Talk:Post-concussion syndrome/GA1

GA Review

This is a very good article that does a great job of presenting a controversial topic, but it still has one major issue that prevents me from passing it—the prose. Here are a few suggestions for the lead:

• “Post-concussion syndrome, also known as postconcussive syndrome or PCS, is a set of symptoms that a person may experience for weeks, months, or occasionally even years after a concussion; a mild form of traumatic brain injury (TBI).” This sentence is ambiguous; it is unclear whether PCS or concussion is a form of traumatic brain injury.

• Better? delldot on a public computer talk 00:38, 2 June 2008 (UTC)

• "PCS may also occur in moderate and severe TBI." Holy TLA syndrome, starting here and persisting throughout the article. It’s OK to repeat the whole term once in a while, particularly when there are other acronyms close by.

• Done delldot on a public computer talk 00:38, 2 June 2008 (UTC)

• “Symptoms of PCS, the most common entity to be diagnosed after TBI...” —Does this mean “the entity most commonly diagnosed in someone following TBI”, or “the second most common diagnosis after TBI”, as in a “top ten” list of diagnoses in those presenting to a neurology service? :)

• Good catch, is this less ambiguous? delldot on a public computer talk 00:38, 2 June 2008 (UTC)

• “...may occur in 38–80% of mild head injury sufferers.” Per WP:MEDMOS, please avoid wording such as “sufferers” or “patients”. There are many substitutes you could use without sounding repetitive—“people who have sustained mild head injury”, “those with mild head injury”, “38–80% of mild head injury cases”...

• Done delldot on a public computer talk 00:38, 2 June 2008 (UTC)

• “Though there is no treatment for PCS itself, symptoms can be treated with medications and other therapies such as education and physical and behavioral therapy. The majority of PCS cases go away after a period of time.” What sort of education? Education about PCS and its prognosis? You may want to expand on this a little, e.g. “physical symptoms may be treated with medication and physical therapy, and cognitive ones may benefit from behavioral therapy.”

• The suggestion makes sense, but I'd have to find that explicitly in a source to put it in the article. Does the fix I used work? delldot on a public computer talk 00:38, 2 June 2008 (UTC)

I'll add comments on the remainder of the article later. Best, Fvasconcellos (t·c) 00:10, 2 June 2008 (UTC)

Many thanks for the very close attention! Let me know if there are still problems with my fixes. I look forward to seeing your review of the rest of the article! delldot on a public computer talk 00:38, 2 June 2008 (UTC)

Looking good so far, thank you for the prompt responses. Now, for some more! Let's take it from the bottom, with "History" :)

• "The controversy surrounding the cause of PCS was started in 1866 when Erichsen published a paper about persisting symptoms after MTBI." I don't think the term "mild traumatic brain injury" was used in the 1860s. Is it used in the source?
• "The idea of the complex of post-concussion symptoms..." How about "The idea that this set of symptoms forms/constitutes a distinct entity..."? Just a thought.
• "Later, the idea... was suggested by Charcot." Is this Jean-Martin Charcot? I think we have an article on that guy somewhere.. :)

More to come. Don't change the channel! Fvasconcellos (t·c) 15:56, 2 June 2008 (UTC)

done these -- Gurch (talk) 22:36, 2 June 2008 (UTC)

Thanks a ton gurch, you're the best. delldot talk 05:55, 3 June 2008 (UTC)

OK, here we go:

• In "Symptoms":
  • "About 10% of people with PCS are sensitive to noise or light..." Develop sensitivity/become sensitive to noise or light, maybe? Or maybe not, if you think that would make the sentence ambiguous. A piped links to photophobia would be nice.

    Rearranged a little to get the link in --Gurch (talk)

  • "One study found that while sufferers of chronic pain without TBI do report post-concussion symptoms..." How about symptoms similar to those found after a concussion/those of PCS"?

    Changed to something along the lines of the latter --Gurch (talk)

  • "...they report fewer symptoms related to memory, slowed thinking, and sensitivity to noise and light than MTBI sufferers do." No "sufferers", please, and keep "patients" to a minimum :)

    Changed by delldot --Gurch (talk)

• In "Possible causes":
  • "Factors that may cause PPCS may include physiological, psychological, or psychosocial factors..." Why are we starting with PPCS? Wouldn't it be better to lead with a brief discussion of the factors behind symptoms occurring shortly after trauma—after all, their etiology seems far less controversial—and then move on to the complex mix of factors associated with PPCS? "Factors... factors" is redundant.

    Removed the redundant 'factors', haven't done anything else yet --Gurch (talk)

    Rearranged a bit to put the more general info in front. Do you think it actually needs more content, or is this enough? delldot on a public computer talk 00:46, 4 June 2008 (UTC)

    The prose is reading much more clearly now, and I think the content is just fine. Excellent work :) Fvasconcellos (t·c) 01:20, 4 June 2008 (UTC)

  • "...whether symptoms are being exaggerated or feigned, for example for financial gain." Malingering hasn't been discussed yet; I'd drop "for financial gain" altogether and leave it to the later section on malingering.

