According to research that was published by the American Academy of Pediatrics, emergency departments across the country are seeing more kids who have suffered a concussion or head injury. Even though 13% less kids are playing contact sports than 15 years ago, the number of kids with concussions has doubled. It wasn’t just high school athletes, but also kids from 8-13 who were also increasingly at risk.

The numbers are frightening but also need to be taken in context. Today’s awareness of the potential for significant long term complications of repeated concussions that are stacked closely in time, has made, athletes, parents and coaches want immediate medical evaluation of every potential head injury. This drives patients to the ER, where statistics capture their every visit. Often there is a push to perform a CT scan to insure no bleeding or bruising of the brain, even if the athlete is neurologically normal. A normal CT is followed by an equally strong push to allow the athlete to return to play.

The latest return to play guidelines stress that no player return immediately, repeat neurologic evaluation be performed and decisions be made days, not hours, later. The reason is pretty clear .While a CT can evaluate the brain’s structure, it is much harder and takes time and skill to assess its function. Many team doctors use computer testing, for example the IMPACT test program www.impacttest.com , to look for subtle changes in concentration and mood. Otcanhers rely on clinical judgment and neuropsychologic testing to decide who can play and who can’t.

This is a major change from a decade ago. Minor head injuries were evaluated on the sideline by a trainer and based on the prevailing wisdom of the time and supported by guidelines form the American Academy of Neurology, some athletes could return to the field of play almost immediately. Often kids weren’t seen until days later by their family physician or pediatrician and CT scan was not an automatic assumption.

While it is likely concussion rates are increasing because athletes are faster and stronger, even in elementary school, it may be that there has been a cultural shift. The more that parents and coaches read about pro athletes suffering from Alzheimer Disease at a young age because cumulative head injuries, the more they want to protect their kids from that potential. Football, baseball, basketball, soccer and hockey all have an increased risk of putting the head in the way of the action and increase the risk of brain injury.

Concussion can be and easy diagnosis. The athlete gets knocked out on the field, has some amnesia and is slow to get up and going. Concussions can also be subtle and hard to appreciate. The hit to the head may not be recognized wit hno immediate symptoms. Those may occur hours or days later and may be no more than a kid having a hard time concentrating in school, doing homework, having sleep issues or being more irritable at the dinner table. Impressive or not, a minor brain injury needs to be completely resolved before the player can return to play.

Treatment is time and rest, not only for the body but also for the brain. Video games, texting, computers may slow the recovery time and it may be the one time in a teenager’s life that they re encouraged to be a slug. But many high school seasons are short and parents and kids realize that being out two or three weeks may mean missing half a season. Frustration with brain healing may be an important part of the treatment that a doctor, team trainer and coach may offer.

There should be the expectation that emergency department visits will continue to rise for minor head injuries in children. Whether it’s from heads colliding playing ball or falling off a bike (please make your kid wear a helmet), the brain is a prime target for injury. Parents will take the cautious approach and bring them to a doctor. The next step is to appreciate that a normal brain on CT does not equal a normally functioning brain. It take time to heal and, as in most things medical, one cannot rush time.

As the great egg recall rolls out across the country, the salmonella scare continues to spread. Finding and destroying a half billion eggs sounds like it might wipe out the country’s egg supply but it is only a tiny fraction of the 80 billion eggs that are produced by US chickens. Few people will become infected, but that will not stop growing numbers to seek medical care to make certain that they are alright. The challenge for the care provider will be to meet the wants of the patient with the reality of what can be provided.

As with every doctor’s visit, the patient has certain expectations. Sometimes they are voiced but many times, they are unasked. A patient who comes in with a headache wants to be reassured that there isn’t a brain tumor present. The parent who has a child with abdominal pain wants to hear the words that appendicitis is not the cause. When people come to their doctor this week with vomiting and diarrhea, they want to be reassured that they are not potential victims of their morning breakfast of eggs over easy and salmonella infection.
Normally when we eat, the stomach acts like a mixing bowl, taking the food and turning it into a slurry. The watery mix passes through the small intestine where nutrients are absorbed into the body and is then delivered to the colon or large intestine. The colon acts like a sausage maker squeezing the stool along, allowing water to be absorbed back into the body and producing a solid bowel movement. When the stomach becomes irritated, it empties itself quickly by vomiting. Irritation of the colon causes it to squeeze down is a single spasm causing pain, and when it relaxes, the liquid stool rushes through the whole length of the colon with no time to allow water to leave. Out comes a liquid, diarrhea bowel movement.

The difficulty with the latest egg scare, is that symptoms of salmonella infection are exactly the same as any other cause of gastroenteritis (gastro=stomach + enter=intestine =itis=inflammation) or “stomach flu. And the symptoms of vomiting, diarrhea and crampy abdominal pain are usually caused by a virus.

The vast majority of people who have these complaints will not have salmonella. Sometimes it’s hard for patients to accept that the treatment is the same. Antibiotics are not used for salmonella, except in patients who have a compromised immune system, and the illness is allowed to run its course and usually resolves in a few days. If the symptoms are the same and the treatment is the same, there is little need to do any testing. Salmonella can be confirmed by cultures a stool sample, but for what purpose? The results will come back (positive or negative) just as the illness is resolving itself. How frustrating for the patient to be told that there is little to do except for supportive care and prevent dehydration.

When a test doesn’t matter, should it be done? Aside for the cost and messiness, there is little reason not to do stool cultures, except that if every patient demanded the testing labs across the country would be overwhelmed and other tests would be delayed. For other illnesses, there are consequences and potential side effects for unnecessary testing. A ”routine” CT scan of the head increases the radiation risk of cancer. Even the lowly blood test can cause bleeding or skin infection because of the needle stick.

As with most illnesses, prevention is the best treatment for salmonella. While the government and the food industry work on their recall, consumers can minimize their risk by cooking their eggs well. Thorough cooking kills the salmonella bacteria which means that over easy is out and the morning protein shake of raw eggs made famous by Rocky and Sylvester Stallone is definitely out.

And as for the next doctor’s visit, try to puts words to the purpose of the visit and ask the questions you want answered. While they can anticipate, sometimes they get it wrong and that can lead to an unhappy patient and unsatisfied care provider. Players on the same team need to communicate to get to where they want to go.