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SPORTS INJURIES. Dan Muse, MD Brockton Hospital. TRAUMATIC BRAIN INJURIES. TRAUMATIC BRAIN INJURIES. Any injury to the brain caused by direct force to the head.
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SPORTS INJURIES Dan Muse, MD Brockton Hospital
TRAUMATIC BRAIN INJURIES • Any injury to the brain caused by direct force to the head. • Any injury to the brain caused by a blow to the body that results in referred trauma to the brain. e.g.: sudden deceleration caused when a player is checked or tackled.
TRAUMATIC BRAIN INJURIES TRAUMATIC BRAIN INJURIES CAN BE BROKEN DOWN INTO… • Severe • Mild
TRAUMATIC BRAIN INJURIES • Severe traumatic brain injuries have associated physical and radiographic findings of injury. • In most cases the patient will have neurologic findings as well.
TRAUMATIC BRAIN INJURIES SEVERE TRAUMATIC BRAIN INJURIES • Epidural • Subdural • Skull fracture • Basilar skull fracture • Cerebral contusion • Cerebral bleed • …………..
TRAUMATIC BRAIN INJURIES MILD TRAUMATIC BRAIN INJURY (CONCUSSION) • Mild traumatic brain injury is considered an injury to the brain at the bio-mechanical level. • Neurologic findings may be subtle and radiographic findings are negative
TBI BY THE NUMBERS 2010, an estimated 2.5 million ED visits, hospitalizations or deaths were the result of traumatic brain injuries, either alone or in combination with other injuries.
TBI BY THE NUMBERS Of them: • More then 50,000 die • 280,000 were hospitalized • 2.2 million ED visits with nearly 80%, treated and released.
TBI BY THE NUMBERS • One third of all injury-related deaths in the United States have an associated traumatic brain injury. • Three quarters of all TBIs that occur each year are concussions or other forms of mild TBI.
TBI BY THE NUMBERS • Each year in the United States, an estimated 38 million children and adolescents participate in organized sports • Approximately 170 million adults participate in some type of physical activity not related to work. • Total pool for potential TBI’s is about 210 million people
TBI BY AGE Traumatic Brain Injuries are most likely to occur in the following groups • Children aged 0 to 4 years • Older adolescents aged 15 to 19 years. • Adults aged 65 years and older. CDC STATISTICS
TBI BY AGE • Almost half a million (473,947) emergency department visits for TBI are made annually by children aged 0 to 14 years. • Adults aged 75 years and older have the highest rates of TBI-related hospitalization and death. CDC STATISTICS
TBI BY GENDER • In every age group, males are more likely to have a TBI than females. • Males aged 0 to 4 years have the highest rates of TBI-related emergency department visits, hospitalizations, and deaths.
COST OF TBI • Direct medical costs and indirect costs such as lost productivity of TBI totaled an estimated $60 billion in the United States in 2000.
SPORTS RELATED TBI2001-2005 • From 2001--2005, an estimated 207,830 patients with sport related TBIs were treated in U.S. hospital EDs annually. This accounted for 5.1% of all sport related ED visits. • 10--14 year olds, followed by 15--19 year olds made up the highest rates of sport related TBI ED visits for both males and females. • Overall, males accounted for approximately 70.5% of sport related TBI ED visits
SPORTS RELATED TBI2001-2005 ACTIVITIES ASSOCIATED WITH THE GREATEST NUMBER OF TBI-RELATED ED VISITS INCLUDED: • bicycling, • football, • playground activities, • basketball, • all-terrain vehicles (ATVs).
SPORTS RELATED TBI2001-2005 ACTIVITIES FOR WHICH TBI ACCOUNTED FOR GREATER THAN 7.5% OF ED VISITS FOR THAT ACTIVITY INCLUDED: • horseback riding (11.7%), • ice skating (10.4%), • riding ATVs (8.4%), • tobogganing/sledding (8.3%), • bicycling (7.7%).
