BehindTheMedspeak: Never let a person with a head injury fall asleep — myth or fact?

Anahad O'Connor's "Really?" column in the November 15, 2005 New York Times Science section looked into the commonly–held belief that you should never let a person with a head injury fall asleep.

Here's what he wrote:

The Facts: Right after a person suffers a potentially serious head injury, those around him often try to force him to stay awake, assuming that being awake will lower the risk of a coma, or worse.

But experts say that like most old wives' tales that belief is rooted in a misconception.

Dr. Philip Stieg, the chairman of neurosurgery at NewYork-Presbyterian/Weill Cornell hospital, said the fear stemmed from a phenomenon known as the lucid interval, in which a person seems coherent shortly after being knocked out but later slips into a coma and dies.

That rarely happens.

A study this year in the journal Pediatrics looked at 314 children in Pennsylvania who were examined after suffering head injuries that later turned fatal.

It found that only 2 percent had been declared lucid by doctors before they died.

Five of those six, the researchers found, were infants whose skills were probably not developed enough to be assessed accurately.



A good rule, Dr. Stieg said, is that unconsciousness is serious.

When someone is knocked out and then comes to and seems drowsy, sleep is immaterial, he said.

Then, only medical attention can make a difference.

The Bottom Line: Trying to keep a person with a serious head injury awake does not help.

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Huh.

You would think that a neurosurgical anesthesiologist — namely, moi — would know the answer to the question posed by O'Connor.

But I must confess that my instinct with an individual who'd sustained a head injury or anything that altered consciousness would be to try and prevent the person from lapsing into unconsciousness before I could get them to an emergency room.

I recall the old story about Cher walking her then–boyfriend, soon–to–be–husband Gregg Allman around after one of his drug overdoses, trying to keep him from lapsing into a coma.

I'm with Cher.