UPMC study finds uptick in reports of head injuries

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In recent years, more young children and senior citizens have been showing up in emergency rooms with head injuries -- and according to one neurosurgeon, that's a good thing.

This upward trend in head injury diagnoses comes from a recently released study, funded by Children's Hospital of Pittsburgh of UPMC, which is slated to be published in an upcoming issue of the Journal of the American Medical Association. The study relies exclusively on data from the Nationwide Emergency Department Sample, which compiles information from emergency departments across the country.

The study indicates that in 2006, 1.7 percent of emergency room patients were diagnosed with a traumatic brain injury. By 2010, visits resulting in a brain injury diagnosis increased by 29 percent.

With patients under the age of 3 and over the age of 60 showing the greatest uptick in visits, researchers remain uncertain whether more toddlers and seniors are actually getting injured or whether this increase is due to more cautious parents and relatives.

Jennifer R. Marin, an emergency medicine physician at Children's Hospital and one of the authors of the study, said that further research needs to be done.

PG graphic: Hospital visits for head injuries rise
(Click image for larger version)

"Our findings just show this increase," Dr. Marin said. "We don't know how much of it is actual patients getting injured."

Micky Collins, a neurosurgeon and director of the UPMC sports medicine concussion program, said the public is more aware of head injuries than in past decades, which could lead some parents to bring their children to emergency rooms unnecessarily.

But when it comes to head injuries, Dr. Collins said it's better to err on the side of caution.

"There's a lot of risks," he said. "These are brain injuries, and it's something that needs to be managed very carefully. Kids may end up with cognitive issues, and their grades may suffer in school."

Dr. Collins said that people often think all concussions are the same. But in the same way that an orthopaedic doctor could diagnose more than 30 different knee injuries, there are many types of head injuries.

"A lot of these systems need rehabilitation," he said. "Dizziness, for example, comes from a system in the brain that needs to be rehabilitated to seek quicker outcome."

Children also take longer to recover from head injuries than adults, he said, pointing to a previous Children's Hospital study that compared high school students' recovery times with those of professional football players and college students.

Dr. Marin said another complication is that head injuries present a broad and subtle array of symptoms. Some people may get an acute headache from a minor concussion, while another person with a life-threatening injury may only exhibit a change in mood or cognition.

"What's unfortunate about concussions, specifically, is that the severity of symptoms doesn't correlate with the severity of the injury," Dr. Marin said.

Some states have adopted bicycle helmet laws for youths, and some states have signed the Safety in Youth Sports Act, which mandates baseline testing to better diagnose concussions among youth athletes (Pennsylvania is one of those states). But for the most part, neither of those efforts helps toddlers or senior citizens.

"We do need to target these groups more, but not at the expense of providing that same level of prevention to those other age groups," Dr. Marin said.

Dr. Collins said toddlers pose particular challenges in diagnosing and treating head injuries, because they often can't describe how they feel, and because CT scans and MRIs can't detect concussions. He said that a clinician can help parents to find the right sleep schedule and the correct amount of exposure to busy environments -- which often will irritate someone with a concussion -- to speed up the child's recovery and limit their discomfort.

Although educating parents on the symptoms and potential risks of head injuries is one part of the equation, making sure that children get the right care is the most important part.

"I do feel that increased awareness is a good thing," Dr. Collins said. "At least here in Pittsburgh, kids are getting the right treatments."

Brett Sholtis: bsholtis@post-gazette.com or 412-263-1581.

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