SPORTS RELATED TBI2001-2005 ACTIVITIES ASSOCIATED WITH THE GREATEST PROPORTION OF TBI-RELATED ED VISITS REQUIRING EITHER HOSPITALIZATION OR TRANSFER INCLUDED: • riding ATVs (30.2%), • riding mopeds/minibikes/dirt bikes (21.9%), • bicycling (15.6%), • golfing (13.6%), • riding scooters (10.5%).
SPORTS RELATED TBI2001-2005 Each year, an estimated 21,311 sport related TBI ED visits occurred that involved patients who were either hospitalized or transferred to another facility for additional care
SPORTS RELATED TBI2001-2005 Approximately 10.3% of patients with sport related TBIs were hospitalized or transferred, compared with 3.1% of patients with sport related injuries overall.
YOUTH SPORTS RELATED TBI2001-2005 • Youth aged 5--18 years accounted for an estimated 2.4 million (59.7%) sport related ED visits. • 134,959 (5.6%) were categorized as TBI-related. • Approximately 17.9% of sport related hospitalizations in this age group were attributed to TBIs. • Activities associated with the greatest number of TBI-related ED visits in this age group included bicycling, football, basketball, playground activities, and soccer • WeeklyJuly 27, 2007 / 56(29);733-737 cdc mmwr
YOUTH SPORTS RELATED TBI2001-2005 ACTIVITIES ASSOCIATED WITH THE GREATEST NUMBER OF TBI-RELATED ED VISITS IN THIS AGE GROUP INCLUDED • bicycling • football, basketball • playground activities • soccer • WeeklyJuly 27, 2007 / 56(29);733-737 cdc mmwr
YOUTH SPORTS RELATED TBI2001-2005 TRANSLATION: TRAUMATIC BRAIN INJURIES MAKE UP A DISPROPORTIONATE NUMBER OF SPORTS RELATED INJURIES AND ADMISSIONS
MILD TRAUMATIC BRAIN INJURYCONCUSSION • “Sports concussion Is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces”. British Sports Med 2005;39:196—204. doi: 10.1 136/bjsm.2005.018614. VIENNA CONFERENCE • Current belief is that mtbi is a dysfunction of the brain’s metabolism rather than structural injury.
WHAT CAUSES A CONCUSSION MTBI/CONCUSSIONS ARE A BLOW TO THE HEAD WHICH CAN BE CAUSED BY • A direct impact to the head • A blow to the body that causes a shaking of the brain
CRITERIA OF A CONCUSSION CDC DEFINITION OF A CONCUSSION (MTBI): • Occurrence of injury to the head, resulting from direct trauma or acceleration or deceleration forces, associated with one or more of the following conditions • ANY PERIOD of observed or self-reported transient confusion, disorientation, or impaired consciousness • ANY PERIOD of observed or self-reported dysfunction of memory (amnesia) around the time of injury • Observed signs of other neurological or neuropsychological dysfunction • ANY PERIOD of observed or self-reported loss of consciousness lasting 30 minutes or less.
DANGER SIGNS OF A TBI • Headache that gets worse and does not go away. • Weakness, numbness or decreased coordination. • Repeated vomiting or nausea. • Slurred speech. • You should be taken to an emergency department right away if you: Look very drowsy or cannot be awakened. • Have one pupil larger than the other. • Have convulsions or seizures. • Cannot recognize people or places. • Are getting more and more confused, restless, or agitated. • Have unusual behavior. • Lose consciousness (a brief loss of consciousness should be taken seriously and the person should be carefully monitored).
MTBI RECOVERY • Most people with a concussion recover quickly and fully. • For others, symptoms can last for days, weeks, or longer. • Symptoms may evolve over several days and even months.
MTBI RECOVERY • Recovery may be slower among older adults, young children, and teens. • Having had a concussion may place a person at risk of having another one and may result in longer recovery time with the follow up concussion(s).
COACHES/TRAINER/EMT ROLE WHEN AN ATHLETE HAS A CONCUSSION • Remove the athlete from play. Look for signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head or body. When in doubt, keep the athlete out of play.
