TBI/Concussion Notes

TBI/Concussions

Head Injury

  • Head injuries can be classified as mild, moderate, or severe.

  • Irreparable cell damage occurs at the time of the initial trauma (e.g., skull fracture, concussion, penetrating injury).

  • Secondary events follow the initial trauma and can lead to further tissue death.

  • TBI is a common cause of pediatric trauma, especially in boys aged 0-14.

  • More than 2500 deaths and 400,000 ER/ED visits per year result from TBI.

  • Approximately 30,000 children suffer permanent disability as a result of TBI.

Subjective Data

  • Details of how the injury occurred are important.

  • Assess for loss of consciousness.

  • Inquire about nausea and vomiting.

  • Ask about headaches.

  • Assess for visual changes.

  • Inquire about numbness.

  • Assess for altered balance or gait.

Objective Data

  • Vital Signs (VS) should be checked.

    • intracranial HTN

  • Complete physical examination should be performed.

    • any other injuries

    • battle signsor raccoon eyes may indicate a basilar skull fracture and require immediate imaging to assess for potential underlying trauma.

  • Detailed neurological examination is necessary.

    • note current mental status

    • Assessment should include orientation to time, place, and person, as well as evaluating memory and cognitive functions to determine the impact of the injury.

  • Use the Glasgow Coma Scale to assess the level of consciousness.

Diagnostics

  • CT scans may be used.

    • 3-12 glasgow means CT

  • MRI scans may be used.

  • Skull films may be used.

Management

  • Management is based on the severity of the head injury.

    • Minor closed head injury without loss of consciousness.

    • Minor closed head injury with brief loss of consciousness.

      • think about CT

    • Moderate head injury.

      • 9-12, 23 hours or more of observation recommended for symptoms monitoring and evaluation for potential complications.

    • Severe head injury.

      • 3-8, referred out

Education

  • Provide a head injury instruction sheet.

  • Educate on when to go to the ER/ED.

  • Educate on what to watch for.

  • Provide information on medications.

  • Inform how long neurologic symptoms may persist.

Head Trauma and Sports

  • The CDC reports that EDs across the US treat >170,000 sports and recreation-related TBIs in children and adolescents annually.

    • Over 70% of these are male.

    • > 50,000 were football-related.

    • Visits have increased 60% within the last decade.

  • Head and neck injuries cause 70% of sports-related trauma deaths.

  • Common sports for injury:

    • Football (#1 boys)

    • Soccer (#1 girls)

    • Basketball (#2 girls)

    • Bicycling (#2 boys/#3 girls)

  • Second-impact syndrome is especially problematic and can be prevented; sideline evaluation is key.