Building Our Future by Bob Gfeller

I've now been in my position for 120 days, and the team and I spent a lot of time looking at what we do well, what we need to do better, and clarifying how we will build our future.

In the six years since the Institute started in 2008, the death rate for injured children has been reduced from 12,400 to the 9,500 per year in the U.S. Many organizations are focused on improving those numbers. The Institute wants to work on topics that have societal impact over the long haul, so we need to clarify our message so that our audience understands what we do.

Part of that is clarifying our mission. Our new mission is to discover and share the best ways to prevent and treat severe injuries in children. We're going to focus on identifying and sharing best practices, particularly from the best pediatric trauma centers to the ones in need. We are going to work more in the area of prevention in addition to treatment and care after an injury.

Our three overarching strategies will now be funding research, education and advocacy, with measurable outcomes for each. From an advocacy standpoint we have to ignite the discussion of pediatric trauma at the local, state and federal government levels, because we need funding help from the government. Additionally, we are going to redesign our private fundraising initiatives to insure that we can raise at least $5,000,000 over the next five years.

With those three strategies we are going to focus our work in two areas:

1. Raising the level of pediatric trauma care nationwide

If your child is cared for at a Level I pediatric trauma center after a severe injury, they have a 25% better chance of surviving than if they're not. The bottom line is certain communities are better prepared to address a severely injured child when they show up at their hospital doorstep than others. We have an opportunity to help those in need get better prepared.

•    Determine pediatric trauma readiness

We've preliminarily mapped the U.S. and identified a number of states like Idaho, Nevada, Montana, Utah, and Georgia, whose pediatric trauma readiness clearly lags states like North Carolina, Oklahoma, Texas, Ohio, and New York, particularly as it relates to having a Level I or Level II pediatric trauma center in their state.

• Pediatric Trauma Summit 2015

We are planning another pediatric trauma summit for 2015, which will resume the work laid out at the 2013 summit. The next summit will move theoretical ideas to more concrete action plans behind two specific aims: 1) extend pediatric trauma care to rural communities through innovative ways, and 2) create a toolkit to share best practices, tools, and techniques from well-established Level 1 pediatric trauma centers to others.

2. Prevention and treatment in youth sports and recreation

• Youth Sports

You've heard a lot about injury in sports, mainly from all the news about traumatic brain injuries (TBI) and concussions (mTBI) in football. We have funded the ongoing iTAKL youth football study for three seasons now. We need to focus on youth, 14 and under, because there is very little work being done for that age group. We plan to go beyond football to learn more about sports injuries for boys, particularly hockey, and we need to research soccer, basketball, lacrosse, cheerleading and other injury-prone sports for girls.

• Youth recreation

Additionally, we need to discover ways to improve safety and treatment for recreational injuries to children, especially regarding ATV safety in the U.S. There are millions of ATVs on the road and there are millions of kids riding ATVs improperly, even though all states have laws regulating children riding ATVs. The problem is that they're riding without supervision, without helmets. They're riding on and driving equipment that's too powerful for their age, and they're falling.

Twenty-one percent of injuries amongst children on ATVs are multi-causal – head, bone, internal injuries. Nationwide, the research says that while children are only 20% of the riders on ATVs, they are 50% of those injured on ATVs. The most astounding fact is that 90% of kids riding ATVs don't wear helmets. We will leverage our relationships and Richard Childress' passion for the outdoors to help address this issue.

We will keep you posted on our progress through our newsletters as each initiative evolves. As always, we welcome your input and support.

Stay inspired!

BobGfeller, Executive Director

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

Head Impacts in Kids by Jillian Urban

How many of you have kids who play soccer, football, hockey, basketball? Have any of you had a concussion or know someone who has had a concussion, particularly a young athlete? Many of your may know that concussions are an important topic at the moment. Head injuries commonly occur in football, but they also occur in many other sports including soccer, lacrosse, cheerleading, and basketball. 

The Center for Injury Biomechanics at Wake Forest University has been working with the Childress Institute for Pediatric Trauma for the past two years, and that partnership is now entering its third year. In that time, the Institute has provided us with $350,000 to support medical image data collection as part of a pilot study to collect head impact, neurocognitive, and imaging data from 147 youth and high school athletes. We have collected tens of thousands of head impacts and medical images on a larger scale than has ever been attempted. This work has allowed us to apply for and receive a grant from the National Institutes of Health worth $3.5 million to continue this study in youth players for the next five years. The focus of our study is on football but there are many opportunities to study head injuries in other sports, helmeted and non-helmeted, as well as in boys and girls.

Other researchers have studied professional and college football for the past 10 years. There are only 2,000 NFL players and 100,000 college football players, one NFL player for every 50 collegiate players. However, these statistics are just the tip of the iceberg. There are approximately 1.3 million high school football athletes (ages 14-18) and 3.5 million youth athletes (ages 6-13). That is 1,750 youth football players for every NFL player. We have a tremendous number of youth athletes in this youngest age group, and it is the age group about which we know the least.  Young children’s brains are growing and developing so one of the questions we are asking is - what happens to the brain of a young athlete who has 100, 500, or even 1,000 impacts over the course of a football season? What can we do to avoid or mitigate these impacts?

We commonly think of exposure when we are talking about sun exposure.  We can apply this concept to head impacts where the concussion is a single bad event, similar to a sun burn, and a season or lifetime of impacts is analogous to a lifetime in the sun. Much of the focus of researchers for the past 10 years has been on the concussion – something that might happen once or twice over the course of a career.  However, the question at hand is what has a greater effect on the brain: a few concussions or a season or a playing career of subconcussive repetitive head impacts?

We are studying this using two methods. Before, post-concussion, and after the football season we collect medical imaging and neurocognitive data. The kids participating in the study come in for an appointment at the hospital where we perform a computer-based test that measures how fast they think and how well they remember things. We collect medical imaging data including a magnetoencephalography scan, or MEG, which listens to their brain - specifically the magnetic activity of the brain and an MRI, which takes different types of pictures of the brain but with no radiation. These together allow us to measure the functional activity of the brain, along with the structure of the brain.

In between the pre- and post-season scan, they practice and play football. We instrument the helmets of youth and high school football players with a sensor system that fits in the existing helmet. The sensor system sits on the crown of the head of the athlete and wirelessly transmits each head impact to a sideline laptop during all practices and games. We are measuring the location of impact on their helmet and the acceleration, representing the severity of the hit in terms of Gs. We use this data to better understand head impact exposure on the field in order to better inform safety on the field, helmet safety, and to better understand age-specific injury risk and injury mechanisms. Our imaging collaborators measure changes in the brain from the MRI and MEG and are looking to see if they correlate to the number and magnitude of impacts they have received.

We have found that many of our athletes are receiving a greater percentage of their head impact exposure during practices compared to games, which is something our players and coaches have direct control of through modifying practice drills and limiting the number of contact practices. Additionally, by studying two different groups with different league rules on contact practice with our partners at Virginia Tech, we have found that one league significantly reduced the head impact exposure of the athletes without affecting how hard they hit during games. 

The study has many opportunities to go beyond youth and high school football. There is a lot we do not know about female athletes and even non-helmeted sports such as soccer where we see a high incidence of concussion. The results of this study will help us to better understand how to reduce head impact exposure and ultimately keep our kids safe. 

- Jillian Urban, Wake Forest University Center for Injury Biomechanics