Brain Injury Studies, Reports, & Research

De Caro & Kaplen partner Michael V. Kaplen, a three-term president of the Brain Injury Association of New York State, and professorial lecturer at law, teaching a course in brain injury law at the George Washington University Law School, discusses important new studies, reports, and research on traumatic brain injury and concussions.

Click the links below to jump to a video breakdown of the study/research, along with a short summary of key findings.

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Report Reveals 800,000 Individuals Are Victims of Misdiagnosis Each Year

Michael Kaplen discusses a stunning new study, which estimates 800,000 individuals each year are victims of misdiagnosis. This includes 371,000 people whose death is attributable to a misdiagnosis and 424,000 who sustain serious injury and disability.

Summary

• A recent study estimates 800,000 individuals annually suffer misdiagnosis-related harm, including 371,000 deaths and 424,000 serious injuries.
• Brain damage is a common consequence, particularly in misdiagnosed cases of strokes, sepsis, blood clots, pneumonia, and cardiac conditions.
• Many misdiagnosis cases go unreported, and the study focuses on the most serious errors.
• Dr. David Toker suggests the actual magnitude of misdiagnosis could range from 50 to 100 million cases.
• Women and Black individuals face a 20 to 30 percent increased likelihood of misdiagnosis.
• Published in the British Medical Journal, the study calls for a comprehensive examination of diagnostic errors and rejects limiting patient rights to seek legal redress.

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Multiple Concussions

Michael Kaplen discusses research published in the Journal of Neurotrauma, which reveals that experiencing multiple concussions, regardless of severity, increases the chances of long-term cognitive impairment.

Summary

• Multiple concussions, regardless of initial severity, increase the risk of long-term cognitive impairment, according to research in the Journal of Neurotrauma.
• The study analyzed medical and lifestyle data, including cognitive tests on 15,764 adults aged 50 to 90, with over 40% having experienced at least one traumatic brain injury (TBI) over 30 years.
• Common cognitive deficits in those with a TBI history included attention and multitasking problems, executive functioning, and difficulties with complex tasks and time management.
• Cognitive issues were “dose-dependent,” meaning they increased with the number of concussions experienced.
• The study emphasizes the importance of understanding the risks of multiple concussions, especially for individuals in high-risk activities like construction work, sports, domestic violence victims, and military personnel.

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Does Screen Time Impact Recovery From Concussions?

Michael Kaplen discusses the findings of a new study which examines the impact of screen time on concussion recovery.

Summary

• Study explores the impact of screen time within 48 hours post-concussion on symptom duration.
• Published in Pediatrics, November 2021, the research supports clinical recommendations to limit screen time during the acute concussion period.
• Participants aged 12 to 25, presenting to the emergency department within 24 hours of concussion, were either allowed or instructed to abstain from screen time for 48 hours.
• Those with screen time had significantly longer median recovery times, per self-reported concussion recovery checklists.
• Children and adolescents (10 to 19 years) have the highest concussion incidence; guidelines suggest cognitive and physical rest for 24 to 48 hours.
• The role of electronic screen viewing in cognitive rest and potential mental health impacts (e.g., anxiety, isolation) needs clarification.
• The study raises questions about screen time restrictions during concussion recovery and their potential impact on mental well-being.
• Return to learn, play, and limitations on mental and physical activity during concussion recovery require further research, including screen time limits.
• Authors recommend larger clinical trials, specific activity analyses (e.g., video games), and exploration of dose-dependent effects.
• Given US teenagers’ high daily screen time (over 7 hours), excluding schoolwork, the study underscores the need for further investigation.
• Importance of instructions and advice to children and parents post-concussion diagnosis is emphasized, as they play a crucial role in recovery.

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The Prevalence of Brain Injury In The United States

Michael Kaplen discusses the vastly underestimated prevalence of brain injury in the United States.

Summary

• A recent study by Centers for Disease Control (CDC) researchers reveals that 27% of adults in the U.S. report having had a concussion in their lifetime.
• Only half of these adults sought evaluation for their last concussion from a healthcare provider.
• The study, titled “Concussion Evaluation Patterns Among US Adults,” highlights the underestimation of concussion frequency in the population.
• The true incidence and prevalence of concussions remain unknown as many individuals do not seek medical evaluation after sustaining a concussion.
• Seeking examination by a healthcare professional is crucial to preventing or mitigating long-term consequences, including post-concussive syndrome.
• Reporting and evaluating concussions are vital for public health officials to understand the injury’s prevalence and its impact on individuals and society.
• Failure to obtain a diagnosis and treatment after a suspected concussion can prolong recovery and increase the risk of subsequent concussions.
• The study identifies slips, trips, or falls as the leading cause of unreported concussions, followed by injuries among bicyclists and incidents of being struck by or against an object.
• Misunderstanding of concussion symptoms may lead individuals to believe their concussion is not serious, or they may lack awareness that they sustained a concussion.
• The study emphasizes that a concussion is a brain injury, and current data on prevalence relies on emergency department visits and hospitalizations, indicating limitations and vast underreporting.
• The underreporting of concussions extends across various societal aspects, including sports, the military, domestic violence, prisons, homelessness, and the elderly, highlighting a public health crisis.
• The findings underscore the need for increased focus on information and programs encouraging individuals with concussions to seek medical evaluation and efforts to improve access to care.

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Study Demonstrates Causal Link Between Repetitive Head Impacts and CTE

Michael Kaplen discusses important news about a new study which demonstrates a clear causal link between repetitive head impacts and CTE.

