paper outlining the new standardized criteria, co-authored by neuropsychologist Grant Iverson of the Harvard University-affiliated Spaulding Rehabilitation Hospital on behalf of the American Congress of Rehabilitation Medicine (ACRM), was published last week in the journal Archives of Physical Medicine and Rehabilitation.

Silverberg said concussion has historically been minimized as a minor injury that does not need medical attention and is believed to get better on its own.

That often means people don't seek medical treatment immediately, or at all, so a potential mild traumatic brain injury goes undetected, said Silverberg, who focuses on concussion recovery and treatment.

However, a concussion may not get diagnosed in an emergency room, where the focus is typically on ruling out catastrophic injuries rather than diagnosing a condition that could involve persistent symptoms and disability, he said.