Head trauma accounts as one of most common injuries and the leading cause of mortality among pediatric population [CDC]. The seriousness of identifying clinically-important Traumatic Brain Injury (ci-TBI) following head trauma necessitates the use of Computerized Tomography (CT) scan. Currently, CT scans are used as reference standard of diagnostic modality. This imaging modality is highly sensitive in diagnosing intracranial injuries and classifying patients needing neurosurgical intervention. The neurological manifestations following head trauma range from loss of consciousness to life-threatening injuries. The American Academy of Pediatrics (AAP) identifies Minor Head Injury (MHI) in otherwise healthy children more than 2 years of age as
normal mental status with no focal neurologic or clinical signs of skull fracture at initial evaluation [Alharty]. About 40–60% of children with head trauma present with Glasgow Coma scale 14-15, recognized as minor head trauma [Schutzman], however, only 10 % of this population shows TBI on neuro-imaging. Moreover, less than 1% of these patients suffer intracranial injuries that require neurosurgical intervention [Klassen]. Since the clinical presentation after a head trauma is not reliable and varies significantly in pediatric population, an upward trend in the use of CT scans has been observed [Simon]. This, further, questions its requirement in pediatric minor head trauma patients that infrequently presents with ci-TBI. In an attempt to solidify guidelines for patients who require neuro-imaging following minor head trauma, clinical decision rules (CDR) have been made worldwide. Of those, the most reliable CDR is The Pediatric Emergency Care Applied Research Network (PECARN) [Kupperman]. Several studies have been conducted to report the practicality of scanning pediatric population for ci-TBI with minor head trauma. The PECARN being highly consistent, however, has not been externally validated till date. In addition to the high cost and use of unnecessary resources for imaging studies, children exposed to ionizing radiation have increased risk of radiation-induced damage. Most importantly, these patients can develop malignancies such as brain tumors and leukemia as a long-term sequel [Brenner]. Therefore, it is important for physicians to identify the risks and benefits of CT imaging in minor head trauma pediatric populations and thus avoiding the unnecessary scanning of these patients. The evidence of high variability in current data has led to the conduction of multi-center studies to validate PECARN guidelines. Our institution performed a retrospective chart review to determine the change in practice of performing head CT to diagnose ciTBI after publication of the PECARN guidelines.
Picture yourself with a brand new child, Holding it in your arms, comforting it, and putting it back to rest in its crib. Then you go about your day at home when all of a sudden the baby starts to cry very loud and doesn't stop. You start getting frustrated so you walk to where the baby is at and start to shake it so it will be quiet. After about ten seconds it calms down, and then falls asleep again. The baby doesn't cry again for a long time so you go back to check on it about two hours later. You notice the baby isn't moving, breathing, or showing any signs of life. What you don't know is that you just committed a murder called Shaken Baby Syndrome. Another term that is close to Shaken Baby Syndrome that I will be discussing in my paper is Abusive Head Trauma.
A. Background In recent years, there has been an increase in research investigating the long-term effects of repeated head trauma on the brain, especially in athletes. Following his discovery of chronic traumatic encephalopathy (CTE), Dr. Bennet Omalu inspired a movement of research aimed at establishing better safety standards and protocols in football. It was not until 2002 that the initial connection between repetitive head trauma, such as concussions, and brain injury was suspected (Ott, 2015). As common as concussions were during the late 1970s and 1980s, they were often swept under the rug, as they were seen as insignificant injuries.
Did you know, that someone suffers from a brain injury every 21 seconds (Haas)? Children get concussions all the time, and most of the time they go unnoticed. The majority of concussions happen when one is playing a sport such as football, hockey, or lacrosse. Many famous athletes have had their careers, even their lives cut short due to concussions. Brain damage and death can result from serial concussions (Schafer). When one suffers from a concussion, one’s brain needs time to recover physically and mentally. Between 2002 and 2006, statistics showed that 52,000 people died from concussions and about 275,000 were hospitalized (Fundukian). Everyone’s recovery process is different (“Injury and Pain Care”). Although concussions seem minor, they are very serious brain injuries that may result in severe damage to one’s brain.
Thesis: Concussions affect children and adults of all ages causing physical, emotional and metal trauma to a person and their brain.
Yates, Keith, et al. “Longitudinal Trajectories of Postconcussive Symptoms in Children With Mild Traumatic Brain Injuries and Their Relationship to Acute Clinical Status.” Pediatrics. 123.3 (2009) : 735-743. Web. 11 Apr. 2014.
Scientific American 306.2 (2012): 66-71. Print. The. Brady, Erik. “Changing the Game on Youth Concussions.”
Traumatic brain injury or TBI occurs when a child has a head injury that causes damage to the brain. These injuries can be caused from being hit in the head or violently shaken. The results of TBI can change how a person’s brain develops, how they act, move, and think. It can also affect how they learn in school (NICHCY, 2012). TBI can affect the way a child thinks, retains information, attention span, behavior, speech, physical activities (which includes walking), and the way a child learns.
