CDC Says 1.7 Million TBIs in the U.S. Annually

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Posted on 19th March 2010 by Gordon Johnson in Uncategorized

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The Centers for Disease Control and Prevention this week released the results of an extensive study of traumatic brain injury (TBI), and it offers a wealth of data – some of it disturbing. http://www.cdc.gov/media/pressrel/2010/r100317.htm There are an estimated 1.7 million deaths, hospitalizations, and emergency-department visits related to TBI in the United States each year, according to the CDC report released Wednesday.

“Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Death,” is based on data from 2002 to 2006 and identifies the leading causes of TBI and incidence by age, race, and gender. Here is other landmark information from that report: There were 52,000 TBI-related deaths and 275,000 hospitalizations annually. Almost 1.4 million, or 80 percent, of the people who sustained a TBI were treated and released from an emergency department.

That doesn’t bode well for these people, who may encounter long term, permanent problems stemming from their brain injury down the road.

The CDC report found that TBIs contribute to nearly a third or 30.5 percent of injury-related deaths in the United States.

Here are some other nuggets from the study:

  • •Children from birth to four years old; older adolescents aged 15 to 19 years,;and adults aged 65 years and older are most likely to sustain a TBI.
  • Falls are the leading cause of TBI (35.2 percent). Rates are highest for children from birth to four years and for adults aged 75 years and older.
  • Among all age groups, road-traffic injury is the second leading cause of TBI (17.3 percent) and results in the largest percentage of TBI-related deaths (31.8 percent).
  • In every age group, TBI rates are higher for males than for females.

“This report not only presents TBI numbers, it helps to show the impact of this injury nationwide,” Dr. Richard Hunt, director of CDC’s Division for Injury Response, said in a press release. “These data can help to impact the lives of millions of Americans as they serve as building blocks that guide TBI prevention strategies. They also help to identify research and education priorities and support the need for services among individuals at risk or living with a TBI.”

The CDC said it’s trying to create educational outreach initiatives to increase awareness and improve the prevention, recognition, and response to TBIs.

The CDC’s “Heads Up” educational initiatives have already been y adopted in emergency departments, doctor’s offices, playing fields, homes and schools. These initiatives provide information to health care providers, patients, school professionals, sports coaches, parents, teens, and youth on how to prevent, recognize, and manage TBIs. A free copy of the TBI report can be downloaded at http://www.cdc.gov/traumaticbraininjury/tbi_ed.html.

The problem with this type of epidemiological reporting is that it doesn’t go far enough.  What is needed is a comprehensive statement from the CDC as to how to best diagnose concussion (detailed investigation of amnesia,not just confusion) and to require that accident and fall cases get the same follow up that sport cases do.

Young Boxer Should Think About His Brain Long Term

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Posted on 16th March 2010 by Gordon Johnson in Uncategorized

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A local paper in Louisiana Monday profiled a brave, but it seems, also foolish, young gentleman from Grand Bois. The headline on the story is “Boxer Is Used To Overcoming The Odds.” http://www.houmatoday.com/article/20100315/ARTICLES/100319615?Title=Boxer-is-used-to-overcoming-the-odds

It should be called “Pressing Your Luck.” The piece is about 21-year-old Roland “Jay Paul” Molinere. He was hit by a jet ski at age 10, which fractured his skull. He was in a coma for three days.

After that accident, Molinere underwent years of physical and speech therapy so he could learn to walk and talk again. He came out of that challenging situation OK. But then what sport did he take up, after he got a second chance at life?

High school football, another venue to get your block knocked off. Molinere played cornerback for South Terrebonne High School. After high school, he returned to a sport he “had loved” since he was only six years old, which was boxing.

Today, Molinere is the 2009 Louisiana Golden Gloves Division Champion, and he has other championships under his belt in his weight class, 152 pounds.

We’d be hard-pressed to think of any sport more likely to cause traumatic damage to your brain than boxing.

Molinere said his goal now is to box for the United States in the Olympics. We suggest that he find a passion he can indulge in that won’t put in brain at risk.

We talk on this blog about the miracles and tragedies.  This case is a misguided approach to turn a miracle into another tragedy.  The single biggest risk factor for a bad result from a head injury is a prior head injury.  Any severe brain injury, one that involves coma, has left significant microscopic damage throughout the brain.  A blow to this young man that might only stun someone else, could cause a catastrophic result.  How did any doctor give him medical clearance to fight?

