OK, I assumed . . .

Specialties School

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First grader comes in sweaty, red faced, states I have a headache. The astute nurse I am asks, where did you come from? He of course answers from the playground. Me, about to explain well if you were able to run and play, you will be fine. Then he says where I was running and ran into a pole.

Do you think the documented/diagnosed concussions were mostly the real deal, or do you think practitioners might over diagnose to cover their derrieres?

From what I've seen, our local ER will diagnose a concussion in anyone that has or may have hit their head, regardless of signs/symptoms. The ER also does not send us restrictions. There is an amazing concussion clinic that sends very detailed info on each child's concussion, their testing results, and their restrictions, plus their next follow up date. I always recommend follow up care with the concussion clinic for this reason.

I've sent out 8 for possible concussions sustained at school and called home about lots more bumps to heads the head. I've only had 5 come back with restrictions. I'm sure there are even more that I've not be told about.

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Specializes in School.
Do you think the documented/diagnosed concussions were mostly the real deal, or do you think practitioners might over diagnose to cover their derrieres?

Most I have seen have been the real deal. My issue is when both the trainer and I express concern about a student having one and the parent just doesn't get it until Little Darling is falling behind in their class because they can't think straight. I have also seen where the little darling has been diagnosed, but does not realize how bad it is. We had a basket ball player who had a severe concussion and all they would talk to you about is the busted eardrum. The eardrum busted due to the head trauma.

I think there is more information now on concussions that helps.

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The pacer test...why, PE teachers, WHY????

I am consistently surprised that a PE/health teacher will send a kid to the nurse because of heavy breathing after running. Or even nausea. Let them get a drink and rest for 5 minutes... That should do it. (Important to note: this does not apply to an asthmatic student or anyone in clear distress)

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Specializes in School Nurse, past Med Surge.
The pacer test...why, PE teachers, WHY????

Do tell... Why can't I figure this out?

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Most I have seen have been the real deal. My issue is when both the trainer and I express concern about a student having one and the parent just doesn't get it until Little Darling is falling behind in their class because they can't think straight. I have also seen where the little darling has been diagnosed, but does not realize how bad it is. We had a basket ball player who had a severe concussion and all they would talk to you about is the busted eardrum. The eardrum busted due to the head trauma.

I think there is more information now on concussions that helps.

Yes.

We are more aware for good reason. I think that we still under diagnose. I see this with my varsity athletes all the time. Gotta get the star football player back in the lineup, ASAP!

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Specializes in IMC, school nursing.

Our school requires clearance from MD, no note, no school.

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Specializes in Cardiology, School Nursing, General.

I call for head injuries, ALWAYS. Most of the time the kid is okay, but I still tell the parents. If the child seems okay and they say they are okay, I send them to class, BUT I tell them if they start to feel dizzy or anything weird, to come back with a buddy and I let their teachers know so they can keep an eye out for them. If they come back feeling worse, I call mom again to pick them up to make sure they are okay and they go see a doctor.

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We need a note from the doc to clear them to start the return to play process. Once the trainer completes that, the district doctor has to sign off.

I call for every head/face injury.

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Specializes in school/military/OR/home health.

I have a letter for ANY bump to the head that explains what assessments I do, and that even though they did not have signs or symptoms in my office there is a list at the bottom of the letter of things to look for at home just in case. Just CYA and keeps me from having to make quite so many phone calls. I hold all head bumps for 10 minutes no matter how good the student feels. Then I have a checklist the CDC put out that has a spot for notes and Q15 min checks for when a student seems symptomatic. It's nice and I really like it. Yesterday I sent a kid to the ER with his checklist and the mom came back and said they told her that means nothing, and the checklist is useless to them.

I mean, it's from the CDC. For head injuries. And I had narrative notes that explained what I saw. But whatever, if the ER didn't like my paperwork...

Note that they didn't have any suggestion for what they would rather I do. Ugh.

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I have a letter for ANY bump to the head that explains what assessments I do, and that even though they did not have signs or symptoms in my office there is a list at the bottom of the letter of things to look for at home just in case. Just CYA and keeps me from having to make quite so many phone calls. I hold all head bumps for 10 minutes no matter how good the student feels. Then I have a checklist the CDC put out that has a spot for notes and Q15 min checks for when a student seems symptomatic. It's nice and I really like it. Yesterday I sent a kid to the ER with his checklist and the mom came back and said they told her that means nothing, and the checklist is useless to them.

I mean, it's from the CDC. For head injuries. And I had narrative notes that explained what I saw. But whatever, if the ER didn't like my paperwork...

Note that they didn't have any suggestion for what they would rather I do. Ugh.

LIKE!

(We need a LOVE button)

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Do you think the documented/diagnosed concussions were mostly the real deal, or do you think practitioners might over diagnose to cover their derrieres?

I think the recent spike in concussion diagnosis CAN be over caution but I also think we know more now and that is why we have more diagnoses.

Same can be said for diagnoses of ADHD and many learning disabilities. They weren't recognized before and students with those disabilities were labeled as "not smart" or "trouble makers" and now we know better.

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Specializes in School nursing.
I have a letter for ANY bump to the head that explains what assessments I do, and that even though they did not have signs or symptoms in my office there is a list at the bottom of the letter of things to look for at home just in case. Just CYA and keeps me from having to make quite so many phone calls. I hold all head bumps for 10 minutes no matter how good the student feels. Then I have a checklist the CDC put out that has a spot for notes and Q15 min checks for when a student seems symptomatic. It's nice and I really like it. Yesterday I sent a kid to the ER with his checklist and the mom came back and said they told her that means nothing, and the checklist is useless to them.

I mean, it's from the CDC. For head injuries. And I had narrative notes that explained what I saw. But whatever, if the ER didn't like my paperwork...

Note that they didn't have any suggestion for what they would rather I do. Ugh.

Ugh, indeed. The ED and docs around me LOVE the checklist. I also think it is awesome! I also write a detailed note on the side with any vital signs and pain levels, etc. I send a copy with every student that I send out to be immediately evaluated and include my office number on top in any questions.

The ones I don't refer out and just call home, I pull the CDC checklist in their health file.

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