The year was 2006. There was a mid-season game between the Philadelphia Eagles and the New Orleans Saints going on. Saints rookie running back Reggie Bush lined up in the backfield in preparation for the next play. The quarterback hiked the ball and threw a screen pass to Reggie; he did not see Philadelphia Eagles cornerback Sheldon Brown coming right toward him. The hit left Reggie stunned and he quickly got up and fell right back down (normally a sign of a major concussion). But the problem is not just occurring with current NFL players. Former players have not received the protection they deserve either. Lets look at former four-time Super Bowl champion, Mike Webster, a nine time Pro-Bowler. Mike played center for the Pittsburg Steelers.
The majority of teens who had encounter a concussion are due to sports. A concussion is a pathophysiological process that impacts the brain, typically caused by a trauma to the brain. Concussions are mainly caused by bumps, falls which makes the head move rapidly back and forth, or by a jolt. The brain is a 3 pound organ floating inside the skull. It’s surrounded by a cerebrospinal fluid, which shocks when its impacted. When the brains starts to move rapidly inside the skull, a concussion has taken place. One common cause is a direct hit to the head. The force makes the brain hit the inside of the skull. When the brain starts to slow down, it hits the other side of the inner skull. The other common scenario is a rotational concussion. This happens when the brain rotates from one side to another. As a result, the brain tissues are strained and sheared. In both cases, fragile neural pathways can be damaged, creating neurological disruption. Scientists suggest if an athlete has already experienced a concussion before, they’re 1-2 times more likely to have a second; 2-4 to have a third; and 3-9 to have a fourth. Surprisingly, research has shown females are more likely to have a concussion, and experience more symptoms compared to males. In addition, women take longer to recover than men. Concussions have shortterm and longterm consequences, or in some cases death.
Phineas Gage, a 25 year old construction worker is known as one of the most famous patients that suffered from a traumatic brain injury. While working at a railroad site, an iron tamping rod (43 inches long, 1.25 diameter) went through his left cheek, through his brain, and out the skull. He surprisingly ended up surviving this traumatic injury. After a month in the hospital, he was back out on the street. Once a nice, caring person, Phineas turned into an aggressive man who could not even keep a job. Just like Phineas Gage, a TBI can potentially change everything. Brain studies on traumatic brain injuries are increasing every year. Even though the brain is very functional, brain injuries can have many physical, emotional, social, and economical effects.
Concussions has been a major topic working in Neurosciences. Many high school athletes do not recognize the signs and symptoms of concussion and fail to report symptoms to a coach because the athlete didn’t realize they were experiencing signs of a concussion. At my facility there has been an increase in admissions with young adults that have suffered one or more concussions. In my opinion, it is part of the nurse’s role to educate the patient and their family about how to prevent concussions. There’s also not enough education in the schools about concussion prevention. The practice issue is that young adults do not receive enough education about concussions therefore athletes are returning to play to soon. Research supports that with
Over 1.7 million traumatic brain injuries are reported each year. According to reports the leading cause of brain injuries are from falls followed by motor vehicle accidents, and accidents that were a result of being struck by something. Falls account for 32.5% of traumatic brain injuries in the United States. 50% of all child brain injuries are from falling. 61 % of all traumatic brain injuries among adults are 65 years old or older. Traumatic brain injuries are very violent blows or jolts to the head or body that result in the penetration of the skull. Mild traumatic brain injuries can cause brief dysfunction of the brain cells. Serious brain injuries can cause bleeding, bruising, physical damage to other parts of the body and torn tissues. Brain injuries are more prevalent with males rather than females. Causes of brain injuries include:
Much attention has been given lately to the effect of heading the soccer ball in youth soccer. Some people say it causes major brain damage later in life. Other people say that there are no major injuries from the ball, it is the collisions between players that causes injuries. I belive heading the ball causes injuries and it should be banned from youth soccer. Heading is seen as dangerous and kids are still growing and developing and shouldn't have to have head trauma at such a young age. Another reason to disallow heading in youth soccer is that the skill is improperly taught, or not taught at all, to many kids who participate in this sport.
Stocchetti, N., Pagan, F., Calappi, E., Canavesi, K., Beretta, L., Citerio, G., … Colombo, A., (2004). Inaccurate early assessment of neurological severity in head injury. Journal of Neurotrauma, 21(9), 1131-1140. doi:10.1089/neu.2004.21.1131
Head trauma is a generalized group of injuries that are inflicted upon the brain by an amount of force from a collision, often by a car accident, or an intrusion of the skull and/or brain. The name ‘head trauma’ is often used as a blanket term for multiple types of brain injuries that can be detrimental to a human's development and current life, such as concussions, contusions, and multiple other force-related head injuries. Technology adapts in order to understand how the brain works under these circumstances, and we as humans create new and more advanced machines and medicine to combat the effects of head trauma. This new technology aids the human race in our quest to both combat and to understand head trauma, as well as help us understand how it can affect our society.