Raising the bar for brain injury awareness

Head injuries are commonly classified as mild, moderate, or severe based on their impact on brain function. Yet even injuries labelled “mild” can have significant long-term consequences, which are often misunderstood in clinical, workplace, and sporting environments.

The Australian Institute of Health and Welfare published in 2020–21 that head injuries resulted in 406,000 emergency department (ED) presentations, 142,000 hospitalisations, and 2,400 deaths. These head injuries accounted for 21 per cent of all injury ED presentations, 25 per cent of all injury hospitalisations, and 17 per cent of all injury deaths. Despite increasing awareness, concussions and mild traumatic brain injuries remain underreported and poorly recognised. Many people never present to hospitals at all, meaning official numbers likely underestimate the true scale. Of the injuries that were reported in 2021–22:

• 17,700 ED presentations were for concussion
• 10,800 resulted in hospitalisation

Falls were the leading cause of concussion hospitalisation, followed by motor vehicle and bicycle accidents, as shown below.

(Table 1) Number of concussion hospitalisations, by cause and sex, Australia, 2021–22

Yet even as ED presentations increase (graph 2), average hospital stay durations for concussions have decreased (graph 3). While this may reflect improved triage and management, it also raises the question of whether shorter admissions risk prematurely discharging patients without appropriate follow-up.

VIEW ALL

(Graph 2) Age-standardised rates of concussion ED presentations, by sex, Australia, 2014–15 to 2021–22

(Graph 3) Age-standardised rates of concussion hospitalisations, by sex, Australia, 2012–13 to 2021–22

In recent years, there have been advancements in research, resulting in Concussion Guidelines in sport and the ANZ Concussion Guidelines for clinical practice (“guidelines”). The ANZ Concussion Guidelines have identified that 20–50 per cent of people with concussions experience ongoing problems that can last months or years after their injury. This is a striking statistic, and one with serious implications for return-to-work decisions, schooling, workplace safety obligations, and potential liability.

The guidelines for clinical practice provide practical guidance on the assessment and management of concussions, including long-term management of persistent symptoms. It addresses managing common symptoms such as cognitive difficulties, fatigue, headaches, and balance problems. It also provides guidance on returning to work/school, sport, and driving. It is anticipated that these guidelines will support doctors in delivering more proactive care and advice, while also helping them identify when to refer patients to specialist services for timely and appropriate treatment and rehabilitation to help improve outcomes.

The guidelines outline several key recommendations designed to strengthen recovery outcomes. Early intervention remains central, with timely recognition of concussion, immediate removal from play, and clear patient education. The guidelines endorse a graded return to activity and outline that optimal management requires a multidisciplinary approach, involving general practitioners, physiotherapists, psychologists, and occupational therapists in the coordinated care of individuals experiencing persistent post-concussion symptoms.

The guidelines will help ensure that concussions are recognised early and acted on promptly, giving individuals the best chance at a timely recovery. This is welcome progress. But there is still a gap between guidelines and real-world practice. There is an opportunity here for industry leaders to push for more consistency in concussion management, better early intervention systems, and more education across workplaces, schools, and sporting institutions.

For personal injury lawyers advocating for those who have sustained brain injuries and, in particular, concussions, this data should prompt closer attention to the client’s symptoms and medical records. Concussion injuries can still be underestimated or inconsistent in how they are managed and recorded, which can create challenges later in the claims process. Ensuring clients’ symptoms are clearly and accurately relayed to medical professionals at the early stages of a claim helps give clients the best opportunity to access timely intervention, support their recovery, and improve longer-term outcomes.

Brain Injury Awareness Month provides that much-needed reminder about advocating for improved concussion care and support for those affected. By raising awareness, we can help ensure that individuals receive timely, evidence-based care and the right education around brain injuries, including concussions, to assist in achieving better outcomes. With the right systems, these brain injuries can be better recognised, better supported, and better prevented.

Nickelle Morris is a partner of Travis Schultz & Partners.