TBI: Massive Increase in Emergency room visits for kids with concussions

Researchers report a skyrocketing increase in the number of visits to the emergency department for kids with sports-related traumatic brain injuries (TBI), such as concussions.

The study, conducted by emergency physicians at Cincinnati Children's Hospital Medical Center, shows that emergency visits for sports-related TBI increased 92 percent between 2002 and 2011.

The number of children and teens admitted to the hospital with the same diagnosis also increased. That increase was proportionate to the increase in emergency department visits – about 10 percent.

Patients admitted during the later years of the time period had less severe injuries and stayed in the hospital shorter amounts of time.

"More people are seeking care for TBI in the emergency department, and proportionately more are being admitted for observation," says Holly Hanson, MD, an emergency medicine fellow at Cincinnati Children's and lead author of the study.

"Here in Cincinnati, we anticipate more children will be seeing their primary care physician or going to the Cincinnati Children's TBI clinic, due to the passage of recent Ohio legislation mandating medical clearance to return to play."

The study of emergency department trends in sports-related TBI is published online in the journal Pediatrics.

The researchers studied more than 3,800 children and teens who came to Cincinnati Children's with a sports-related TBI between 2002 and 2011. Of these patients, 372 were admitted.

Injury severity, however, decreased from 7.8 to 4.8, based on an established medical score to measure trauma severity. Length of stay changed little but trended downward.

Skiing, sledding, inline skating and skateboarding had the highest admission rates for patients who visited the emergency department.

Their research did not concentrate on why more children and teens with less severe injuries were admitted to the hospital during this time period.

They speculate that emergency physicians may be ordering fewer CT scans and observing patients in the hospital, or perhaps that athletes are getting bigger and stronger, causing more head injuries needing longer periods of observation.

The Centers for Diseases Control and Prevention has called TBI an "invisible epidemic" because these injuries are often profound but not readily apparent to the public.

TBI is responsible for approximately 630,000 emergency visits, more than 67,000 hospitalizations, and 6,100 deaths in children and teens each year.

Medical evaluations for sports-related TBI increased 62 percent between 2001 and 2009, according to previous studies.

More Information: Sports related head injuries
Read more about minor head injuries on children

Children Concussion visits up 60 pct

The number of children going to hospitals with concussions is up 60 percent in the past decade, a finding that is likely due to parents, teachers and sport coaches being more careful about treating head injuries, according to a new US federal study.

"It's a good increase, if that makes any sense," said Steve Marshall, interim director of the University of North Carolina's Injury Prevention and Research Center.

"These injuries were always there. It's not that there are more injuries now. It's just that now people are getting treatment that they weren't getting before," said Marshall, who was not involved in the new research.

Bicycling and football were the leading reasons for the kids' brain injuries, but health officials said that could be at least partly related to the popularity of those activities. For example, it's possible many more kids bike, so a larger number of bike-related injuries would be expected.

The Centers for Disease Control and Prevention study is based on a survey of 66 hospital emergency departments that was designed to be nationally representative. The CDC looked at non-fatal data for the years 2001 through 2009 for kids and teens ages 19 and younger.

The agency looked at traumatic brain injuries, a category of injuries that mostly counts concussions but also includes skull fractures and bleeding in the brain.

The estimated numbers of kids coming into ERs with these brain injuries rose dramatically, about 153,000 in 2001 to nearly 250,000 in 2009. The rate also rose, also by about 60 percent.

However, there was not a significant increase in the rate of kids who were immediately admitted to the main hospital for further treatment. That suggests that more so than in the past, more coaches and parents have been bringing kids to the ER with mild concussions and blows to the head, said Dr. Julie Gilchrist, a CDC epidemiologist who led the study.

That's probably due to more awareness of the formerly under-appreciated long-term hazards of concussions, she added.

In 2003, the CDC started a "Heads Up" youth concussion awareness campaign targeting doctors. Since then, the agency has expanded the focus to coaches and school officials.

Dyslexia - Blue Coloured Filters

The effects of blue on dyslexia
Coloured filters, either worn as spectacles or used as overlays, have been successfully employed in the treatment of dyslexia for many years but there is no agreement about how they work.

Bright white light increases the activation of the parts of the brain involved in directing attention, such as the posterior parietal cortex.

Abnormal function in these attention-modulating parts of the brain has been implicated in the pathogenesis of dyslexia.

It is therefore likely that blue light selected optimally to recruit ipRGCs will have the greatest effect on improving alertness and concentration and may therefore be the best for remediating the impaired attentional responses seen in dyslexia.

The DRT has carried out a randomised control trial that showed that in suitable dyslexic children wearing blue filters for 3 months improved their reading age by an amazing 9 months.

