While traumatic brain injuries, or TBIs, have declined in school aged boys over an eight year period, they’ve remained high in girls, a recent study found.
An analysis of data on emergency department visits that included more than 6 million children who had sustained TBIs between 2000 and 2019 revealed that brain injuries related to consumer products — anything from floors to footballs — increased from 4.5% in 2000 to 12.3% in 2019, with most occurring in boys, according to the report published in the American Journal of Preventive Medicine.
The reduction in brain injuries in boys “shows that the (changed) guidelines really do make a difference and they need to be followed,” said study coauthor Dr. Alan Cook an associate professor of surgery and of epidemiology and biostatistics and medical director of the trauma research program at the University of Texas at Tyler. Especially important are recommendations “to seek medical care when a mild traumatic brain injury is suspected, because we know there can be significant long term effects.”
To take a closer look at trends in TBIs in kids, Cook and his colleagues turned to data collected between 2000 and 2019 by the National Electronic Injury Surveillance System—All Injury Program, which monitors consumer product related injuries that show up at the emergency rooms of participating hospitals.
Among the 6.2 million injuries to children who went to emergency departments during the nearly 20 years covered by the study, nearly twice as many occurred in boys as in girls: 681.2 per 100,000 versus 375.8 per 100,000). Between 2000 and 2008, the annual change in TBI rate was an increase of 3.6%, as compared to an increase of 13.3 percent between 2008 and 2012 and a decline of 2% through 2019. In girls the number of injuries rose between 2000 and 2012 and then remained stable, while in boys there was a similar increase up until 2012 and then a decline through 2019.
Cook attributes the decline in brain injuries in boys to the changing attitudes towards concussions in sports, especially football.
It’s not clear why the number of TBIs haven’t gone down in girls, Cook said. “But it’s possible that the biggest source of TBIs in boys have been contact sports like football, in which changes to rules and officiating have led to a decrease in TBIs,” he added.
Parents need to understand that even if the symptoms of a mild TBI appear to be resolving quickly, a second concussion too soon after the first may result in more than just a continuation of symptoms, Cook said. “The amount of disability can be cumulative,” he added. “And the TBIS are not just additive, they can be multiplicative, resulting in disability or even death.”
Parents who don’t witness their child getting injured should be concerned about a TBI if they see their kid “ask the same question repeatedly or have any sign of cognitive impairment,” Cooks said. “Nausea or vomiting after a child strikes their head can also be very worrisome.”
The study spotlights the changing attitudes toward concussions, said Dr. Michael McDowell, a professor of neurological surgery at the UPMC Children’s Hospital of Pittsburgh.
Back in the early 2000s, people often dismissed football concussions as just dings and bell-ringers, McDowell said. Then the public became aware of the dangers of concussions and coaches realized when a football player got hit “maybe he shouldn’t be put back out there for a second, maybe more serious, hit to the head,” he added.
Girls get TBIs in sports too, McDowell said. But there haven’t been the kinds of changes in the sports they play as there were in football, he said, adding that it’s possible that girls also should be required to wear gear to protect their heads.
While most of the brain injuries appear to be related to sports like football, basketball and soccer, the data suggest many also occur in the home and are tied to contact with floors, stairs, ceilings and walls.
To prevent these, parents should look around their homes for potential dangers, McDowell said. “For example, maybe there’s a floor board that everyone keeps tripping over or a rug that’s very slippery that might trip children running around and playing,” he said. “Parents should take prevention measures to reduce those kinds of obstacles.”
If you don’t see your child hit their head, you should be concerned if they develop headaches, changes in appetite or sleep patterns, become irritable, or have concentration issues, McDowell said.
The warning sign that the TBI might be more severe include not getting better after two weeks or the symptoms getting progressively worse, McDowell said. “These signs should warrant an immediate call to the primary care physician or a presentation to the emergency room,” he added.