Patients with head injuries get faster, more streamlined care at new concussion clinic

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Traumatic brain injuries are often difficult to diagnose and can take a long time. Opened in September 2013, St. Michael’s Hospital’s new urgent care concussion clinic could have sped up the assessment and treatment of 28-year-old Sarah Jayne Benedict.

An avid equestrian, Benedict fell off her horse and hit her head slightly in April 2012. After waiting eight hours at a hospital without being seen, she gave up and returned home believing she felt fine.

For months afterwards, Benedict experienced sensitivity to noise, dizziness and headaches that kept her from classes at Wilfrid Laurier University, where she was in her third year. Unable to cope, she eventually had to drop out and moved back home to Collingwood.

“This is a classic case of a concussion,” says Dr. Donna Ouchterlony, director of the Head Injury Clinic at St. Michael’s Hospital in downtown Toronto. “Up to 90 per cent of people with mild traumatic brain injury get headaches and experience dizziness – more frequently than people with severe TBI – and the nausea and sensitivity to light and stimulation at school are also common symptoms. Unfortunately, there aren’t any universally agreed upon tools to assess head injuries, so diagnosis can be delayed.”

In Collingwood, Benedict had difficulty finding someone to see other than her family doctor to get specialized treatment. “I developed a lot of anxiety, I had trouble focusing and balancing and I had zero concentration,” Benedict says. “I’m normally a big reader, but at the time, I could only read for five minutes. I fell into a depression because I couldn’t figure this out.”

St. Michael’s new urgent care concussion clinic facilitates quicker and more streamlined treatment.  “Mild traumatic brain injuries and concussions are a major cause of injury and the most resource intensive, non-acute medical issue these days,” says Dr. Ouchterlony. “If this patient had come to us right away, she could have avoided months of pain and uncertainty.”

Within a month of meeting with Dr. Ouchterlony and the Head Injury Clinic team in January 2013, Benedict’s health improved “more in that month than in the past eight combined. They made me feel confident in their care.”

Dr. Ouchterlony is also co-chair of an Ontario Neurotrauma Foundation working group to develop standard guidelines for the assessment of brain injuries. “We’re essentially trying to get everyone – military physicians, sports and rehab physicians and family docs – on the same page in terms of assessing and treating traumatic brain injuries.”

Another component of the new urgent care concussion clinic is the opportunity for patients to get involved in research. Dr. Cindy Hunt, a research associate with the Head Injury Clinic, is working on developing a standardized data set. In addition, the team is developing a screening tool that will be a resource for health care providers to help triage and direct treatment.

For example, at St. Michael’s, when patients contact the Head Injury Clinic, they are interviewed over the phone and asked a number of questions. The “score” they are assigned, based on their answers, determines their treatment, which can range from receiving an information booklet to getting referred to the Head Injury Clinic.

“We’ve created a new model of patient care with this urgent care clinic,” says Dr. Andrew Baker, the medical director of the Trauma and Neurosurgery Program and chief of the Department of Critical Care at St. Michael’s Hospital. “Patients who have experienced a mild traumatic brain injury or concussion will benefit from rapid referral as our clinic fills the gap between an emergency department, where patients are seen right away, and going to your family doctor, which can sometimes take up to six weeks to get an appointment. The system will benefit because patients will get the most appropriate care by the most appropriate care provider at the most appropriate time.”

After a year and a half after falling off her horse, Benedict was able to return to school in September on a gradual back-to-school program.