LA Galaxy’s Eskandarian Takes Leave From Soccer Due to Concussions

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Posted on 13th March 2010 by Gordon Johnson in Uncategorized

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Alecko Eskandarian, a former University of Virginia soccer star and LA Galaxy player, is taking an indefinite leave from the game after sustaining multiple concussions. http://www.potomacsoccerwire.com/news/700/10387

Eskandarian, 27, confirmed that he was taking a leave on his Twitter feed.

“As some of you have already heard, I haven’t been medically cleared to play pro soccer and am forced to step away from the game at this time,” he tweeted.

Eskandarian was a star at the University of Virginia and won the Hermann Trophy. He was drafted by D.C. United in 2003, and wound up on the LA Galaxy in 2009.

He has sustained at least two concussions during his soccer career.

Hammering Home the Seriousness of Concussions

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Posted on 10th March 2010 by Gordon Johnson in Uncategorized

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It’s always good for the American public to be made aware of the dangers of brain injury, and that a concussion is not “just” a concussion.” And that’s the message that’s being taught this month, which has been designated Brain Injury Awareness Month. http://www.healthnewsdigest.com/news/Family_Health_210/It_s_Not_Just_a_Concussion_-_It_s_a_Brain_Injury_printer.shtml

It’s never a bad idea, and can’t be stressed too often, that concussions do constitute brain injury. One physician pointed out that of the 1.4 million traumatic brain injuries (TBI) in the United States each year, 75 percent are usually concussions.

Public information about the danger of head injury and concussions doesn’t have to be dry and dull. The Mission Children’s Hospital has put together a clever nine-minute video for kids about why they need to wear helmets to protect against head injury.

http://www.youtube.com/watch?v=yr0YAoWe9XI

A demonstration of how a brain is bounced around in the skull when a head sustained a blow is done with jelly in glass bowl, and makes its point quite vividly.

Arizona Teen Dies From Brain Injury Sustained in Accident at 24-Hour Endurance Race

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Posted on 3rd March 2010 by Gordon Johnson in Uncategorized

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An 18-year-old youth was died Tuesday of brain trauma he sustained when he was hit by a car during a 24-hour endurance relay face this past weekend in Arizona. http://www.azcentral.com/community/phoenix/articles/2010/03/02/20100302brophy-teen-dies.html#

Robert Mayasich, a student at Brophy College Prep, passed away at St. Joseph’s Hospital and Medical Center three days after he was transported by air from Arizona 74 west of Lake Pleasant.

He had been part of a 12-man team in a race from Prescott to Tempe. But he wasn’t running his part of the race when he was hit by a Toyota Camry Solara.

Arizona public safety officials could release a report on Mayasich’s fatal accident by the end of the week.

Those who participate in the 24-hour race are encouraged to wear reflective safety gear, like headlamps and reflectors.

Possible NFL Draft Picks To Undergo Brain Test

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Posted on 27th February 2010 by Gordon Johnson in Uncategorized

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With concern over concussions a hot issue now, potential National Football League draft picks will have to undergo a brain test and face questions about their brain-injury history, according to the Associated Press.

http://www.latimes.com/sports/football/nfl/wire/sns-ap-fbn-nfl-combine-concussions,0,5717019.story

The 329 players coming to a scouting combine in Indianapolis this week will have to take the ImPACT test, a baseline brain activity examination – a first for the NFL.

Doctors can use the information gathered from the test to create a standard way to evaluation players, and to possibly track data on concussions.

The NFL has already made changes to its rules regarding players returning to play after hitting their heads.

The NFL’s competition committee this week saw demonstrations of new helmets that purportedly would be protective against head injuries.

Friday the NFL players’ union will conduct a Player Safety and Welfare Summit in Indianapolis, where companies can come to discuss any gear or services they offer that are supposed to make football safer.

That night, team doctors will meet to talk about new treatment for players. That meeting will include a discussion of head injuries.

Details On Measures the NFL Is Looking At To Limit Concussions

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Posted on 22nd February 2010 by Gordon Johnson in Uncategorized

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No more three point stance? That will be the acid test as to whether the NFL is willing to put player safety first. Eliminate the three point stance and you change the nature of football. Oddly, the running game would likely be the biggest benefactor, which is a complete contrast to the direction the league has been going. It is hard to imagine a traditional defense without line men digging in to stop the run. Will the NFL force such an organic change in the way the game is played for player safety? I doubt it. Frankly, I am not even sure that such change would make a biomechanical difference.

