Case "Vignette" Published in New England Journal of Medicine Contains Outdated Theories Concerning Concussion

Michael Phelan

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The January 11, 2007 issue of the NEJM contains a "case vignette" entitled, Concussion. Ostensibly, a case study about a 64 year old woman who fell on ice and hit her head on a sidewalk, the article reads like an HMO-authored attack on the alleged overuse of CT scanning. The article relies on outdated research and offers medical conclusions that have been long debunked. For example, the authors state that

[t]he clinical status of momentary sensation of being 'starstruck,' or dazed after head injury without a brief period of loss of consciousness is uncertain....

In support of this assertion, the authors cite a 1931 commentary on minor head injury. Apparently, the authors have not surveyed pertinent literature from the past seven decades, including a consensus statement from the Centers for Disease Control, which conclude that one need not lose consciousness to suffer a concussion. The CDC defines concussion as a brain injury. Furthermore, the Concussion authors suggest that

a brief convulsion...immediately after an otherwise mundane concussion [is neither a cause for concern nor] requires the administration of anticonvulsant medication.

One expects and hopes that the New England Journal of Medicine will be inundated with Letters to the Editor from physicians interested in setting the record straight and citing the most current and generally accepted research in the peer reviewed medical literature on the issues of concussion and post concusion syndrome..