Wednesday, November 26, 2014

How Doughnuts Can Save Injured Kids



On Saturday November 15, we ran the 6th annual Matthew Gfeller Memorial Doughnut Run. It was a freezing cold day, about 30 degrees by race time at 9:00 a.m., but we had a great turn out. We had 790 runners; a little less than last year, but given the weather, we did very well. We had bright sunshine and lots of fun with family, friends and supporters. We had the Boy Scout troop that Matt belonged to attend. The band from R.J. Reynolds High School also was there to sing the National Anthem and the Alma Mater. NBC media personality Kenny Beck was our emcee and Benji Jones Racing Company this year helped us put on the event.

Most of the runners are families. You see multi-generations; grandparents, parents, kids, dogs, strollers, and a lot of friends. Friends running with friends. We had family members there from Virginia and Oklahoma. Our kids, Robbie and Haley, came home and they brought some friends to run. It was just a successful event.

The most important thing about the event is keeping the spirit of Matthew alive. Matt was fun-loving. He loved Krispy Kreme doughnuts. His friends, Camden, John and Thomas, invented the run and actually John and Camden, who are both seniors in college, attended the event this year. That's what Matt would have been, a senior in college. Those two guys joined us on stage when we delivered all the running awards and all the wonderful raffle prizes that our sponsors gave us.

The proceeds from the race are divided evenly between the Childress Institute for Pediatric Trauma and Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at UNC Chapel Hill. We're hoping that the proceeds will be greater than last year. Last year, each organization received $21,000 to go to research, education, and outreach. This year, we're hoping it will be a little north of that. We are already debriefing about this year’s event and planning for 2015. Maybe we will run it earlier in the year so it's not as cold! I want to thank everybody who came and of course, all of our sponsors and we look forward to next year.
The money donated to the Gfeller Center has funded a Ph.D. student for a year and they will work on one project that's related to traumatic brain injury in sports. Sometimes that's associated with an NCAA study. Sometimes that's been associated with a local Chapel Hill high school study and it really depends on what Dr. Guskiewicz and Dr. Mihalik have on the docket for the next year.

At the Childress Institute, the money received from the race has been used to continue The Childress Institute's investment in the multi-year study that was the KIDS study and is now the iTAKL study that measures head impacts in youth football players. It goes to purchase equipment that's needed for the on-field study with the kids. It's also helped to fund the athletic trainer along the way. Knowing that Dr. Stitzel, Powers, Maldjian, and Whitlow will continue the study through 2019, gives us confidence that the money donated to The Childress Institute from the Matt Gfeller Doughnut Run is doing good work. We know Matt is smiling on us for all the good work the run accomplishes.

- Bob Gfeller, Executive Director of the Childress Institute for Pediatric Trauma

Wednesday, November 19, 2014

Kids and Cars by Dr. Meredith


Motor vehicle crashes are the number one cause of death from injury in children. It’s more than 50 percent of all pediatric trauma injuries, according to the Centers for Disease Control and Prevention.

The number of deaths spike sharply as kids approach getting their driver's license. There's a great deal we can do in terms of preventing deaths and injuries. Those prevention strategies include driver's license strategies, drinking and driving strategies, automobile design and safety strategies, all of which have been effective and need to significant resources investments to continue and improve.

It is safer on our highways than it's ever been before. Per vehicle mile driven there are fewer deaths both in children and in everyone else. Nonetheless, it will be a long, long time before we eliminate motor vehicle crashes as a cause of injury or a cause of death.

Until that time occurs, another strategy that needs to be implemented is the development of trauma systems so that kids who are injured in crashes can be identified. Researchers are working on automatic crash notification systems that will identify if people are likely to have significant injuries in them and notify the system automatically.

You think about commercials of cars that look for the crash potentials, automatically slow down and proactively help the driver. It is equally possible for a car to sense how severe a crash is and automatically notify folks, from notification through the response. Once EMS is notified, they need to have localized people who can get to crashes quickly. When they arrive they need to have the training, expertise and equipment that is necessary to recognize and treat the injuries. 