But eliminating the three point stance is one of the rule changes being considered by the NFL and its players are considering rule changes to ward off concussions, according to a detailed account in The Washington Post.
http://www.washingtonpost.com/wp-dyn/content/article/2010/02/19/AR2010021902973.html Some of the other measures being discussed are barring helmet-to-helmet hits on all ball carriers; limiting off-season practice; and exemptions for players recovering from concussions.

The possible changes could be in place by next season, according to The Washington Post. The league is trying to put the kibosh on the number of concussions that players suffer.

Thom Mayer, the medical director for the players’ union, is quoted saying that he envisions a 20 percent to 25 percent drop in the number of practices with collisions between players being permitted.

The possible changes will be part of the agenda when the NFL competition committee and union reps are together in Indianapolis next week.

Some safety measures were already implemented by the NFL following congressional hearings in October, which took testimony on player concussions causing long-term memory-related problems.

More Than 1,000 Disabled in N.J. Could Lose Benefits From Cash-Strapped Traumatic Brain Injury Fund

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Posted on 20th February 2010 by Gordon Johnson in Uncategorized

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Roughly 1,300 disabled people in New Jersey could lose treatment and services because of budget cuts impacting the state’s Traumatic Brain Injury Fund.
http://www.nj.com/news/index.ssf/2010/02/nj_assembly_committee_discuss.html

A New Jersey Assembly committee met Thursday to talk about possible ways to raise more money for the fund. In order to keep within the fund’s yearly $3.4 million budget, some officials have recommended that the fund only serve those who sustained a blow to the head, not those who suffered brain injury from a stroke, tumor or other type of trauma.

If that change were made, 60 percent of the 2,000 people who now get services from the program would be ineligible for it.

One of the solutions being considered is raising the 50-cent surcharge on car registrations that funds the program now.

Recipients who would be cut off from the Traumatic Brain Injury Fund are understandingly upset, as described in this well-done human interest story by The Star-Ledger of Newark, N.J.

http://www.nj.com/news/index.ssf/2010/02/state_brain_injury_fund.html

The story talks about the case of Michael Jankowsky of Toms River, who got stabbed in the heart trying to protect a friend 25 years ago. His brain didn’t get oxygen, and he suffered brain damage. He needs constant care, at age 45.

“He uses a wheelchair, slurs his speech, and struggles to concentrate,” The Ledger writes. “He has made progress over the past few years, his mother says, thanks to New Jersey’s Traumatic Brain Injury Fund, which paid for speech therapy and other treatments not covered by insurance.”

The story goes on, “That could end soon. The Brain Injury Fund is going broke, and the state wants to limit whom it helps to people whose brain damage came from a direct blow to the head.”

This is absurd. The issue is whether the brain is injured, not what mechanism of injury caused it. Some of the most serious of brain injuries don’t involve any blow to the head and as high as 50% of concussions do as well. See http://subtlebraininjury.com for more on the mechanical forces which cause brain injury.

Olympics Marred by Luger Death Before The Really Dangerous Sport Kicks Off, Snowboarding

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Posted on 16th February 2010 by Gordon Johnson in Uncategorized

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Observers feared that daredevil snowboarders might wind up dead at the Winter Olympics in Vancouver, pounding their skulls while attempting death-defying feats in the competition. But it was the luge sport that right out of the gate turned the games “into a gallows,” as one sportswriter out it.

And Olympic officials appeared more concerned about covering their asses than addressing the why of what happened.

This weekend there were many eloquent stories in the national press about the cowardice of the sports officials who blamed Nodar Kumaritashvili, the Georgian Luger killed at the Vancouver Olympics last week, for causing his own tragic death.

In its five-paragraph statement Friday, the International Luge Federation said that the Kumaritashvili came out of a curve and “did not compensate properly…there was no indication that the accident was caused by deficiencies in the track.”

http://www.vancouver2010.com/olympic-news/n/news/fil-statement-on-mens-luge-competition_274462nE.html

There was no mention of the fact that the steel pillar that the 21-year-old luger slammed his back into at racetrack speeds wasn’t padded, or that Olympic lugers were terrified of the track.

The New York Times did a Page One story Sunday on that topic, headlined “Fast and Risky, Sledding Track Drew Red Flags.”

http://www.nytimes.com/2010/02/14/sports/olympics/14track.html?ref=sports

Also on Sunday, The Times blasted the luge federation for its findings in a story headlined “Quick to Blame in Luge, and Showing No Shame.”

http://www.nytimes.com/2010/02/14/sports/olympics/14longman.html?hp

“Olympic officials treated the death of Nodar Kumaritashvili, the Georgian luge athlete, less as a tragedy than as an inconvenience,”
The Times wrote.

