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Articles Posted in Traumatic Brain Injury

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child-head-injuy-1Because young children can’t express themselves proprely it can be challenging for doctors to diagnose a traumatic brain injury or concussion.  A recent article published in Pediatric Emergency Care suggests that using previous “Characteristics of Diagnosed Concussions in Children Aged 0 to 4 Years Presenting to a Large Pediatric Healthcare Network” might be helpful. The study was authored by Podolak, Olivia E. MD*; Chaudhary, Sofia MD*,†; Haarbauer-Krupa, Juliet PhD‡; Metzger, Kristina B. PhD, MPH*; Curry, Allison E. PhD, MPH*,†; Kessler, Ronni S. MEd*; Pfeiffer, Melissa R. MPH*; Breiding, Matthew J. PhD‡; Master, Christina L. MD, CAQSM, FACSM*,§,∥; Arbogast, Kristy B. PhD*,†,§ (Click here For author Information)

The researchers analyzed the medical data of 329 young patients aged 0 to 4 who visited the Children’s Hospital of Philadelphia healthcare network from October 1, 2013, to September 30, 2015 . They identified  the 3 top common mechanisms of injury.

The first one was fall and represented 64.4 % of all young patients who were diagnosed with a concussion with children younger than 2 year old being at a higher risk of sustaining a concussion in a fall than children from 2 to 4 year old.  Falling from furniture was the most common type of fall leading to traumatic brain injury, followed by tripping and hitting the ground and falling down the stairs.

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child head injuryWhen a child sustains head injury, parents always worry about the risk of traumatic brain injury and now more than ever seek medical advice through telephone triage call systems. When parents call such systems, they will be connected to a triage nurse who will provide them with recommendations on what to do next. However the question is, how parents follow up on these recommendations. A recent study  by Catherine C. McDonald, PhD, RN, FAANorcid, Melissa R. Pfeiffer, MPH, Roni L. Robinson, MSN, RN, CRNP, Kristy B. Arbogast, PhD, Christina L. Master, MD, FAAP, CAQSM published in Clinical Nursing Research, tried to determine if parents follow recommendations and what percentage of the phone calls result in a TBI diagnostic.  They especially wanted to know if parents who had been recommended to see a doctor because a traumatic brain injury was suspected, would indeed do it.

84.1% of parents follow phone recommendations to seek medical care for their child’s head injury

The researchers analyzed one year of pediatric head injury calls at the Barton Schmitt Pediatric Head Injury Telephone Triage Protocol. Among the 5,045 phone calls for patients ages 17 and younger and meeting the criteria for the study, they found 2, 464 calls during which the triage nurse recommended to seek medical care urgently or in the next 24 hours. They estimated that in 84.1% of cases parents followed the recommendations provided on the phone and brought their children for an urgent medical consultation at their medical home network or at an outside care facility. Among those children who were recommended to seek urgent care, 39.5% were diagnosed with traumatic brain injury.

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crying babyChildren and adolescents are prone to traumatic brain injuries (TBI). Among the 1.7 million patients diagnosed every year with TBI in the US, 700,000 are children below 19 year old. A recent study by Bina Ali, Bruce A Lawreence, Ted Miller from the Pacific Institute for Research and Evaluation and Jennifer Allision from Health Imperative in Brockton, MA that was recently published in the Official Research Journal of the International Brain Injury Association (IBIA) investigate leading consumer products and activities that can cause children and adolescents to suffer traumatic brain injury.

By analyzing data from from the National Electronic Injury Surveillance System from 2010 to 2013, the searchers found that home furnishings and fixtures as well as sports and recreation products were the products most commonly associated with accidents causing TBI. Beds, stairs, floors and footballs are among the most dangerous products for children and teenager.

Toddlers and older teens most at risk of a TBI

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Donna Sturm was killed by a cyclistDonna Sturm, a pedestrian who suffered traumatic brain injury after being struck by a bicyclist in midtown Manhattan almost two weeks ago died from her injuries over the week-end. Donna was left in a coma since the accident that occurred on April 24 around 1:00 pm. The 67 year old woman was coming back from lunch and was crossing 57th Street between Fifth and Sixth Avenues when  a bicyclist identified as 40-year old Damian Dewart recklessly ran the red light and struck her. (see our previous blog for more details on the accident)

Our managing partner, New York Personal Injury Attorney Ben Rubinowitz who is representing the family of  Donna Sturm  issued the following statement on behalf of the family:

Donna Sturm was a vibrant, energetic and wonderful woman who died as a result of carelessness and negligence.

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West 57th street between 5th and 6rth AveA pedestrian suffered a traumatic brain injury  after being struck by a cyclist in Manhattan last week. 67 year old Dona Sturm just had lunch and she was crossing west 57th Street between Fifth and Sixth Avenues around 1pm when the accident occurred. As Dona was in the crosswalk, a cyclist blew the red light and collided with her. The impact was so intense that both of them fell on the ground. The cyclist was ok but the woman was lying on the ground with a bleeding skull fracture. She was rushed to the hospital and was diagnosed with traumatic brain injury. She is now in stable condition according to her husband.

The cyclist, 40 year old Damian Dewart stayed at the scene of the accident. He told the police that his brakes were not working proprely. The police gave him a ticket for a red light violation. In the days following the accident, the police were seen cracking down on cyclists in the area. 57th street is a very busy street in Midtown Manhattan and people working in the area have been complaining about cyclists zipping dangerously between pedestrians.

In a statement the employer of Dona Sturm wrote : “All of us who live or work in New York City do so at our peril because of bike riders speeding through intersections and often going against traffic on one-way streets. Bicycles should have a license plate to create accountability for the riders. We pray that Donna will fully recover from this tragedy.”

