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.

- Dr. J. Wayne. Meredith, Medical Advisor, Childress Institute for Pediatric Trauma

Recognizing Concussions

USA Today recently brought up the topic, “how do families with concussion concerns pick sports?” Although there is much talk in the news about youth football injuries, many other sports pose injury concerns for parents and athletes. According to Safe Kids Worldwide, soccer players have the same percentage of injuries that are concussions as football players. Soccer player Tori Bellucci told her concussion story earlier this year as part of the White House’s summit on concussions and youth sports. The summit shined a spotlight on the nation’s interest in finding new ways to identify, treat and prevent serious head injuries in youth athletes.

After a successful high school soccer career at Huntington High School, Bellucci was offered a full scholarship to play soccer at Towson, but the physical and emotional effects of multiple concussions made her realize the risks of continuing to competitively play the sport she loves. Tori elected not to play soccer in college after she suffered her fifth concussion.

“It changes the way you think and feel,” Bellucci, 18, said. “I was just like really sad, really kind of desperate type of feeling. I couldn’t do anything because of my head, so I would just be in my room with the shades drawn. I was like, ‘I don’t want to live like this anymore.’”

Unfortunately, the effects of initially unrecognized and repeated concussions meant Bellucci’s dream of playing soccer in college ended, but she continues to work hard to recover and remains active in sports by teaching young children how to play soccer. At the summit, President Obama referenced Bellucci’s experience as an example to other young athletes and parents about the commitment ahead of us to change perceptions and improve outcomes.

Safe Kids reports that every three minutes in the U.S., a child is seen in the emergency department for a concussion, yet 54 percent of athletes admit they have played injured. The CDC has great resources for parents and athletes for preventing, recognizing and treating sports injuries.

Signs of a concussion that coaches, athletic trainers and parents may notice:

·         Appears dazed or stunned

·         Is confused about assignment or position

·         Forgets an instruction

·         Is unsure of game, score, or opponent

·         Moves clumsily

·         Answers questions slowly

·         Loses consciousness (even briefly)

·         Shows mood, behavior, or personality changes

·         Can’t recall events prior to hit or fall

·         Can’t recall events after hit or fall

Symptoms that athletes may report:

·         Headache or “pressure” in head

·         Nausea or vomiting

·         Balance problems or dizziness

·         Double or blurry vision

·         Sensitivity to light

·         Sensitivity to noise

·         Feeling sluggish, hazy, foggy, or groggy

·         Concentration or memory problems

·         Confusion

·         Does not “feel right” or is “feeling down”

For an easy reference, visit the Childress Institute for Pediatric Trauma's easy concussion overview and click the graphic to download and print. For more information and stories from athletes, parents, coaches and athletic trainers, please visit:

• CDC's concussion reference
• CDC's Heads Up program for athletes
  
• CDC's concussion story from a basketball player
  
• A parent's story about concussion in youth athletes
  
• Matthew Gfeller Foundation
  
• Safe Kids' youth sports culture infographic
  
• Safe Kids' sports safety infographic
  
• Safe Kids' Ten Tips for Parents
• USA Today's story on concussions and youth athletes

Concussions in Kids

Many of you have heard a lot of talk in the news lately about concussions and head injuries from kids playing sports. I’m personally invested in this issue because my wife Lisa and I lost our younger son, Matthew, after he sustained a traumatic brain injury during a high school football game in 2008. I’m professionally motivated by the issue as the executive director of the Childress Institute for Pediatric Trauma.

As your kids go back to school and sports this month, we wanted to give you facts about concussions to help kids continue to play it safe:

• Young children and teens are more likely to get a concussion and can take longer to recover than adults 
• Recognizing and responding properly to concussions when they first occur can help prevent further injury or even death 
• Athletes who have had a concussion, at any point in their lives, have a greater chance of getting another concussion 
• Traumatic brain injuries (TBI) or concussions are a contributing factor to 31 percent of all injury-related deaths in the U.S.

Although the NCAA and NFL have pledged millions of dollars to study college and youth sports safety, up until now the effects of sports on kids have been vastly understudied. Did you know that 70 percent of the U.S. football-playing population is younger than 14? The Childress Institute is in its third year of funding a long-running study of 9- to 12-year-olds to track the cumulative impact on the brain of head contact across multiple seasons. The good news is, people are paying attention and we can start to make a difference as we learn more.

• Symptoms may appear mild, but the injury can lead to significant life-long impairment
• Each year, U.S. emergency departments treat an estimated 175,000 sports-related TBIs for boys and girls 
• During the last decade, emergency department visits for sports-related TBIs, among children and adolescents increased by 60 percent 
• 62 percent of sports-related injuries occur during practice not games

Based on the research we do have, we can help prevent and reduce injuries:

• Limit contact during sports practices (when appropriate for the sport) 
• Change rules and/or ban or limit the use of certain drills or techniques to help reduce the chances of injury 
• Check sports equipment often to make sure the equipment fits the athletes well, is in good condition, stored properly, and is repaired and replaced based on instructions from the equipment companies 

Action can help improve outcomes for kids:

• Educate coaches, parents, athletic trainers and athletes – inform and educate coaches, athletes, and their parents and guardians about concussion through training and/or a concussion information sheet

• Remove athlete from play – an athlete who is believed to have a concussion should be removed from play right away – “When in doubt, sit it out”

• Obtain permission to return to play – an athlete can only return to play or practice after at least 24 hours AND with permission from a health care professional trained in concussion care

My best advice as a parent of children who played multiple sports is not to be afraid to go to practice and ask questions. You are your child’s best advocate, so the more you know the better off everyone is.

To learn more about recognizing concussions in your young athlete, visit the CDC’s concussion website. You can learn more about my family’s personal story with sports-related traumatic brain injuries by visiting MattGfellerFoundation.org. We hope you will all help kids play it safe this fall.

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