Summary

• A recent report highlights concerns about brain injuries caused by repetitive head trauma in sports-related activities.
• The report discusses inquiries from entities defending against sports-related brain injury lawsuits, particularly focusing on inadequate supervision, delayed removal of athletes with concussions, premature return to play, endorsement of dangerous conduct, and lack of education on concussion risks.
• Chronic traumatic encephalopathy (CTE), an incurable brain disease associated with repetitive head impacts, is the central focus.
• CTE has been identified in athletes from various sports, and the study establishes a definitive link between repetitive head trauma and CTE using the Bradford Hill criteria.
• Athletes in contact sports are found to be 68 times more likely to develop CTE than the general public, challenging denials from organizations like the Concussion in Sports Group (CISG), including the NFL.
• The study criticizes the CISG for faulty methodology and calls for prevention efforts, especially for children who cannot legally consent to potential long-term risks.
• Legal consequences for professional and amateur sports leagues, state and federal sports regulation, and contact sports may be significant.
• Previous lawsuits, limited by the challenge of proving a definite link between head trauma and CTE, may see a shift in judicial attitudes due to this study.
• The study may influence parental attitudes toward allowing children to participate in sports like football and ice hockey.
• Legislative bodies may consider measures to limit head contact in sports, such as mandating tag football for children, setting concussion limits, and increasing educational requirements for coaches and trainers.

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Almost 7% Of Children In The USA Show Signs Of Brain Injury

A new report from the Centers for Disease Control estimates that close to 7% of children in the United States show signs of a brain injury.

Summary

• Approximately 7% of children in the United States exhibit signs of a brain injury, with causes including sports, falls, and abuse.
• Prevalence of brain injuries increases with age, from 2% in children up to 5 years old to 12% in 12- to 17-year-olds.
• Boys show a higher prevalence (8%) of concussion or brain injury symptoms compared to girls (6%).
• The reported figures likely underestimate the actual extent of injuries, often unnoticed or unreported.
• The significance lies in potential long-term consequences such as post-concussive syndrome, affecting areas like headache, visual disturbances, coordination, mood, and school performance.
• Cognitive problems, communication difficulties, and behavioral/emotional struggles may result in some children.
• The findings emphasize the need for increased vigilance in the medical profession to screen for concussions and other brain injuries after head trauma.
• Schools should be attentive to disturbances in children returning to the classroom after a head injury, offering reasonable accommodations.
• Coaches, trainers, and those overseeing children’s safety in sports must take precautions to minimize injury risks and keep children out of play after a concussion until medically cleared.
• Children suspected of being victims of child abuse should be screened for concussions.
• The full report, titled “Concussions and Brain Injuries in Children 2020 NCHS Data Brief no 423,” was published by the National Centers for Health Statistics in December 2021.

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Children and the Persistent Post-concussive Syndrome

Michael Kaplen discusses the Persistent Post-Concussive Syndrome in children, and a new test developed by The Buffalo Group, which aims to help school personnel, trainers, and medical professionals better evaluate the recovery of children and student athletes after concussion.

Summary

• New study in the British Journal of Medicine focuses on identifying children at risk for Persistent Post-Concussive Syndrome (PPCS) after sports-related concussions.
• Limited existing research prompts the development of a decision rule tree for safe return-to-play decisions.
• PPCS involves the persistence of physical, cognitive, emotional, and behavioral symptoms beyond the expected recovery period.
• Cognitive symptoms include attention, memory, and focus difficulties, while physical symptoms involve headaches, dizziness, sensitivity to light and sound.
• Duration of “normal” recovery after a concussion is debated, with some studies suggesting recovery can extend for months or even years.
• Children take longer to recover than adults, leading to delayed judgments on recovery.
• Researchers develop a simple scoring system for use by school personnel, trainers, and medical professionals to facilitate decision-making regarding children’s return to play.
• Identified signs indicating delayed recovery in children and adolescents with concussions:
  • Lightheadedness and dizziness upon standing from a lying position.
  • Balance and vision problems.
  • Difficulty performing a tandem gait test (walking heel to toe).
• Children exhibiting these signs are more likely to develop PPCS, necessitating increased observation and timely intervention.

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Study Finds Increased Risk of Opioid Misuse For TBI Survivors

• Traumatic brain injury survivors are 52% more likely to use opioids post-injury and face a 65% higher risk of opioid misuse than the general population.
• Described as a “perfect storm,” Brandeis University researchers link brain injury survivors’ unique vulnerability to pain and substance abuse to increased opioid use.
• Individuals with a TBI may experience chronic pain, including headaches, with 40-50% reporting long-term headaches and 75% of mild TBI or post-concussive syndrome survivors reporting headaches.
• Over 51% of brain injury survivors have chronic pain from associated physical injuries, such as orthopedic injuries (whiplash, bone fractures).
• Opioid use may result from a lack of alternative treatment options for these individuals.
• TBI survivors are more prone to substance abuse due to temporal lobe damage, impairing judgment and impulse control; those with a history of substance abuse face a greater risk of misuse post-TBI.
• Risks extend to overdose, leading to respiratory depression, oxygen deprivation, and further cognitive impairment due to hypoxia.
• Medical professionals should screen patients for a lifetime TBI history before prescribing opioids due to increased vulnerability to misuse and dependence.
• Individuals and families should be aware of the heightened risk of substance abuse and suicide linked to opioid use post-TBI.
• There is an urgent need for further research in civilian and military populations.
• Judicial and medical systems should recognize the opioid misuse-TBI association to ensure appropriate care and rehabilitation.