Emergency Room Not Diagnosing A Concussion, Revisited

A few months ago, I wrote a short article describing why emergency rooms do such a bad job at diagnosing concussions/brain injuries: The emergency room didn’t say anything about a concussion. Does that mean I don’t have a brain injury?

Recently,  I came across a study that really quantifies the problem I discussed.

The study, primarily led by several doctors from the University of Washington, was laid out in an article entitled Accuracy of Mild Traumatic Brain Injury Diagnosis, which was published in the August 2008 issue of the Archives of Physical Medical Rehabilitation.

The article starts by noting:

Accurate identification and diagnosis of a mild TBI is the first step toward providing clinical care.

Unfortunately, despite the accurate diagnosis of a brain injury being so important, the study found that emergency rooms are not very good at making the diagnoses.

The study looked at 197 patients who had been to emergency rooms.  They looked at medical records, and in some cases interviewed the patients, to determine whether they patients had a brain injury, as defined by the Centers for Disease Control mild Traumatic Brain Injury work group.  The researchers then took those patients who were diagnosed with a brain injury and looked at the patients’ emergency room records to see what was diagnosed in the emergency room.

The results were startling.

The emergency room doctors failed to make a diagnoses of a head injury or concussion in 56% of the patients who were later determined to have a brain injury.

That’s a stunning number.

There are some things that can help improve the accuracy of the emergency department physicians.  If the patient complained in the emergency room about confusion, feeling dazed, or having memory problems, then the diagnoses was more accurate.  However, even with those findings, the emergency department still missed the diagnoses on 37% of the patients.  That’s still a substantial number of patients who have a brain injury that doctors are missing.

Oddly, the emergency room physicians’ diagnoses weren’t dramatically better even when the patient reported a loss of consciousness — which should be a red flag.  The doctors still failed to make the proper diagnoses of a head injury in about 50% of the patients who had told the doctors that they had lost consciousness.

This means that you have to be diligent about noticing symptoms.  I’ve repeatedly written that misdiagnoses is a problem and that the best way to find the problem and to get proper treatment for the problem is for someone close to the person to look for symptoms.

To learn more details about potential symptoms, you can read our other articles:

If you or a loved one has sustained a brain injury in an accident, please call us at (512)476-4944 and we’d be happy to see if we can help.

My MRI or CT Scan Was Negative. Does This Mean I Don’t Have A Brain Injury?

This is another question I’ve recently received from potential clients.  They were involved in an incident — a car wreck, a slip and fall, or something similar.  They went to the ER, and the ER performed an MRI or a CT san looking for problems, but scan came back negative.  Does this mean that the was no brain injury?

Absolutely not.

While an MRI or a CT scan can find some brain bleeds or some damage, they don’t find most problems.  As a result, the vast majority of people who have brain injuries have a normal (what we call negative) MRI or CT scan.

Indeed, while insurance companies sometimes try to argue about claims when you have a normal MRI or CT scan, virtually all scientific literature and all neurologists agree that you can still have a normal scan.  Not only that, virtually all neurologists will agree that most of the patients they see for brain injuries have normal scans.

So if you feel like you’re off or your family members are telling you that you’re different after a car wreck, a fall, or another event, don’t rule out a possible brain injury just because you had a normal CT scan or MRI.  You may very well still have a mild traumatic brain injury that needs to be treated

Brain Injuries: Risk Of Suicide May Increase Three Fold After A Concussion

brainI’m part of a nation-wide group of lawyers who regularly exchange articles and other information with one another about brain injury cases.

This week, we were having an online discussion about suicide, and we shared a study from earlier this year finding that persons who have suffered even a single concussion may be at a much higher risk for suicide.

What really struck me is how these risks apply to my clients.

In a Scientific American article about the study, Dr. Donald Redelmeier, one of the study’s lead authors stated:

The typical patient I see is a middle-aged adult, not elite athlete.  And the usual circumstances for acquiring a concussion are not while playing football; it is when driving in traffic and getting into a crash, when missing a step and falling down a staircase, when getting overly ambitious about home repairs — the everyday activities of life.

These are the things we routinely see in our practice. Over the last year, I’ve represented clients who have had brain injuries in car wrecks, bicycle wrecks, slip-and-fall accidents, and more.

Too often the diagnoses of these injuries is slow, and in many cases, not recognized until very late in the process.   This delays the treatment, including the psychological treatment, that clients need to help them start the road to recovery from these devastating injuries.

 

New Study Explains Why Rest Is Key Following A Brain Injury

brainWhen my son suffered a concussion two years ago, his doctor told him the key was rest.  For this then 11 year old, that meant laying down, with no reading, no television, and no video games.  Just rest.

Rest has long been thought to help following a brain injury, but recently, a new study came out explaining why that was the right advice.

The study, which examined trauma in the brains of mice, found that when there is single, mild incident, the mice lose 10-15 percent of their neuronal connections in the brain, but there was no accompanying cell death.  When the mice rested for three days, almost all of the connections came back, healing the brain.

However, the study found that without rest, when additional events occur, the neuronal connections don’t heal and can become permanent.  Thus, the prescribed rest is critical to offer the brain an opportunity for any mild injuries to heal.

One issue with the study is that it is only based on very mild injuries.  In more severe cases, a one-time incident can cause cell death and have long-term consequences even if the victim tries to take the rest needed or prescribed.

If you or a loved one has suffered a brain injury as a result the conduct of someone else, please call us at (512)476-4944 so we can help you.