In addition to funding crash notification research, the Childress Institute is committed to developing and providing training programs for all health care professionals. Surgeons, who treat mostly adults, need extra help in knowing how to treat kids. It's not as common and it's so emotionally charged which makes it difficult. The same thing is true for paramedics. They need that training and we're committed to developing it and disseminating educational programs for first responders. 

When an injury occurs, we need a good trauma system that can recognize kids with triage protocols. Responders need to comprehend who has injuries that require trauma center care and have ready access to get to trauma centers.

There are not enough trauma centers or pediatric trauma centers in our country. There's not enough coordination of the children's hospitals with the trauma centers and the trauma systems in our country. The Childress institute is working very hard to foster the development of more children's hospitals becoming trauma centers. We have worked very hard to support the Pediatric Trauma Society, which is a group of professionals whose goal is to further the knowledge and develop trauma systems and improve trauma centers.

The last piece of the puzzle is the actual care of injury victims and understanding more. So much of the treatment for these high energy crashes and the injuries that occur in them comes from extrapolation of injuries that occur in adults and the way we treat them. The research that is necessary to figure out the best way to treat specific injuries in children has not yet been done. And it must be.

The Childress Institute has already funded research investigating the relationship of shock and head injury, which are the top two causes of death from trauma in children from car crashes. The outcomes of this research could be revolutionary for the treatment of injured children. It's full impact and how generalizable that is, needs further research. We need to be at the forefront of helping get that done and we need funding to help us make that kind of research a reality. Then after we develop new knowledge, we need better tools to disseminate that knowledge to the caregivers in our country.

Currently it takes sometimes ten years for new knowledge to become the standard of care widely used. We need to shorten that cycle time. Can you imagine the cycle time of learning to develop a new way of setting up the shock absorbers for a certain race track? If that took ten years, many teams would be extinct. You have to make these turnarounds at least every week. Health care needs to get there and trauma leaders need to forge the path.

Wednesday, November 12, 2014

What Youth Athletes Think About Concussions


Cailin Davis, 16, Emily Hunter, 17, Katie Mueda, 16, Brie Boothby, 17.
According to a new study by Safe Kids Worldwide, youth and teen athletes commonly ignore concussions and sports injuries because they feel pressure to play through pain. Elizabeth Murray and Sheinelle Jones from the TODAY Show shared a story last week about Brie Boothby. During a high-school field-hockey game in September 2013, near her Virginia hometown, Boothby was struck in the side of her head with an opponent's stick and blacked out. 

"The only thought in my mind was getting back in the game," she told Jones. And despite her injury, the field-hockey player kept playing. "I thought I had to be tough. I thought I had to go back in because we were losing and I needed to support my team."
That night, the 17-year-old felt nauseous, and began losing her memory. A trip to the doctor revealed devastating news: Boothby had sustained a serious concussion that left her with permanent brain injuries. 

It took Boothby 10 months of physical therapy just to be able to stand up without falling over. Since then, Boothby said that her school work suffered, and she's been diagnosed with ADHD. "MY GPA dropped so much that I'm really anxious about college," she said. "I'm not sure if I'm gonna get into what I've worked for my entire life."

Boothby's story is one of more than 1 million young athletes who are brought to the emergency room every year. And a new study by national research group Safe Kids Worldwide may help explain why one child is taken to the emergency room for a sports injury every 25 seconds. The study's results show that young athletes are engaged in a dangerous culture comprised of ignoring sports injuries, and feeling pressure to play even when they're hurt. 

The study, which surveyed 3,000 athletes, coaches and parents, found that:
  • 42 percent of kids said that they have downplayed or hidden injuries so that they could keep playing.
  • 53 percent of coaches said they've felt pressure to put injured players back in the game.
  • Almost 1/3 of kids surveyed said it's "normal" to play rough in a game, to "send a message" to the other team.
While this problem in youth sports has been well-publicized, this new research found that many young athletes are still putting themselves at unnecessary risk. 

