April 28, 2006

Cars and sports leading causes of concussion

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Tom Abramo, M.D., sees patients with concussive injuries in the Pediatric E.D.
Photo by Anne Rayner

Cars and sports leading causes of concussion

Experts at the Emergency Department at the Monroe Carell Jr. Children's Hospital at Vanderbilt say they are seeing more cases of concussion in children than ever before. Springtime is traditionally a time they see an increase in cases of concussion, but the recent higher rates may be a reflection of advanced types of play.

“We have more types of activities that include high rates of speed, potential for collision with cars and aggressive sports,” said Tom Abramo, M.D., medical director of the Pediatric Emergency Department. “The No. 1 cause of concussive brain injury in children is children being hit by a car while walking, or riding a scooter or bicycle. Next, children injure themselves in falls from scooters, bicycles and other types of toy vehicles. Sports injuries are No. 3 on the list and growing.”

“Trauma season,” as doctors call it, extends from April through September, and while all traumatic injuries are serious, head injuries have the highest rate of lasting complications. That's why emergency physicians are saying trauma season should be synonymous with “helmet season.” Children should wear helmets if they are playing on a toy or vehicle that gets them going faster than they can run, or makes it easier for them to fall or stop suddenly. Any sport that involves the potential for head injury should also utilize helmets.

“That means that goalies in soccer need to wear a helmet, and baseball and football helmets need to be mandatory gear,” Abramo said.

Some sports, like skiing, have not made traditional use of helmets, but that may be changing.

Jan Overton was discussing that trend with her 15-year-old son, Will, before the family's annual snow skiing trip during spring break. Despite Jan Overton's encouragement to consider using a helmet, her son wanted to be like most young skiers, including his friends, and go helmetless. That turned out to be a mistake on this particular trip.

“He skied off a boulder and landed on his face; cracked his goggles,” she said.” He's a responsible young man, and usually checks jumps before he does them, but this one he hadn't checked and it was a 10-foot drop.”

Will was able to ski the rest of the way down the mountain, but he began to experience serious headaches, and within two days he knew something was seriously wrong.

“He began to experience dizziness and his memory was fuzzy. He found he couldn't remember what had happened the night before the accident,” Jan said.

The family brought Will to the Pediatric Emergency Department where he was diagnosed with a concussion. He was seen by neurologic experts and had his balance and memory carefully tested. Luckily, Will's symptoms disappeared after about two weeks.

“It was a scary thing,” Jan Overton said. “He knows how serious it could have been. He's back to playing soccer now, but he won't be heading the ball for a while, and next time he skis, he will have a helmet on.”

“When a child sustains a concussion, it means they have shaken or hit their head hard enough to bruise the tissues inside the skull causing bleeding into and around the brain,” Abramo said.

“There are hallmark signs parents need to watch out for, first immediately after the injury, and then later in the day.”

Signs include:

• Loss of consciousness

• Vomiting

• Amnesia

• Vision problems

• Change in other senses

• Feeling “dazed” or hazy

• Headache that doesn't go away

• Balance problems

• Seizures

• Shaking or tremors

• Change in muscle tone, weakness

If your child has any of these signs, they should be seen by a doctor right away.

“Parents need to know that there is no such thing as a 'simple' concussion,” Abramo said. “There can be long term problems that can last years or more. While it is important to treat a child soon after a head injury, the best medicine is precautionary.”