At 6’2” and 180 lbs., 16-year-old Tommy is an imposing young man. But even his size and strength were unable to protect him when he suffered a concussion while playing quarterback for the Palatine High School junior varsity football squad in early October. Briefly knocked unconscious, he was taken to the pediatric emergency department at Northwest Community Hospital in Arlington Heights, which is staffed by emergency medicine specialists from Children’s.
There he was examined by Richard Marble, MD. When imaging tests indicated Tommy might also have a skull fracture, Dr. Marble consulted with colleagues at Children’s and recommended an immediate transfer by ambulance to the hospital’s Emergency Department, where Tommy, who had suffered a concussion as a freshman, could receive advanced care. A short time later Tommy and his parents, Mary Ann and Tom, arrived at Children’s, a national leader in pediatric emergency medicine that sees more than 65,000 Emergency Department patient visits each year.
“It was amazing,” says Mary Ann. “The paramedics wheeled him in, and within seconds there were five or six people helping him – attending physicians, paramedics, nurses, interns, residents. It was phenomenal how they all paid so much attention to him. In every way, the care Tommy received at Children’s was just incredible. They even explained how they were limiting the number of CT scans he would undergo to limit his exposure to radiation.”
Numbers of pediatric concussion cases treated are on the rise
Concussions are a type of traumatic brain injury caused by a jolt or blow to the head that results in the sudden movement of the brain within the skull. They can cause damage to brain cells and even cause chemical changes in the brain. Symptoms of a concussion include headache, nausea, dizziness, double or blurry vision, sluggishness or grogginess, confusion and problems with concentration and memory.
Concussions can occur in virtually any sport and at any level. This season the National Football League has seen a rise in the number of players suffering concussions (including Chicago Bears quarterback Jay Cutler), and announced it would begin suspending players for illegal and dangerous hits that often result in head injuries. And in the U.S. House of Representatives, two separate committees are considering legislation that would establish nationwide guidelines for managing concussions in school-age athletes and require schools to provide special scholastic services for athletes recovering from concussions.
According to the Centers for Disease Control and Prevention, each year, emergency departments in U.S. hospitals treat about 135,000 sports- and recreation-related traumatic brain injuries, including concussions, among children ages 5 to 18. Additionally, a recent study of concussions suffered while playing organized sports published in Pediatrics found that emergency department visits for 8- to 13-year-olds doubled between 1997 and 2007, and tripled for 14- to 19-year-olds.
“We are seeing many more children of all ages with sports-related concussions,” says Steven Krug, MD, head of Children’s Division of Pediatric Emergency Medicine, which has a staff of more than 25 physicians and nearly 80 nurses, who was one of the doctors who cared for Tommy. “In part that’s because there is greater awareness of the problem and more vigilance by coaches, athletic trainers and parents.”
A special expertise in treating head and brain injuries
Tommy was fortunate to receive care at Children’s, which has special expertise in treating head and brain injuries and has developed special protocols to treat them. The hospital also offers comprehensive concussion evaluation services for young athletes through its Institute for Sports Medicine.
Further tests indicated Tommy had not suffered a skull fracture, but may have injured one of the vertebrae in his neck, and he was fitted with a neck brace. Because he had been knocked unconscious, the Emergency Department staff admitted him overnight for observation. After determining that he had not suffered further injury, Tommy was discharged the next day.
Concussion symptoms often linger, and even two weeks after his injury Tommy was still experiencing headaches, sensitivity to light and periodic difficulties focusing. He received follow up care from Children’s neurosurgeon Arthur J. DiPatri, Jr., MD, and had to limit his physical activity until his symptoms resolved, and then begin a program to gradually increase activity before he could be cleared to play football again.
“Not being able to play was frustrating – especially because the varsity team had just made the playoffs, and I wanted to be out on the field with my teammates,” says Tommy, a three-sport athlete at his school. “But I know that concussions are serious injuries, and it’s important for players to let their coaches know when they have concussion symptoms, come out of the game and receive medical attention if they need it.”
The family has had more than its share of experiences with brain injuries. Tommy’s sister Jessica suffered a concussion during a high school swimming meet when she was 16 and was rendered unconscious for 30 minutes.
“Jess missed more than a month of school, and had seizures, migraines and difficulty focusing,” says Mary Ann. “She needed physical therapy, and it took her almost a year to recover. Now she’s a sophomore at St. Louis University, and is studying to be an occupational therapist. She wishes to practice at the pediatric level to work with children who have suffered brain injuries and strokes.”
Dangers of multiple concussions
Cynthia LaBella, MD, is medical director of Children’s Institute for Sports Medicine, which is also involved in concussion research and offers a wealth of resources on sports-related concussion for patients, families, coaches and athletic trainers. She says physicians are learning more and more about the long-term effects of multiple concussions.
“Studies show that people who have had one concussion are at greater risk for another,” she says. “This is probably because the brain’s ability to recover from a concussion is reduced after multiple concussions. After each subsequent concussion it often takes less impact force to cause the next concussion. There is also some evidence that cognitive performance is lower in athletes who have had multiple concussions.”
Tommy’s mom advises parents of young athletes to educate themselves on the dangers of head injuries. And while she’s relieved that he’s on the road to recovery and following proper post-concussion protocols, she says she finds it hard to relax at his games.
“Head injuries are very scary because they take a long time to heal,” says Mary Ann. “You also don’t know how these injuries may affect your child down the road. I always tell Tommy, I’m the mom who is sitting up in the stands saying a prayer every time I see him running out on the field.”
Story originally appeared in the November 2010 issue of Heroes Update