"The awareness we have about injuries and the risk to our children is not matching the behavior that we're seeing on the field," said Kate Carr, president of Safe Kids Worldwide.

Doctors can't say if Boothby made her injury worse by continuing to play, but there are very serious risks for athletes who continue playing with a head injury.

"If kids return to play too soon after a concussion or a head injury, they're at risk for second impact syndrome, which is a really serious brain injury," said Dr. Tracy Zaslow, a sports medicine physician at Children's Hospital Los Angeles.

All 50 states now require young athletes to be pulled from play if a concussion is suspected, and many have restricted contact in youth sports practices. Sports associations say they're training coaches to resist pressure to play injured athletes, and the High School Coaching Association is pushing for new laws that would require medical personnel at all youth sports games. 

Boothby said that until young athletes really understand the message, they'll continue to play. Even though it's now not what she recommends. "I think when in doubt, sit it out," Boothby said. "And yes, it might stink sitting under the lights on the bleacher. It's better to be safe than sorry. I mean, what is one game compared to your entire lifetime?"

For more information about the warning signs of concussions in youth sports, visit the CDC's website.

Thursday, November 6, 2014

What is a Trauma Center? By Dr. Meredith



What's a trauma center? When people discuss the number of trauma centers in the country and the number of children's trauma centers they are referencing the American College of Surgeons' standards for being a trauma center. The American College of Surgeons writes those standards and it also has the ability to, through its verification committee, to verify that any given hospital meets those standards.

It does not designate, it verifies. The difference being it verifies that those resources are available. Only a state or a government body can designate a hospital as a trauma center. It is very common to see the words American College of Surgeons Verified State Designated Trauma Center. There are a lot of very good trauma centers in the country that have not gone to the American College of Surgeons for verification but are designated by their state. In doing so, in general, the state will require the hospitals to demonstrate basically the same requirements as the American College of Surgeons does.

So what is a trauma center? A trauma center is a hospital that has made a tremendous commitment to the care of an injured patient. It's made a tremendous commitment in terms of readiness and terms of expertise. Trauma is a disease which can occur in any part of our population, in any place in our country, at any time of day, on any day of the week.

It is a societal investment in the care of our citizens similar to the fire department or a police department. There are very good studies that analyze the effects of improving trauma care, most notably the NSCOT study, the “National Study on Cost and Outcomes in Trauma,” published by Mackenzie, Jurkovich and Rivara. In the New England Journal of Medicine it shows that the death rate for severe to serious injuries was 25 percent less in patients treated at trauma centers than in patients treated in non-trauma centers.

This is a huge difference. We go to an awful lot of trouble to administer, for instance, chemotherapy to a cancer patient with the hopes of garnering a 2 or 3, maybe a 5 percent increase in survival, or decrease in death rates. A 25 percent reduction in death rate is the sign of a very good treatment.

The marked improvement is made because these verified trauma hospitals have made a commitment to have a certain level of training and expertise amongst well-defined staff members, including surgical, emergency medicine, anesthesia, and other medical specialties. They make a commitment to have certain services immediately available, including diagnostic services like CT scanning. Most importantly, trauma centers have the ability of those surgical specialists and operating rooms and intensive care units to take care of the most seriously injured patients immediately and with a high level of expertise.

This is a huge commitment on the part of these hospitals. It's a huge cost on the part of these hospitals and trauma centers, and the public owes them a debt of gratitude. Many of us are privileged to live in communities and states that make this commitment. For others, there is still much work to be done. 

Of the 5,700 hospitals in the U.S., only 1,200 of those are trauma ready. That means only 20 percent of hospitals are truly equipped to handle a trauma. If we can save many more lives and reduce disabilities by having more trauma centers, then we need to discover how that can be done effectively and efficiently and share those plans with hospitals. We can save more lives, especially the lives of injured children, by improving the care they receive when emergencies happen.