The effects of blue light on sleep
Blue light therapy has been shown to help people with sleeping problems, to improve alertness during night shift work and to help overcome jet lag.

It probably works on the suprachiasmatic nucleus to alter the timing of diurnal rhythms. We found that children whose reading benefitted from wearing blue filters during the day often reported also that their sleeping patterns had improved, and we showed that this was probably due to an effect on the SCN; at night secretion of the sleep hormone, melatonin, which is also under the control of the SCN, can be inhibited by just 15 minutes of blue light ie blue light can reset the SCN rhythms to improve sleeping.

The effects of blue light on migraine
Likewise we found that in these dyslexics, who often complain of migraine type headaches, the blue filters often improved their headaches.


Migraine was previously thought to be due to swelling of the arteries in the membranes surrounding the brain, the meninges, but we now believe that the hypothalamus and specifically the SCN is responsible.

Coloured filters, worn as spectacles, have been found to be highly effective in reducing the frequency of migraine symptoms. Their efficacy probably does not result from their effects on conscious visual perception via the retinogeniculocortical pathway, but rather by affecting the hypothalamus via the retinohypothalamic pathway.

So blue filters are the most efficacious in reducing migraine.

Light and Seasonal Affective Disorder
Seasonal affective disorder (SAD) is a depressive syndrome experienced by around 5% of the population, the symptoms of which recur in winter and autumn.

A number of experimental findings combined with the circannual pattern of symptom expression implicate disordered diurnal rhythms controlled by the SCN in the pathogenesis of SAD.

SAD symptoms are likely to be the result of an abnormal phase-delay in the circadian rhythm. Hence exposure to blue light, particularly in the morning, often improves SAD greatly.

Fluorescent Lighting
Exposure to natural daylight at work and school is often minimal and fluorescent electric lighting is usual.

Unfortunately most fluorescent lights radiate very little short wavelength blue light.

Full spectrum fluorescent lights, the spectral output of which is similar to that of natural daylight, or blue light should therefore be superior for the promotion of human health and cognitive function because they stimulate the retinal hypothalamic system more effectively.

Dyslexia Research Trust - Vision & Coloured Filters

6 Things You Need to Childproof

1. The floor.
I heard a child safety expert recommending that you regularly "take a trip around your home on your hands and knees," so you can "see it like a child." She very rightly says that you must check for;

• concealed paper clips (they hide in all sorts of places),
• strings, ties, and blind cords hanging at neck level,
• wood splinters in the hardwood,
• exposed or unprotected electrical outlets,
• power cords that can be pulled to bring a lamp down,
• tablecloths, napkins and stray hanging drapery that can be pulled down,
• nails, tacks and jagged things in carpet seams,
• seasonal hazards (pumpkin laanterns, easter eggs, Xmas tree decorations etc.)
• other (because the list of potential hazards is endless)

Also, best not to let your neighbours catch you doing this too often, they might get the wrong idea about how you spend your days and dressing up in a furry animal costume to do this doesn't help either, believe me.

2. The baby gate.
Never use spring-loaded baby gates at the top of stairs. You know those ones that are simply jammed between the wall and the stair post by a couple of springs and blind faith. They might hold back a crawling baby at ground level, but a determined toddler on his feet will soon push it over and down will come baby, baby gate and all. Wall-mounted gates are essential.

3. The fireplace.
Don't just block access to the fireplace to prevent serious burns and to foil attempts to escape by climbing up the chimney; the next most likely hazard is to the head via the hard, sharp hearthstone in front of the fireplace.

As children transition from crawling to walking to running, they fall a lot and it is essential that there are only soft things to bang their heads on. Fence off any hazards that will damage soft bones. A hearth gate can keep children away from the entire hazardous fireplace area and give you some peace of mind.

4. The television.
More than 15,000 kids are injured or crushed each year by falling furniture and most of those are caused by falling television sets. Children are naturally drawn to the bright lights of a TV. So, secure yours to the wall or the back of your entertainment center, especially those new smart flat-panel TVs, which tip very easily.

At this time of year you may also consider the Xmas tree as a hazard for small children. It is equally attractive to them as the TV and has so many things on it that they can grasp, prior to bringing it down on themselves.

5. The cat.
Cats and children are a constant source of amusement and disasters, sometimes one following on quickly from the other. Scampering and exploring felines can and do, step on toddlers while they are trying to sleep. So, if you own a cat, keep it out of the bedroom, away from the child and invest in a crib tent.

6. Yourself.
Toddlers are programmed to watch, learn and imitate what you do. So, don't let your child see you operate the baby gate, or because they will copy you. Likewise, if they see you step over the gate, they'll try to climb it, too.

Remember: A well-childproofed house is not a good baby-sitter. Constant adult supervision is the only way to prevent injury or at least greatly reduce the likelihood of injury.