Curbing concussions

Jax physician is helping develop new guidelines about kids and TBI

By Matt Galnor

Dr, Madeline Joseph

A UF College of Medicine-Jacksonville professor is among a select group of experts appointed to develop the first national guidelines regarding assessment and treatment of youth with mild traumatic brain injury, or TBI.

Madeline M. Joseph, M.D., a professor of pediatric emergency medicine, is leading one of six workgroups tasked with writing guidelines to be released in 2014 by the Centers for Disease Control and Prevention.

Joseph’s group is looking at factors that could identify patients at risk for important intracranial injury and for delayed recovery from mild TBI. The group will examine the mechanism of injury, duration of loss of consciousness, as well as symptoms, biomarkers and abnormalities on neurological, cognitive or balance tests.

The overall task force, the Pediatric Mild Traumatic Brain Injury Guideline Workgroup, includes about 50 medical professionals and other leading experts in TBI from across the country.

The guidelines will help fill an important gap and ensure consistent and evidence-based care of young patients with mild TBI, according to the CDC.

While much of the attention related to concussions has focused on sports injuries, Joseph said only 10 percent of concussions occur during athletic events. That makes it even more imperative that emergency departments and first responders keep an eye on symptoms while treating children.

As chair of the pediatric emergency medicine subcommittee for the American College of Emergency Physicians in 2011, she led the writing of imaging guidelines to reduce the use of expensive, high-radiation studies for children with possible TBI.

Her interest in the issue grew, and she’s now leading two studies in Jacksonville gauging parental awareness about concussions and their symptoms. She and other researchers surveyed more than 600 parents of football and soccer players and found that none could identify every concussion symptom. She also helped the Health Planning Council of Northeast Florida with a study about hospital usage and neuroimaging for youth sports concussions.

As a soccer parent herself, she’s pushing to get the word out and saw the results of increased awareness firsthand at one of her sons’ tournaments. One of his teammates was kicked right above the eye, causing a deep, bloody cut.

When the player stood up and was unsteady, the referee immediately called for an ambulance so he could be evaluated at a hospital.

“People are looking for signs of a concussion and that’s important,” Joseph said. “It was great to see that was the first thing the referee was looking for.”

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