Major head injuries ‘public health crisis’

Concussions too often overlooked by doctors, says UCSF professor

The last thing Sean Sanford remembered, before waking up at San Francisco General Hospital with a terrible headache, was riding his skateboard on a concrete ledge near Glen Park.

“I slipped out,” Sanford said. “I hit my head. I woke up, and I kept repeating myself. I kept asking my wife, ‘What happened?’ ”

Sanford, a 36-year-old San Francisco writer, required surgery for a cracked skull and cranial bleeding. The surgery was successful. And when he left the hospital in February 2017, shortly after the operation, he thought he was all better. He wasn’t.

Eight months later, while study-

“I slipped out, I hit my head. I woke up, and I kept repeating myself. I kept asking my wife, ‘What happened?’ ”

Sean Sanford

ing his college homework assignments in a San Francisco coin-operated laundry and watching his shirts spin around, he suffered a seizure. It’s a complication that Sanford was told might occur.

Such incidents trouble Geoffrey Manley, a professor of neurosurgery at UCSF who co-wrote a study that found too many concussion patients fail to get adequate follow-up treatment, advice and counseling after their injuries.

Many health care professionals believe that concussion patients don’t need or cannot benefit from subsequent visits and treatment. Manley’s study, published last month in the Journal of the American Medical Association Network Open, found just the opposite.

“This is a public health crisis that is being overlooked,” Manley said in an interview. “If physicians did not follow up on patients with diabetes and heart disease, there would be accusations of malpractice. For too many patients, concussion is being treated as a minor injury.”

About 4 million Americans suffer traumatic brain injuries per year. Of the patients in Manley’s study, only 2 in 5 saw a doctor or other medical provider within three months of being injured.

Concussion research has focused on football players and other athletes, Manley said, not on ordinary people who “fall off their bike or slip off their skateboard or down the steps (and) need to be aware of the potential risks of concussion.”

Half of concussion patients are discharged without being warned about possible followup symptoms, red flags and dangers. Such conditions are particularly prevalent among the homeless and the incarcerated. Concussion patients have a greater chance of developing such ailments as Parkinson’s disease and dementia.

“The data just absolutely floored us,” Manley said. “There (is) obviously no organized program of (follow-up) care. Some were seen by general practitioners, and only a small percent were seen by specialists. It’s very disturbing.”

Manley drew parallels between traumatic brain injuries and other diseases, noting that it is important to think of a head injury as an ongoing condition rather than an isolated event.

“If you have a heart attack, you get great care,” he said. “If you have a blood sugar of 400, you’re diagnosed with diabetes. A doctor will follow up with you. With (traumatic

“This is a public health crisis that is being overlooked. If physicians did not follow up on patients with diabetes and heart disease, there would be accusations of malpractice. For too many patients, concussion is being treated as a minor injury.”

Geoffrey Manley, UCSF professor of neurosurgery

head injuries), we have a whole bunch of people out there that when we looked at those that aren’t being seen, they needed to be seen. We have got to do a better job.”

Manley said even though there is no specific drug for brain injury, it’s “not true that there are no treatments — all of the symptoms reported by people in this study have a treatment, whether that’s a headache or sleep disorder. Leaving these people untreated is just not right.

“My hope would be that every person who walks into an emergency department with a head injury is treated the same as a soldier or professional athlete that sustains a blow to the head,” he added. His patient, Sanford, agrees. “I got great care, but my injuries did not end when I left the hospital,” Sanford said. “I had manic depression, gnarly thoughts and short-term memory loss. I needed help.”

He did get back on his skateboard, because, in his words, that’s what a skateboarder does after an accident.

“But now,” he said, “I wear a helmet.”

Photos by Scott Strazzante / The Chronicle Sean Sanford (right), who fell off his skateboard and had a concussion, chats with Dr. Manu Hegde at UCSF.

Sanford, who now wears a helmet when skateboarding, takes it off after, revealing a healing cracked skull. He also suffered cranial bleeding with symptoms that appeared months after the incident.

Photos by Scott Strazzante / The Chronicle Sean Sanford, carrying his skateboard, runs across Third Street to a Muni train platform on his way to a doctor’s appointment after his injury and concussion.

Sanford, a writer who is still recuperating from his concussion, works in his office at Lowcard, a skateboard magazine.