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Articles Tagged with traumatic brain injury

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child-playingChildren and teenagers are prone to traumatic brain injuries (TBI). Over a million of them check in an emergency room in the US for a non fatal Traumatic Brain Injury every year. A recent study conducted by researchers under the lead of Bina Ali for the nonprofit Pacific Institute for Research and Evaluation  looked at the causes of these injuries.  To do so the researchers used data from the National Electronic Injury Surveillance System. They  found that between 2010 and 2013 more than 4 million children were diagnosed by emergency room doctors for non fatal TBI.

Among the different categories of ages, those the most prone to suffer TBI were among the youngest and among the oldest. 1,085,680 children between the age of 1 and 4  and 1,107,463 teenagers between 15 and 19 year old were diagnosed with TBI during the period under review.

The causes of  TBI vary depending on the age of the child. Almost 3 quarters of TBIs suffered by  toddlers were related to home fixtures, furniture and structures.  Falling from chairs and beds were the most common furniture related accidents while tripping on the floor or falling down the stairs caused the most TBIs related to home fixtures and structures.

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traumatic-brain-injury-picture-1A concussion is a traumatic brain injury that affects the brain function. It is diagnosed quite frequently among children however its diagnosis remains challenging. Doctors often rely on symptoms and historical factors.

A recent study published by the “Minds Matter Concussion Program at the Children’s Hospital of Philadelphia” found that the Visio-Vestibular Examination is an easy and useful tool to distinguish to concussed from not concussed children following a head injury. The exam can also be conducted outside of the Emergency Department setting.

The Visio-Vestibular Examination (VVE) is a series of examinations that determine if the patient has some degree of visio-vestibular deficit such as impaired eye movements and pupil response. The following examinations are being done:

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traumatic-brain-injury-picture-1According to a new study on traumatic brain injury, most victims of mild TBI suffer sleep-wake disturbance and fatigue that can last up to one year or more. For most of them, these problems resolve over time but for some, they persist and become chronic. The study was done in Norway by Simen Berg Saksvik, Migle Karaliute, Håvard Kallestad, Turid Follestad, Robert Asarnow, Anne Vik, Asta Kristine Håberg, Toril Skandsen and Alexander Olse. It was published last month in the Journal of Neurotrauma.

The researchers. compared the sleep quality and fatigue of a sample of patients suffering from mild traumatic injury with a sample of patients suffering from orthopedic trauma and with another sample of regular people from the community not suffering any trauma. Every TBI patient was matched with a patient suffering orthopedic trauma of same age, sex and education and a community person of same age and sex.

Each patient with TBI went through a clinical MRI and was subjected to an interview related to injury characteristics, demography and premorbid health problems. The patients then went through another round of interviews and questionnaires 2 weeks, 3 months and 12 months after the date of the injury. Patients with orthopedic trauma were submitted to similar interviews and questionnaires and non-injured matched people from the community took the 2 weeks, 3 months and 12 months interview and questionnaire.

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skeleton athleteWhile there has been a lot of media and medical attention in regards to traumatic brain injury related to football boxing or other contact sports, there are other sports that have a high risk of TBI.

A recent article in the New York Times looks at traumatic brain injury caused by skeleton, the headfirst Olympic sledding sport. Skeleton is very popular in Canada. In 2010 when Canada hosted the Olympic games, skeleton athletes thought they had a great advantage as they had early access to the track and could train for unlimited time.  Instead many of them are still suffering from the long term consequences of  traumatic brain injuries caused by over training.

Mellissa Hollingsworth was one of the favorite skeleton competitors this year. She recalls taking as many as 11 runs a day on the Whistler track that was specifically built for the Olympic games and was the fastest in the word. At the end of a training day, her brain was scrambled. She could not tolerate noises and she could barely speak. At the time, skeleton athletes were experiencing mental fog, headache, speech inability, loss of appetite and high sensibility to sound. They thought it was part of the training routine like sore muscles or fatigue and just casually called it “sled head”. Now years later they are still suffering from the consequences of over training, repetitive shaking and crashing head first on icy surfaces.

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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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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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