kids’ hrad cases

Monday, August 30, 2010

According to research that was published by the American Academy of Pediatrics, emergency departments across the country are seeing more kids who have suffered a concussion or head injury. Even though 13% less kids are playing contact sports than 15 years ago, the number of kids with concussions has doubled. It wasn’t just high school athletes, but also kids from 8-13 who were also increasingly at risk.

The numbers are frightening but also need to be taken in context. Today’s awareness of the potential for significant long term complications of repeated concussions that are stacked closely in time, has made, athletes, parents and coaches want immediate medical evaluation of every potential head injury. This drives patients to the ER, where statistics capture their every visit. Often there is a push to perform a CT scan to insure no bleeding or bruising of the brain, even if the athlete is neurologically normal. A normal CT is followed by an equally strong push to allow the athlete to return to play.

The latest return to play guidelines stress that no player return immediately, repeat neurologic evaluation be performed and decisions be made days, not hours, later. The reason is pretty clear .While a CT can evaluate the brain’s structure, it is much harder and takes time and skill to assess its function. Many team doctors use computer testing, for example the IMPACT test program www.impacttest.com , to look for subtle changes in concentration and mood. Otcanhers rely on clinical judgment and neuropsychologic testing to decide who can play and who can’t.

This is a major change from a decade ago. Minor head injuries were evaluated on the sideline by a trainer and based on the prevailing wisdom of the time and supported by guidelines form the American Academy of Neurology, some athletes could return to the field of play almost immediately. Often kids weren’t seen until days later by their family physician or pediatrician and CT scan was not an automatic assumption.

While it is likely concussion rates are increasing because athletes are faster and stronger, even in elementary school, it may be that there has been a cultural shift. The more that parents and coaches read about pro athletes suffering from Alzheimer Disease at a young age because cumulative head injuries, the more they want to protect their kids from that potential. Football, baseball, basketball, soccer and hockey all have an increased risk of putting the head in the way of the action and increase the risk of brain injury.

Concussion can be and easy diagnosis. The athlete gets knocked out on the field, has some amnesia and is slow to get up and going. Concussions can also be subtle and hard to appreciate. The hit to the head may not be recognized wit hno immediate symptoms. Those may occur hours or days later and may be no more than a kid having a hard time concentrating in school, doing homework, having sleep issues or being more irritable at the dinner table. Impressive or not, a minor brain injury needs to be completely resolved before the player can return to play.

Treatment is time and rest, not only for the body but also for the brain. Video games, texting, computers may slow the recovery time and it may be the one time in a teenager’s life that they re encouraged to be a slug. But many high school seasons are short and parents and kids realize that being out two or three weeks may mean missing half a season. Frustration with brain healing may be an important part of the treatment that a doctor, team trainer and coach may offer.

There should be the expectation that emergency department visits will continue to rise for minor head injuries in children. Whether it’s from heads colliding playing ball or falling off a bike (please make your kid wear a helmet), the brain is a prime target for injury. Parents will take the cautious approach and bring them to a doctor. The next step is to appreciate that a normal brain on CT does not equal a normally functioning brain. It take time to heal and, as in most things medical, one cannot rush time.

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