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accident sceneThe cyclist struck by a drunk and unlicensed driver in New York last Sunday is still in a coma. 55-year-old Nancy Pease was part of a group of 6,000 cyclists who were participating in the “NYC Century bike tour” organized by Transportation Alternatives. Nancy and a group of around 25 cyclists were waiting at a red light at 12th Ave and 39th Street in Borough Park, Brooklyn, when a minivan plowed into them. Several bicyclists were injured. Among them, Nancy who disappeared under the minivan as the driver literally drove over her.

The driver, 39-year-old Antonio Pina, was highly intoxicated. According to the police who arrested him he had a blood alcohol level of .287, three times the legal limit. Pina also told the police he didn’t have a driver’s license. He had been drinking margaritas and Coors light before driving his van. Witnesses saw him getting out of his parking space and crashing into another vehicle before accelerating and intentionally plowing into the group of cyclists. After he ran over the woman he got out of his car with bloodshot eyes and a disheveled appearance. As the police took him away he stuck his tongue out of his mouth looking crazy.

The FDNY had to remove Nancy Pease from under the van (see video below). Pease suffered serious physical injuries including a lacerated liver, abdominal bleeding and a traumatic brain injury. She had to undergo surgery and her spleen was removed. She is still in a coma according to the most recent news from the New York Post. A few other bicyclists also suffered injuries during the   accident.  They were treated for minor injuries at the scene of the accident and declined to go to the hospital.

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children at campConcussion is one of the most commonly sustained injuries by children and teenagers when they are at camp.  Therefore it is important that camps not only have specific requirements and guidelines to prevent traumatic brain injuries but also have a medical staff that is trained to recognize and treat concussions.

In regards to prevention, camps should always make sure that children wear proper helmets for activities involving motorized vehicles as well as activities such as skate boarding and skating.  Helmets also have to be mandatory when kids are involved in adventure activities such as climbing, spelunking or zip lining.  Children should also wear a helmet when bike riding as well as when horseback riding including pony riding.

Despite actively preventing concussions, accidents still happen and the camp medical team has to be ready.  The camp medical staff has to be able to recognize and evaluate a concussion sustained by a camp goer.  After  the camp clinician properly evaluates the young patient, he will have to communicate not only with the child but also with the parents to assure a proper recovery.

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 Electronic Health RecordThe Children’s Hospital of Philadelphia (CHOP)  released a study on Monday that looked at 14,527 traumatic brain injury-related primary care office visits for 7284 unique patients over a period of 4 years. They found out that after physicians used a concussion management tool provided to them through the Electronic Health Records (EHR) of their patients, they perform better diagnosis and treatment. 

82% of children suffering from concussion visit a primary care physician rather than a specialist to be treated. In the study, the researchers from the Children’s Hospital of Philadelphia (CHOP) found that many primary care physicians  then refer their young patients to specialists because they feel they are not properly equipped to manage Traumatic Brain Injury cases.

With the input of the primary care physicians, the researchers developed an electronic template guiding the physician through a step by step approach for diagnosis, treatment and follow-up of young patients suffering from concussion injuries. The electronic tool was integrated in the Electronic Health Record of the patient. The tool provided physicians with a “concussion Smartset” allowing them to document the evolution of the patient. Physicians were trained to used the tool at various seminars organized by CHOP researchers.

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young driverPeople who are driving after recovering from a concussion may be at higher risk of a car accident. A recent study lead by Julianne Schmidt, associate professor in the UGA College of Education’s department of kinesiology shows that despite being asymptomatic, people who recently suffered concussion may drive erratically. The study was recently published in the Journal of Neurotrauma.

During the study, Julianne Schmidt and her team compared the driving skills of 14 students who suffered concussion but were symptom free with the driving skills of 14 students who didn’t suffer from concussion. Participants were required to to complete a graded symptom checklist and a neuropsychological exam. Participants with concussion were asked to take a 20.5 km driving test within 48 hours of becoming asymptomatic. Healthy participants of the same age were required to complete the same driving test.

The study showed that participants who previously suffered concussion but were cleared of symptoms exhibited driving behavior similar to someone driving under the influence of alcohol.  The researchers compared the number of crashes between the two groups of students as well as the number of tickets, the number of lane excursion, the way they were driving in curves and their speed. They found out that concussed participants were not well controlling their vehicles especially when driving in the curves. They also swerved a lot more than healthy drivers putting themselves and other road users at a greater risk of accidents.

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NFL Brain Injury   The Radiological Society of North America reports that a study published in the journal of radiology found measurable changes in the brains of children after one season of participating in youth football without a diagnosis of a concussion. Christopher T. Whitlow, M.D., Ph.D., M.H.A., associate professor and chief of neuroradiology at Wake Forest School of Medicine in Winston-Salem, N.C., the lead author of the study stated “We wanted to see if cumulative sub-concussive head impacts have any effects on the developing brain.” 25 male football players between 8 and 13 years old were studied. The Head Impact Telemetry System (HITs) was used to record head impact data. Participants in the study underwent pre- and post-season evaluation with multimodal neuroimaging, including diffusion tensor imaging (DTI) of the brain. DTI is an advanced MRI technique, which identifies microstructural changes in the brain’s white matter. Diffusion tensor imaging measures what is known as fractional anisotropy (FA), of the movement of water molecules in the brain and along axons. Dr. Whitlow stated that the participants in the study “…who experienced more cumulative head impact exposure had more changes in brain white matter, specifically decreased FA, in specific parts of the brain.” He stated further research is needed to determine the significance of these findings. Read the RSNA Press release here.

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