    Was thinking of doing this before. Removed --Gurch (talk)

  • "Electroencephalograms, while usually normal..." ...usually normal in people with PCS?

    Changed by delldot

  • "The presence of PCS symptoms may be due to a combination of factors, including psychological and physiological ones." Could you... jazz this up a little? As is, it just seems redundant to the introduction of "Possible causes". Sorry for being vague here :)

    I did some rearranging and this sentence ended up very different. Is this ok? delldot on a public computer talk 01:47, 4 June 2008 (UTC)

  • "Proponents of the view that PCS has a physical or organic basis point to findings that concussed people score lower than expected on standardized tests of cognitive function." Wouldn't a decline in cognitive function be expected immediately after a concussion? If the source is talking about a persistent decline in scores, the sentence should be reworded.

    The finding that cognitive scores show deficits (in whatever time frame) is used to support the idea that neurocognitive dysfunction is occurring. Changed the wording, does this fix it? delldot on a public computer talk 02:10, 4 June 2008 (UTC)

  • "Studies have shown that people with PPCS score lower than controls on neuropsychological tests that measure attention, verbal learning, reasoning, and information processing." Would a link to information processing be appropriate here?

    Done, probably by gurch. delldot on a public computer talk 01:47, 4 June 2008 (UTC)

  • "...one study found that cognitive and physical symptoms were not predicted by the adjustment of parents and family members after the injury..." Adjustment?

    Better? delldot on a public computer talk 02:10, 4 June 2008 (UTC)

• In "Psychological":
  • "Symptoms in PCS may be due to psychological or social factors, such as expectations that these symptoms will occur." Again, this seems redundant—I'd much rather have the section start with the sentence that follows ("It has been convincingly shown..."). Do you think you can work "...such as expectations that these symptoms will occur" into another portion of the paragraph?

    Done. [[[user:delldot on a public computer|delldot on a public computer]] talk 05:39, 4 June 2008 (UTC)

  • "Setbacks related to the injury, for example problems with physical, work, or social functioning..." How about Setbacks related to the injury, such as problems with physical or social functioning or [decreased/impaired/altered...] work performance? That would sound better IMHO (if the reference supports it, of course).

    The ref doesn't really specify what kind of setbacks occur at work. Is the slight rewording I did ok? delldot on a public computer talk 06:21, 4 June 2008 (UTC)

• In "Malingering":
  • "Additionally, people with more severe symptoms may be more likely to sue, all other things being equal." Seems obvious, but a reference would be nice :) I've piped a link to ceteris paribus.

    Tough one. I'm not sure I'm going to be able to find this in a ref, I haven't seen it before. An anon added it I think, it might be OR. I think I'll remove it as such but keep looking for a source for it. delldot on a public computer talk 06:21, 4 June 2008 (UTC)

Not done yet... :) Fvasconcellos (t·c) 15:00, 3 June 2008 (UTC)

Brilliant suggestions FV, thanks again for the effort you're putting in to giving this a thorough and thoughtful review. I'll hopefully have time to finish this up at work tonight, if they don't make me work too hard. ;) delldot talk 22:02, 3 June 2008 (UTC)

Thank you for the brilliant improvements to match the suggestions ;) I'll go over the rest of the article more thoroughly tonight (a quick read doesn't show much else needing work) and leave my final comments. Fvasconcellos (t·c) 15:45, 4 June 2008 (UTC)

Section break

OK, final comments:

• Under "Diagnosis":
  • "The ICD-10 first proposed a set of diagnostic criteria for PCS in 1992." This is a nitpick, but the ICD-10 doesn't really propose anything. The WHO may propose a set of diagnostic criteria, or it may be codified in the ICD-10.

    How's established? delldot on a public computer talk 03:09, 5 June 2008 (UTC)

  • Very impressive work on the table, few articles make good use of them.

    *Bows* ;) delldot on a public computer talk 08:57, 5 June 2008 (UTC)

  • Do you think a very brief (single-sentence or even parenthetical) description of the tests named in the last paragraph can be added?

    Is this enough? delldot on a public computer talk 08:57, 5 June 2008 (UTC)

  • "Because of the similarities to other conditions, such as depression, there is a risk that PCS may be misdiagnosed" Hmmm... any condition may be misdiagnosed, and few, if any, could ever be considered so distinctive as to not share characteristics of other diseases :) Do any of the cited sources expand on misdiagnosis, e.g. noting a "significant" risk of misdiagnosis, or that PCS is a "commonly misdiagnosed condition"? I'm basically looking for any qualifier that would assert why this risk is worth noting, and make this a less generic statement.

