Bike Crashes & Concussions: A Discussion with Dr. Charles Tator
We know firsthand from representing cyclists that incidents of head injury and concussion are terrifyingly common in crashes that occur when a cyclist is hit by a motorist. According to the U.S. Federal Highway Administration and the American National Safety Council over 1/3rd of non-fatal bicycle crashes result in an injury to the head. To make matters worse, 80% of cycling fatalities involve a head injury.
Despite the alarming statistics, we find that all too often concussions are misdiagnosed or ignored by medical assessors following a crash. Perhaps it is understandable. When an injured cyclist is rushed into a busy ER medical professionals tend to focus on the obvious injuries while ignoring more subtle things like head injury.
In fact, when we speak to cyclists post-collision, their focus too is often on their objective injuries. Unless specifically questioned about concussion symptomology they are silent on the issue. This stoicism as it relates to concussion can be a major problem.
Early concussion detection management and treatment can vastly change the outcome of a cyclist’s medical prognosis as well as the valuation of their legal claim.
Because of the importance of managing concussions we are constantly working to build our knowledge and educate the cycling public on what we have learned.
Recently we had the fortune of working and interviewing Dr. Charles Tator, one of Canada’s top Neurologists and a leader in research and education on the issue of acquired brain injury in sport. Over the years, Dr. Tator has taken an active role educating and informing doctors, lawyers and members of the public about the importance of brain health, concussion prevention and management.
The following is a brief overview of our recent discussion with Dr. Tator.
Q. Thank you for taking the time with us Dr. Tator. Can you start by providing us with your definition of concussion?
At this time concussion is best defined in terms of symptoms. These symptoms include, but are not limited to, headache, nausea, dizziness, light sensitivity, confusion, fatigue, mood change and a host of other physical and emotional symptoms. These symptoms can be caused by a blow to the head, but it is erroneous to conclude that they require a “loss of consciousness”.
The Diagnosis of a concussion takes expertise. Though the medical world has been searching for biomarkers of concussion for years thus far they do not exist therefore the most accurate way to diagnose concussion is a careful assessment by a trained physician.
Q. If concussion is best diagnosed by a physician why do we so often see situations where client’s who attend an emergency room with clear indicia of concussion leave without a proper diagnosis?
This is something that really bothers me. Physicians are taught how to assess for concussion, but in our current environment doctors are under such great pressure that diagnosing concussion is overlooked. When a physician is working in a busy emergency room they are often faced with overwhelming and sometimes severe situations. In a loud, frantic high paced environment the time and space required to engage in highly sensitive concussion may be ignored.
Q. Why is early and accurate diagnosis of concussion important?
Earlier treatment is better. From a medical perspective it makes a difference if a person suffering from concussion symptoms gets treatment as soon as possible. At minimum an early diagnosis may prevent the patient from exacerbating their symptoms by returning to a high level of activity too soon.
Furthermore, there is a serious emotional and mental health aspect to concussion. Data shows that at least 1/3rd of concussion patients score significantly lower on tests for depression. They also score very poorly on objective quality of life measures.
Failing to diagnose a concussion can leave a patient confused as to what is happening. This confusion can be aggravated if their condition is called into question or if they are labelled as exaggerating. This is especially dangerous in situations where a person has a history of mental health problems.
Q. In our legal practice we have faced situations where client’s have advised us that they do not want to report symptoms of concussion for fear of stigma – from a medical perspective is this a problem?
Patients often feel anxious about what their condition means for their life. For example, a person suffering vertigo is probably not safe to drive a car or ride a bike. The thought of losing a licence or having to refrain from sport may prevent fulsome reporting. The truth is however, that failure to diagnose a concussion can put a person at great risk. Firstly, symptoms of concussion may reduce a patient’s capacity to safely engage in higher level activities; and secondly, concussions seem to be progressive. The body seems to remember it’s last concussion and it takes less force to suffer secondary concussions with worse and longer lasting symptoms.
Q. Why do you think it is so important for the medical profession, the legal profession and the general public to understand more about concussions?
Better education and understanding of concussion is incredibly important. Too often people are labelled as malingering. Words like catastrophizing and somaticizing are used to downplay and belittle people who have suffered what can be a lifechanging injury. These loaded terms are unhelpful and potentially dangerous. For instance Rowan’s Law was only developed after the death of a young athlete. If the public has better awareness and understanding of concussion than communities are better able to avoid needless suffering.
We are eternally grateful for the care provided by and head injury leadership of Dr. Tator.
If you’ve been involved in a collision on your bike and hit your head, be sure to take the following steps:
Seek immediate attention and report all injuries, including a hit to your head even if you’re initially a-symptomatic. If your helmet is at all damaged, bring it with you and show the doctor.
In the day or two following your crash take it easy. Be mindful of the symptoms Dr. Tator noted above, take brief notes of them and report within the week to your family doctor.
Get a concussion diagnosis if you have symptoms either immediately following your crash or in the days after.
Get a referral to a trusted concussion specialist, clinic or hospital facility.
Save your helmet, take pictures of it. Put it in a closet safely hidden away and never use it again. Get a new helmet, the insurer will pay for it.
Contact a lawyer.
Ride safe friends and contact us if you have any questions: email@example.com