3 ms·

I wish we had better diagnostic tools for concussion. In our ER, the majority of patients with potentially significant head injuries are moderately to highly in

I wish we had better diagnostic tools for concussion. In our ER, the majority of patients with potentially significant head injuries are moderately to highly intoxicated, provide minimal history, and even though we generally CT all impaired patients with head trauma and hold them until they are no longer intoxicated, in many cases it can be difficult to differentiate a significant hangover from a concussion.

Llamamoe 3y ago
There's got to be some discoverable biomarker for it. If it's significant enough to affect gross brain function, it's got to have some effect on for example brain waste clearance, neurohormones, assorted growth factors, or produce some form of inflammatory markers.
nonameiguess 3y ago
It shouldn't be that hard if you really hold them until they are no longer intoxicated. The last time I had a mTBI was actually in a hospital, luckily enough (passed out from standing up after traction). All the standard tests, i.e. follow this pen with your eyes, stand up straight and touch something, were things I continued not being able to do well for weeks. Alcohol impairment goes away after a few hours. Granted, they obviously get more mild than that, but the milder they are, the less they matter as long as it isn't happening repeatedly.
- n8henrie 3y ago
  > Alcohol impairment goes away after a few hours. I think this is a gross oversimplification. If memory serves, the rate of ethanol metabolism is something around 0.015 (units?) per hour. In my ED, an average BAL for a patient that we realize is intoxicated (and choose to get a level) is probably 0.3 or so. 0.4 - 0.5 is common, and we see nearly 0.8 (in ambulatory patients!) from time to time. So for 0.3, if you are maximally generous and consider "sober" 0.08 (the level for an automatic DUI in my state), you're looking at 15 hours of observation. Not exactly "a few." Further, your own anecdote highlights exactly my point. How you you *know* you had a TBI? Because it felt like one? Because a doctor told you it was one? Because a physician's (subjective) assessment of your exam suggested it was one? Because your insurance would cover an inpatient stay for one if they listed that as the diagnosis? Don't misunderstand, I do a relatively thorough neurological exam compared to my colleagues, but I have no pretenses as to the level of subjectivity in my assessment, or to the external biases that could potentially sway my judgment. A more objective measure would be greatly appreciated, both to help ensure that I was acting in patients' best interest, and frankly to help me compel others to act in appropriate cases.

Llamamoe 3y ago

There's got to be some discoverable biomarker for it. If it's significant enough to affect gross brain function, it's got to have some effect on for example brain waste clearance, neurohormones, assorted growth factors, or produce some form of inflammatory markers.

nonameiguess 3y ago

It shouldn't be that hard if you really hold them until they are no longer intoxicated. The last time I had a mTBI was actually in a hospital, luckily enough (passed out from standing up after traction). All the standard tests, i.e. follow this pen with your eyes, stand up straight and touch something, were things I continued not being able to do well for weeks. Alcohol impairment goes away after a few hours. Granted, they obviously get more mild than that, but the milder they are, the less they matter as long as it isn't happening repeatedly.

n8henrie 3y ago
> Alcohol impairment goes away after a few hours. I think this is a gross oversimplification. If memory serves, the rate of ethanol metabolism is something around 0.015 (units?) per hour. In my ED, an average BAL for a patient that we realize is intoxicated (and choose to get a level) is probably 0.3 or so. 0.4 - 0.5 is common, and we see nearly 0.8 (in ambulatory patients!) from time to time. So for 0.3, if you are maximally generous and consider "sober" 0.08 (the level for an automatic DUI in my state), you're looking at 15 hours of observation. Not exactly "a few." Further, your own anecdote highlights exactly my point. How you you *know* you had a TBI? Because it felt like one? Because a doctor told you it was one? Because a physician's (subjective) assessment of your exam suggested it was one? Because your insurance would cover an inpatient stay for one if they listed that as the diagnosis? Don't misunderstand, I do a relatively thorough neurological exam compared to my colleagues, but I have no pretenses as to the level of subjectivity in my assessment, or to the external biases that could potentially sway my judgment. A more objective measure would be greatly appreciated, both to help ensure that I was acting in patients' best interest, and frankly to help me compel others to act in appropriate cases.