 

 

 

Do Self-Driving Cars Need Driver’s Ed?

I’ve been following the stories of self-driving cars.  As a personal injury lawyer who sees the devastation of car wrecks, I’m interested in technology that can help my clients be more safe.  On the other hand, knowing all the calculations that go into safe driving — watching for other cars, pedestrians, bicyclists, animals, and other risks — I’ve wondered how technology would be able to handle all of those risks.

Well, it looks like we might still have a ways to go.  Google and other companies have been testing nearly 50 self-driving cars around California.  Reports earlier this week confirmed that, since September, the self-driving cars had been involved in four accidents.  While that might not sound like a lot, if four out of every 50 cars on the roads were involved in wrecks during that same period, it would be catastrophic.

The companies aren’t releasing many details of the wrecks, but reports indicate that two of the wrecks occurred while the cars were in self-driving mode and two occurred while the drivers controlled the cars.

We’ll see how this technology develops going forward.

Posted on: May 12, 2015 | Tagged

What Should I Do After An Injury?

The most important thing you can do after your injury is to get the medical care that you need.  This is important on two grounds.  First, it’s obviously important for your health.  Going to the doctor as soon as possible gives the doctor an opportunity to either provide treatment or to send you to a specialist.   Going to the doctor and following the advice of your doctors is probably the most important thing to do to get better.

Second, going to the doctor(s) and following your doctors’ advice is important for your personal injury claim.  For a lot of insurance companies, your claim will be penalized if you don’t get to the doctor early, have a gap in treatment (fairly long time periods between doctors’ appointments), or you don’t follow your doctors’ advice.

The next thing you should do for your claim is to talk to a personal injury lawyer early.   There are several things that we can help you with early in the process that can affect the value of your claim.   If you wait until later to hire a personal injury lawyer, you’re potentially missing out on several steps that will likely affect the value of your case.

 

Posted on: November 24, 2014 |

Head Injuries and Concussions — From Players’ Perspective

If you know me, you know I’m a huge University of Texas sports fan.  Because of that, I’m a huge fan of the Longhorn Network.  Usually, the stories just relate to my sports passion, but in light of David Ash’s retirement from football due to his repeated concussions, the LHN ran a great piece that talked with three former UT players about their battles with concussions.

Watching it, one thing that stood out to me was something that we see in our practice (and which the science backs up), and that is, once you have had a concussion (or multiple concussions), it takes a smaller impact to re-injure the brain.  Additionally, with a history of concussions, the symptoms appear to get worse.

If you have any interest in head injuries, concussions or sports, I highly recommend the story below.

Leading Causes of Traumatic Brain Injury

TBIStats_Causes

 

 

 

 

 

 

 

 

We represent a number of clients who have brain injuries, and I received this infographic the other day describing the causes of traumatic brain injuries.  I thought it was brilliant, and I wanted to share it here.

 

I fell in a parking lot because of broken pavement/sidewalk. Can I sue?

This question was posed to me recently, and the short answer is “yes.”

This is called a premises liability case.  In Texas, a customer can prevail in a premises liability case against a business if the customer can prove several things: (1) that the condition (here the broken pavement or sidewalk) posed an unreasonable risk of harm; (2) the business owner knew or reasonably should have known of the danger; (3) the business failed to use reasonable care to make the condition safe; and (4) the business failed to use reasonable care to warn the customer about the condition.

While these questions may seem simple, there are a lot of difficult issues hidden inside of them.  For instance, almost all premises cases have disputes about whether the condition was unreasonably dangerous.  This often requires expert witnesses who can talk about building codes or other rules and regulations that might apply and why failing to comply with those regulations is dangerous.

Additionally, when proving whether the business owner knew or should have known of the danger, arguments arise over how long the condition had been present.  In this type of case, where broken pavement or sidewalk is likely to occur slowly over time, the issue might not be important.  But if you’re suing a business over a spilled drink on a floor or something similar, then you have to prove how long the drink had been on the floor.  As you might imagine, that can be difficult.

There are other similar difficult issues that make this a much more complicated question than it might normally seem.  That’s why it’s so important to have a competent lawyer on your side when you’re hurt in these situations.

 

 

Posted on: July 24, 2014 |

Brett Favre’s Admissions Shed Light On Traumatic Brain Injuries

In an interview this week, retired NFL quarterback (and all around tough guy) Brett Favre discussed memory loss issues he’s been having since retirement.  Favre attributes these issues to potential brain injuries he suffered as a player.

Favre isn’t alone in these types of symptoms.  We’ve had the pleasure of representing a number of clients who have suffered from brain injuries.  Sadly, memory loss is a popular symptom.

I’ve said it before, and I’ll say it again, the concussion issues arising in the NFL and in the military are terrible.  But they may be the best thing to happen to traumatic brain injury patients.  These stories have put a light on the issues of concussions and brain injuries, and they’re also sparking research that might help my clients and others as they seek to return to normal lives.

Perlmutter & Schuelke, PLLC maintains offices in Austin, Texas. However, our attorneys and lawyers represent clients throughout the state of Texas, including Dallas, Houston, San Antonio, Forth Worth, El Paso, New Braunfels, San Marcos, Kyle, Buda, Round Rock, Georgetown, Lockhart, Bastrop, Elgin, Manor, Brenham, Cedar Park, Burnet, Marble Falls, Temple and Killeen. By Brooks Schuelke


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