    I had originally intended this to be a kind of introductory sentence, to bring up the idea of differential diagnosis. Looking at the rest of the paragraph, it seemed redundant so I took it out. Is it too abrupt without it? delldot on a public computer talk 09:39, 5 June 2008 (UTC)

    Added "PCS, which shares symptoms with a variety of other conditions, is highly likely to be misdiagnosed in people with these conditions." delldot on a public computer talk 10:44, 5 June 2008 (UTC)

• In "Treatment":
  • "There is no scientifically established treatment for PCS, so the syndrome is usually not treated, though specific symptoms can be targeted." This is a really circular sentence. How about something really succinct, along the lines of Post-concussion syndrome is usually not treated, though specific symptoms can be addressed; for example...

    Done. delldot on a public computer talk 10:44, 5 June 2008 (UTC)

  • "Though no pharmacological treatments exist especially for PCS, doctors may prescribe medications used for symptoms that also occur in other conditions" Since the next sentences claim that medications should be avoided if possible, how about appending if necessary to "doctors may prescribe..."?

    Done. delldot on a public computer talk 03:09, 5 June 2008 (UTC)

  • "Side effects of medications..." Side effects should link to adverse drug reaction.

    Done. delldot on a public computer talk 03:09, 5 June 2008 (UTC)

  • "About 40% of PCS patients are referred to psychological consultation." Is this too few? A lot? Why are they referred? Is this meant to imply that some patients suffer deficits significant enough to warrant psychological treatment, is it meant to imply that more patients should get psychological support, or is it a simple statement of fact?

    It's a simple statement of fact, just a statistic. I rearranged it a little, does the context help? delldot on a public computer talk 11:20, 5 June 2008 (UTC)

  • "One study found that PCS patients who were coached to return to activities gradually, told what symptoms to expect, and trained how to manage them had a reduction in symptoms compared to a control group of uninjured people." Is my grasp on scientific methodology completely lost at this hour, or should this be a control group of PCS patients who received no such education?

    No, you're not nuts, this is actually a methodological flaw of a lot of PCS studies. Weird, huh? Don't know whether I should take out info from these studies, or maybe make it explicit that these studies have received criticism. delldot on a public computer talk 11:20, 5 June 2008 (UTC)

• In "Prognosis":
  • "Symptoms are largely gone in about half of people with concussion by one month after the injury and about two thirds by three months." How about Symptoms are largely gone in about half of people with concussion one month after the injury, and two thirds of people with minor head trauma are symptom-free within three months.

    Done. delldot on a public computer talk 03:09, 5 June 2008 (UTC)

  • "It is commonly believed that 15% of patients still suffer PCS 12 months after the injury, but this figure may be an overestimate because it is based on people admitted to a hospital." Is this actually commonly believed, e.g. mentioned frequently in the literature/part of neurology "lore"? :) "12 months" could me simply changed to "a year".

    That's exactly right--in fact, the ref I just switched to actually uses the words "clinical lore". Reworded and added a bit of info from new source, year thing done. delldot on a public computer talk 06:12, 5 June 2008 (UTC)

  • "At least in children, the way in which people cope with the injury after it occurs may have more of an impact than factors that existed prior to the injury." How about just The way in which children...?

    Done. delldot on a public computer talk 08:57, 5 June 2008 (UTC)

• Under "Epidemiology":
  • "Since PCS by definition only exists in people who have suffered a head injury, demographics and risk factors are similar to those for head injury; for example, young adults are at higher risk than others for receiving head injury" , and, consequently, of developing PCS?

    Done. delldot on a public computer talk 03:26, 5 June 2008 (UTC)

  • "Clinical research has found higher rates of PCS in children with TBI than in those with injuries to other parts of the body, and that PCS is more common in anxious children." Perhaps change PCS to post-concussion symptoms to avoid ambiguity?

    Done. delldot on a public computer talk 03:26, 5 June 2008 (UTC)

  • "Symptoms in children are similar to those in adults, but children exhibit fewer symptoms than do their adult counterparts." Counterparts seems more than a little awkward here. "PCS is rare in young children." How rare? How young? Rarer than in older children? Any more or less controversial a diagnosis in younger kids? Sorry for the third degree, you don't need to expand this—it would just be nice ;)

    No problem, good suggestions. Fixed the counterparts thing, I'll try to find more on the condition in children tonight. delldot on a public computer talk 13:36, 5 June 2008 (UTC)

Well, that's it. Please don't take it personally if any of the above was inordinately harsh, or unnecessary; I just like to know that I did my best to ensure that a Good Article is actually a good article :) Best, Fvasconcellos (t·c) 02:35, 5 June 2008 (UTC)

Not too harsh at all, everything is very reasonable and on-point. I certainly appreciate yout taking the extra time to do a thorough and high-quality review. I'll work on these and get them done as soon as I can. delldot on a public computer talk 08:57, 5 June 2008 (UTC)

OK, then. Thank you for your willingness to respond to each point, and for the excellent work. Since there is no deadline and no such thing as a perfect article, you may keep continue to improve and expand the article well after I've passed it as a GA—which I have just done. Congratulations, and don't forget to let me know when it's up at FAC ;) Best, Fvasconcellos (t·c) 14:31, 5 June 2008 (UTC)