, 7 tweets, 3 min read Read on Twitter
Do you need a CT scan for a concussion? Who needs to be woken up so they don't die in their sleep? Let's briefly explore this important topic...
First off, concussions are a bigger deal than we once thought. They're common, and can lead to a host of downstream problems, from headaches and visual problems to learning deficits and psychiatric problems. ncbi.nlm.nih.gov/pmc/articles/P…
But--a CT isnt required for diagnosis. In fact, while the "official" definition of concussion is debated, its considered a syndrome of traumatically-induced alteration of brain function, typically affecting memory+orientation--W/OUT radiographic evidence of structural damage.
That means if you bring your child, friend, or family into the ED with concern for concussion, we often wont even image. Using the Canadian Head CT (mdcalc.com/canadian-ct-he…) or PECARN rules (mdcalc.com/pecarn-pediatr…) we can avoid radiation while maintaining diagnostic accuracy.
"Waking up concussions" is an old wives tale, from a time before neuroimaging or decision aids, when a patient w/a significant head injury could be in whats called the "lucid interval" of a subdural hematoma. If youre concerned enough to wake someone up, they should be in the ER.
"Brain rest" is a hotly debated topic, with a lot of contention in the topic borne from this 2015 paper in @AAPJournals which suggested no benefit to the practice, and maybe even harm: pediatrics.aappublications.org/content/135/2/…

I strike a medium note here, and often recommend modified brain rest.
If you or a loved one (or an enemy...) takes a blow to the head, they should be evaluated by a physician--but with outstanding clinical evaluation and strong research tools, they don't necessarily need a CT scan, and certainly don't need to be woken up every few hours.
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