COACHES/TRAINER/EMT ROLE WHEN AN ATHLETE HAS A CONCUSSION • If you suspect a concussion, the player should not return to play in the game or practice. • Any athlete, at any age, by law has to be cleared by a health care professional, before returning to play.
COACHES/TRAINER/EMT ROLE WHEN AN ATHLETE HAS A CONCUSSION • Ensure that the athlete is evaluated by a health care professional. • Do not try to judge the severity of the injury yourself. • Health care professionals have a number of methods that they can use to assess the severity of concussions.
COACHES/TRAINER/EMT ROLE WHEN AN ATHLETE HAS A CONCUSSION Relaying the following information can help in the medical assessment of the patient: • How did the contact occur and how much force was involved. • Was it a direct blow to the head or body or both. • Any loss of consciousness (passed out/knocked out) and if so, for how long • Any memory loss immediately following the injury • Confusion? Amnesia? Perseveration?
COACHES/TRAINER/EMT ROLE WHEN AN ATHLETE HAS A CONCUSSION • Inform the athlete’s parents or guardians about the possible concussion. • Make sure they know that the athlete should be seen by a health care professional.
COACHES/TRAINER/EMT ROLE WHEN AN ATHLETE HAS A CONCUSSION • If the athlete begins to complain of symptoms consistent with concussion after returning, remove the player from the game or practice and do not allow the player to participate until reevaluated by a healthcare professional.
COACHES/TRAINER/EMT ROLE WHEN AN ATHLETE HAS A CONCUSSION • Always keep in mind that players (and sometimes parents) are not forthright with information and may return sooner than they should. • Believe your eyes instead of the doctor and if you believe the player still has a concussion, remove the athlete from the activity.
COACHES/TRAINER/EMT ROLE WHEN AN ATHLETE HAS A CONCUSSION • A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems. • In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death.
HEAD CT • Recommendations • Level A recommendations. A non-contrast head CT is • indicated in head trauma patients with loss of consciousness or • post-traumatic amnesia only if one or more of the following is • present: headache, vomiting, age greater than 60 years, drug or • alcohol intoxication, deficits in short-term memory, physical • evidence of trauma above the clavicle, post-traumatic seizure, • GCS score less than 15, focal neurologic deficit, or • coagulopathy.
HEAD CT • Level B recommendations. A non-contrast head CT should be considered in head trauma patients with no loss of consciousness or post-traumatic amnesia if there is a focal neurologic deficit, vomiting, severe headache, age 65 years or greater, physical signs of a basilar skull fracture, GCS score less than 15, coagulopathy, or a dangerous mechanism of injury. Dangerous mechanism of injury includes ejection from a motor vehicle, a pedestrian
CONCUSSION RESOURCES • ON LINE COURSES FOR COACHES • National Federation of High School Coaches on line course: http://www.nfhslearn.com/electiveDetail.aspx?courseID=15000 • CDC on line course for coaches: http://www.cdc.gov/Concussion/
CONCUSSION RESOURCES WEBSITES ON CONCUSSION • http://www.cdc.gov/concussion/ • http://www.inpacttest.com • http://www.sportsconcussions.org/ • http://www.sportslegacy.org/ • http://www.biama.org/whatdoes/playsmart.html
HIGH SCHOOL SPORTS RELATED INJURIES 2005-2006 • Records kept during the year showed that: • 7.2 million students participated in high school sports • Nine sports were followed in the study
HIGH SCHOOL SPORTS RELATED INJURIES 2005-2006 • Participation in high school sports resulted in an estimated 1.4 million injuries at a rate of 2.4 injuries per 1,000 athlete exposures • Concussions and fractures were more common in games than in practices.
MANAGEMENT OF THE SCENE • When a 911 call is made, it is implied that the EMT’s are responsible for the care of the patient • Sporting events always have the potential of having medical or pseudo-medical personal in the stands. • Most are well intended but every so often you will encounter an obnoxious individual who feels he or she should be in charge. • Any help is determined by the EMT’s.