Research - Concussion & Head Injury
Concussions and sports have been in the news lately, largely with the attention on professional athletes, but many young athletes also suffer from concussions. Concussions-a type of traumatic brain injury (TBI) caused by a bump or jolt to the head or body impairing normal brain function-occur in all sports. Young children also are concussed from falling while running or biking.
Whatever the cause, TBI is a serious health problem in the United States. Annually, between 1.7 and 3.8 million people sustain a TBI, according to the Centers for Disease Control and Prevention. Most are concussions and can range from mild to severe and cause headaches; loss of consciousness, coordination, balance or memory; and even affect emotions, reasoning skills and other cognitive functions.
The CRU is researching both the acute and long-term effects of concussion and head injury, especially among the pediatric and adolescent population, and the many issues faced by these patients and their health care providers, families and communities.
The CRU aims to streamline the management of concussion and head injuries for children across various points of care in the health care system and in the schools. Our objectives encompass various projects and partnerships and have led to international, national and local presentations and publications. These combined efforts to understand head injury in children have resulted in WakeMed's Children's Head Injury Research Initiative (CHIRI), which is a collaboration between the CRU, the Children's Emergency Department and our community partners interested in bettering care for head-injured children.
We are involved in several projects with the overall mission to improve the treatment and outcomes of pediatric patients suffering head injury:
Epidemiology of Community Concussion Services
WakeMed’s Concussion Services has managed over 500 student athletes with concussion symptoms since opening in 2009. With this, we have the opportunity to present to the scientific community a comprehensive understanding of one of the largest cohorts of high school athletes with concussion. The CRU has assisted staff with the development of a user-friendly electronic template for recording the patient experience. This data is providing us with important information regarding the scope of concussive injury in adolescents and allowing us to recognize relationships and patterns in this population to improve patient education and quality of care.
Activity Restrictions Following Concussion
Given that emergency physicians are often the first provider to assess and manage the pediatric patient with acute head injury, it is imperative that decision making and discharge instructions regarding concussion, specifically as it pertains to cognitive and physical activity restrictions and appropriate follow up, are appropriately communicated at the time of the emergency department visit. Our retrospective review of a cohort of pediatric patients evaluated for head injury in the ED identified gaps in discharge information explaining concussions as well as for recommendations regarding activity restrictions. Future projects will help close those gaps in the ED setting, bringing us closer to our goal of improving knowledge and management of concussion across all health settings.
Evaluation of the Use of CT Imaging in Children with Head Injuries
An intracranial injury may be suspected on grounds of a patient's clinical presentation; however, computed tomography (CT) is currently the gold standard for investigation of intracranial injury. Because CTs can be costly, emit potentially harmful radiation and sometimes require that younger children be sedated, using clinical decision rules may help to identify patients at extremely low risk for intracranial injuries who do not require brain imaging.
The CRU is currently undertaking a prospective evaluation of CT utilization and outcomes for pediatric head injured patients in the six WakeMed emergency departments. This data will help us to determine whether adoption of a clinical decision rule would reduce the need for patient sedation and radiation exposure without missing potentially catastrophic or life-threatening injuries.
Common Data Elements in Concussion Care and Research
Because concussion care can be complicated, the CRU is leading a collaboration in North Carolina between providers with both research and clinical expertise to understand and identify the most important and clinically relevant data to collect concerning concussion for pediatric and adolescent student athletes.
Understanding Concussion in Youth Sports through a Concussion Education Program
On the education front, the CRU is evaluating the effectiveness of information interventions on the knowledge, attitudes, and behaviors concerning concussion among youth athletes, parents, and coaches. (Funded by the National Operating Committee for Standards on Athletic Equipment.)
Our Community Partners
WakeMed Concussion Services, Wake Emergency Physicians, PA, UNC Matthew Gfeller Sport-Reated TBI Research Center, Raleigh Neurology Associates, PA, Carolina Family Practice & Sports Medicine