Alex's Story

“Alex was a varsity football player at our school. He was a tough kid, and a hard-hitting athlete. One Friday during a game, he took a really hard hit from the side. The Athletic Trainer did not directly see the hit, as she was attending to another player who had a concussion. A few minutes later, Alex started acting strangely. When asked what happened, he said he wasn't sure, he just remembered getting hit. Because there had been a string of concussions on the team that season, the Athletic Trainer began asking him questions pertaining to a concussion, but it didn't seem to follow the normal signs or symptoms. Alex also began complaining that his stomach felt upset and painful. By the end of the game, he was no better, and the Athletic Trainer decided to advise his parents to take him to the Emergency Room."

"A couple of days later, the Athletic Trainer was informed that Alex was admitted to the hospital that night with a lacerated liver. The Emergency Room staff had almost missed the diagnosis, also going on the assumption that he was suffering from a bad concussion. They took a Head CT, which was clear. However, because Alex continued to complain of increasing abdominal pain, they decided to do an abdominal CT scan on him as well. Luckily, they saw the laceration of the liver, and were able to surgically repair it. He stayed in the hospital for a few days and was released. Alex was not allowed to play contact sports for 1 full year following this injury."

Discussion Questions:

1. What information was used to make the Athletic Trainer's initial diagnosis?

The Athletic Trainer used The Athletic Trainer used Alex’s symptoms (acting strangely, memory issues, and abdominal pain) and the recent history of concussions on the team to initially suspect a concussion.

2. Having not seen the injury directly, how could the Athletic Trainer have gained more information about Alex's injury?

The Athletic Trainer could have gathered more information by speaking with teammates, coaches, or reviewing game footage to understand the nature of the hit.

3. Why did the Athletic Trainer send Alex to the Emergency Room?

Alex's persistent symptoms, particularly his worsening abdominal pain and atypical concussion symptoms, prompted the Athletic Trainer to advise a hospital visit.

4. Why did the Emergency Room staff decide to do further diagnostic imaging on Alex?

The Emergency Room staff decided to conduct further imaging because Alex's abdominal pain continued to worsen despite a clear Head CT.

5. What do you think could have happened had they not done this additional imaging?

Without the additional imaging, the liver laceration could have gone undiagnosed, leading to internal bleeding and potentially life-threatening complications.

6. What can we learn from Alex's story about looking for abdominal injuries?

Alex’s case highlights the importance of considering abdominal injuries in contact sports, even when head injuries seem more likely, and ensuring thorough medical evaluation for unexplained symptoms.