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Fast-tracking concussion care

Toronto, February 23, 2015

By Kate Manicom

Dr. Chantal Vaidyanath meets with patient Todd Sharman
Dr. Chantal Vaidyanath, a physiatrist with St. Michael’s Head Injury Clinic, meets with patient Todd Sharman about his progress. (Photo by Yuri Markarov)

Traumatic brain injury is likely to become one of the biggest public health problems by 2020, according to the World Health Organization.

But patients who come to the Emergency Department at St. Michael’s Hospital with mild TBI are often unsure of their next steps after diagnosis. They face a long wait list to see a specialist and struggle to find appropriate support to manage persistent symptoms such as headaches, dizziness or difficulty concentrating after they go home.

“We were seeing patients who’d made more than 30 hospital visits because their symptoms never improved,” said Dr. Donna Ouchterlony, who leads St. Michael’s Head Injury Clinic. “We clearly needed to change our system to give more support to these patients.”

The hospital recently created the Urgent Care Concussion Clinic to fill the gap for patients between leaving the ED and visiting their family doctor or a specialist, where it can take several weeks to get an appointment.

Now, when a St. Michael’s patient is diagnosed with a mild TBI or concussion, he or she can be referred to the Urgent Care Concussion Clinic. Before discharge, referred patients receive an education booklet about their condition and are told that someone will call to follow up within five days.

During the followup phone call, a clinical nurse specialist uses a comprehensive questionnaire to determine the need for rapid referral. Patients with milder symptoms are directed to their family physician, those with acute symptoms are seen in the Urgent Care Concussion Clinic for short-term care, while those with more severe symptoms are sent to the Head Injury Clinic.

“We’ve brought in social workers to assess the psychological needs of patients and to provide support for them and their families. And we developed the education booklet,” said Dr. Ouchterlony. “Our goal is to standardize guidelines for brain injury assessments and try to get everyone – military, sports and rehab physicians and family docs – on the same page in terms of assessing and treating traumatic brain injuries.”

According to Dr. Chantal Vaidyanath, a physiatrist, or rehabilitation physician, at the clinic, the prolonged symptoms of mild TBI can be challenging for patients.

“They fear they won’t be able to work, they can’t sleep and the continuation of these problems can result in depression,” said Dr. Vaidyanath. “That’s why it’s so important that we find ways to treat the symptoms and help patients feel like themselves again as quickly as possible.”

According to Dr. Ouchterlony, the Head Injury Clinic still has a long wait list, but the Urgent Care Concussion Clinic’s fast-tracking improvements and new research should help TBI patients to improve their quality of life.

Common symptoms of a mild traumatic brain injury
Physical
Behavioural / Emotional
Cognitive
  • Headache
  • Nausea
  • Vomiting
  • Blurred or double vision
  • Seeing stars or lights
  • Balance problems
  • Dizziness
  • Sensitivity to light or noise
  • Tinnitus
  • Drowsiness
  • Fatigue/lethargy
  • Irritability
  • Depression
  • Anxiety
  • Sleeping more than usual
  • Difficulty falling asleep
  • Difficulty concentrating
  • Difficulty remembering
  • Feeling “slowed down”
  • Feeling “in a fog” or “dazed”
From Ontario Neurotrauma Foundation

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.