Back injuries aren’t the only thing to anticipate with these luge races. Last week a Romanian, Violeta Stramaturaru was knocked unconscious on Thursday and taken to a hospital after slamming into a wall several times.

http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/12/2010-02-12_luger_nodar_kumaritashvili_rushed_to_hospital.html?page=1#ixzz0fYFguzaH

Here’s the best summation we read of the tragedy over the weekend, by New York Daily News sports columnist Filip Bondy.

http://www.nydailynews.com/sports/more_sports/winter_olympics_2010/2010/02/13/2010-02-13_quit_playing_a_risky_game.html

“In the end, it wasn’t the halfpipe or the freestanding aerials that turned the Winter Olympic into a gallows,” he wrote Saturday. “It was as slippery-sloped luge track, designed by someone who didn’t know the sport and nurtured by a system that reward outrageous risk-taking.”

The New York Times Saturday said in a Page One story that the Georgian’s death “casts a pall” over the Winter games.

http://www.nytimes.com/2010/02/13/sports/olympics/13luge.html?hp

On the sports pages that same day, The Times noted that the Winter Olympics have “had ample adversity and controversy,” from too-little snow “and doping” scandals, “but genuine tragedy has been a rarity.
http://www.nytimes.com/2010/02/13/sports/olympics/13clarey.html?hp

Prompted by last week’s death, Olympics officials have taken steps to make the luge track safer. For example, they have moved the men’s start line farther down the track.

We’ll see if that helps – and hold our breath for when the supposedly really dangerous competition starts: snowboarding.

Study To Research Impact of Progesterone on TBI Patients

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Posted on 12th February 2010 by Gordon Johnson in Uncategorized

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Ironically, despite a strong recommendation from the authors of the Guidelines for the Management of Severe Traumatic Brain Injury that the use of steroids was NOT recommended for the treatment of severe traumatic brain injury, research in the area continues. The irony is that the Brain Trauma Foundation is supporting such research, despite the fact that they were the publishers of the Guidelines. The Guidelines were published in Journal of Neurotrauma, Volume 24, Supplement 1, 2007. http://www.braintrauma.org/site/PageServer?pagename=Guidelines

The latest guideline said this about steroids:

The majority of available evidence indicates that steroids do not improve outcome or lower ICP in severe TBI. There is strong evidence that steroids are deleterious; thus their use is not recommended for TBI.

Currently there is little enthusiasm for re-examing the use of existing formulations of steroids for treatment of patients with TBI. If new compounds with different mechanisms of action are discovered, further study may be justified.

I guess a lot has changed in less than three years. A nationwide study, named ProTECT, on the use of progesterone to treat moderate to severe brain injury will be conducted at 17 hospitals across the nation, it was announced Wednesday.
http://www.henryfordhealth.org/body.cfm?id=46335&action;=detail&ref;=1057 Progesterone also known is a steroid hormone which is part of the female reproductive cycle.

The study, funded by the National Institute of Neurological Diseases and Stroke, will track 1,100 patients nationally for at least three years. http://www.freep.com/article/20100210/BUSINESS06/100210029/1320/Hospitals-take-part-in-brain-injury-study

The goal of the research is to find out if the hormone progesterone can lessen the disability and death, that can stem from Traumatic Brain Injury, the leading cause of death and disability in those younger than 44 years old, according to the Brain Trauma Foundation.

Research with animals has found that progesterone may lessen brain damage resulting from TBI.

ProTECT is a double-bind study, and will evaluate patients with moderate to severe brain damage. The evaluation must take place within four hours of the injury, and enrolled patients will either be given a placebo or the progesterone intravenously.

The Food and Drug Administration is allowing hospitals to enroll patients without written consent because TBI patients may not be conscious or have the ability to make an informed decision right after their injury.

Four Detroit hospitals will take part in the study, namely Henry Ford Hospital, Detroit-Receiving Hospital, Sinai-Grace Hospital and Beaumont Hospital.

One of the last studies on the use of steroids for TBI was halted mid-trial because of hard evidence that it was doing more harm than good. We hope this one is monitored with extremely tight controls, with no vested stake in continuing the study if things start to go wrong.
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