prevention of TBI

Concussion!

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If you follow “contact sports” such as football or hockey, you’re aware of reports of concussion for school, college, and professional athletes. Such incidents receive a lot of media attention and have resulted in controversy regarding rules of play, protective equipment, and limitations on participation or returning to play. As important as sports brain injuries are, they are not the whole story. Not by a long shot.

Contrary to media hype, falls are the leading cause of traumatic brain injury (TBI), accounting for 40% of all cases in the U.S. Among children age 0-14, falls account for 55% of TBIs. And among adults 65 years and older, falls cause 81% of TBIs.

Being struck by or against an object or person, including sports injuries, is the second leading cause of TBIs.

The third leading cause is vehicle crashes. They are especially serious and result in massive injury and death more often than other causes of TBI do. (Source: http://www.cdc.gov/traumaticbraininjury/get_the_facts.html.)

Such facts add up to a major conclusion: mild, moderate, and severe traumatic brain injury affects our daily lives more than we might realize. We need to be alert to the symptoms of brain injury in ourselves and others, and we need to pay attention to ways to prevent or minimize such injury.

Signs and Symptoms of Concussion

“Concussion” is the name most of us use for mild traumatic brain injury (mTBI) that results in temporary impairment of function lasting only 7 to 10 days. According to the CDC, signs and symptoms of such injury include:

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Observable TBI Signs

·      Appearing dazed or stunned

·      Forgetting an instruction

·      Moving clumsily

·      Answering questions slowly

·      Losing consciousness (even briefly)

·      Showing mood, behavior, or personality changes

·      Being unable to recall events prior to and/or after a hit or fall

Symptoms Reported by Persons with TBI

·      Headache or “pressure” in head

·      Nausea or vomiting

·      Balance problems or dizziness

·      Double or blurry vision

·      Sensitivity to light or noise

·      Sensation of feeling sluggish

·      Concentration or memory problems

·      Confusion

·      Not “feeling right” or “feeling down”

·      Mood changes, such as irritability, sadness, nervousness, anxiety, or acting more emotional than normal

·      Changes in sleep patterns
(Source: https://www.cdc.gov/headsup/basics/concussion_symptoms.html.)

Symptoms in Young Children

Because young children cannot tell us how they feel, it is often difficult to spot symptoms of mild TBI in them. Consider seeking medical attention if the following symptoms appear.

·      Appearing dazed

·      Listlessness and tiring easily

·      Irritability and crankiness

·      Loss of balance and unsteady walking

·      Crying excessively

·      Change in eating or sleeping patterns

·      Lack of interest in favorite toys

Medical Attention for TBI

It is important not to try to diagnose head injury or concussion yourself. The State of Connecticut Department of Education, for example, requires athletic coaches to permit athletes to resume participation in athletic activity only after having been cleared to do so by a licensed medical provider. If symptoms appear to be mild, it is probably all right to wait a day or so before seeing a health care provider. But if symptoms are more severe or if they become worse, immediate medical attention should be sought.

When you take the injured person to your regular physician or an urgent care center, you will be asked a series of questions about the person’s medical history, any current medications, and how the injury occurred. The clinician will check for observable injury to the skull and neck.

Evidence of amnesia or any loss of consciousness will be important. The injured person’s behavior—especially signs of dizziness, visual problems, feelings of nausea, sensitivity to light or noise, numbness, difficulty concentrating, irritability, etc.—will be closely observed. An X-ray exam will not be administered because X-ray does not detect health of brain function. Similarly, a CT exam will not be ordered unless there are signs of severe injury or trauma.

If a referral to another specialist is indicated, your doctor or health care provider will develop a follow-up action plan. Often, no follow-up beyond further observation at home for a few days is required.

Some situations, however, require referral to an emergency department or trauma center:

·      Apparent structural injury to the skull or other massive trauma

·      Headaches that worsen

·      Seizures

·      Differences in pupil size between the eyes

·      Extreme drowsiness

·      Repeated vomiting

·      Slurred speech

·      Inability to remember people or places

·      Increasing confusion, irritability

·      Numbness in arms or legs

·      Neck pain

·      Change in consciousness

Prevention

Since falls account for the largest number of TBIs in young children and elderly persons, preventing falls should be high on our agenda.

The activity of very young children should be observed closely. Child gates can keep them from gaining access to stairs, and window locks or other devices can prevent them from falling out an open window. Playground equipment should be checked for safety regularly, and the surface underneath such equipment should be soft, even spongy. Some equipment, such as backyard trampolines, should be avoided altogether (see my blog post on summer safety for children).

Parents must never shake young children because of irritation or as a form of discipline. Doing so can cause massive TBI that results in permanent injury or death.

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Senior adults should exercise in ways that increases strength and balance. Stairs should be well lit and furnished with sturdy handrails. Grab bars should be installed in showers and bathtubs. Use of ladders and stepstools should be minimized or avoided.

School children and athletes are generally required to have a physical exam before participating. They should also be educated about TBI and how to avoid it according to the particular sport that they play. Adult athletes should follow similar precautions.

Safe driving and wearing seat belts (or child-appropriate restraints) are essential to preventing the most massive and life-threatening TBI.

Final Thoughts

Traumatic brain injury—whether mild as in “concussion,” or severe—is a frequent, unwelcome feature of our lives. Often, it can be prevented or minimized. But when it occurs, all of us need to be able to spot the symptoms and to make sure that those who are injured receive the medical attention that they need.

If you or someone you know has suffered an injury to the head, be sure to watch for relevant symptoms of the type of injury that requires attention. If your regular health care provider is unavailable, get to an urgent care center where evaluation of such injury is frequently conducted. In cases of severe injury, call 911 or go to an emergency department.

For more information about traumatic brain injury and concussion, visit the major CDC website devoted to these topics: https://www.cdc.gov/traumaticbraininjury/index.html.

Traumatic brain injury is important. Don’t ignore it!

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