Concussion Recommendations in Children and Adolescents in Sports Related Injuries

In recent years, concussions have made their way into the media more and more. Something that we once thought was a simple injury that could be shaken off is now being thought of as a serious injury.  There are specialists who dedicate their practice to concussions.  This type of injury is commonly associated with sports.  Concussions are a common injury that occurs in sports especially football.  It has been somewhat of a controversy this past decade because the NFL has made changes in their roles and regulations to protect the players from concussion injuries.  Children and adolescents are also affected from these injuries.  This article looked at how providers are supposed to handle young patients that have sustained a head injury.

Within 1 to 2 days of the injury, the patient should be presented to a physical to have symptoms checked.  The patient should not be left unattended within 48 hours of the injury.  Rest for the first 1 to 2 days is critical to the patient’s recovery.  It is not, however, recommended for the patient to have prolonged bed rest.  The notion that patients should rest until there are no longer any symptoms is not the preferred method of treatment anymore.  Patients should return to school and normal activity within a couple weeks to avoid depression and other negative symptoms.  Accommodations can be made but can usually be discontinued within 2 weeks.

A system was developed called SAFE (Symptoms, Assessment, Follow-up, Execute, and return to pay) to help providers decide what actions need to be taken with the patient.  This system was made into a flow chart so that a provider can follow the protocol for each patient.  This system can help determine when a patient should be referred to a specialist and what kind of tests need to be performed.  It also helps figure out back to school and return to play times.  There have been laws passed in all 50 states to help outline when a patient is ok to come to back and play for their sport.  This article shows how important it is to have a standard method of treatment for patients with concussions.  Each patient may be different, but this method could help make sure that the provider is doing their best to follows the protocol treatment for each patient.

ORTHOPEDICS. 2016; 39: 24-30

http://ORTHOPEDICS. 2016; 39: 24-30

Advocating Against the Health Risks in Youth Tackle Football

As Super Bowl weekend winds down, many are left with football on the mind. When played correctly and fairly, the sport is in its glory and one of America’s favorite past-times. However, this is not always the case and injuries are common, especially in younger age groups learning to play the game. In fact, in the past Fall 2015 football season, at least 11 US high school athletes died due to football injuries. Brain traumas are not uncommon and studies show repetitive injuries to the head have serious short- and long-term consequences, including behavioral problems, headaches, cognitive attention disorders, sleep disturbances and mood disorders.

This is not a new discussion. It first began in the 1950s when the AAP decided to take a stronger stance against tackling in youth football. This was met with mixed emotions from the football community. Some agreed whole-heartedly and turned to medicine and technology to alleviate some of these injuries. For example, they encouraged new helmet designs and required players to have medical supervision while playing the game. Others disagreed, and argued that modifying the game would take away from the boys learning teamwork and mental toughness. Nevertheless, even with constant supervision, regular physical exams and improved helmets, players still were dying from a bad hit or the accumulation of minor head traumas. The main focus of this article is on brain injuries, but it points out the countless additional orthopedic risks posed to youth football players as well.

Policies are being made in response to these findings, both in football and other contact sports. For example, this past November, the US Soccer Federation passed a policy prohibiting headers for players under 10 years old. Right now, the biggest thing that can be done is encouraging conversations about the dangers of tackling with youth athletes. It is important to weigh the risks and benefits of the sports parents choose for their kids. Health care professionals can only do so much once an injury has occurred; prevention is key right now. Advocating for the safety of youth athletes is developing into an important role future health care providers will have to assume.

My question for the readers is: how do you think pharmacists can play a role in advocating for this cause? What about a pharmacist’s position allows them to get involved?

Original article can be read here.

Reference: Bachynski, Kathleen E. Tolerable Risks? Physicians and Youth Tackle Football. N Engl J Med. 2016;374:405-7

Weight Gain in Children

In the longitudinal study, researchers were determined to track and identify possible causes of adolescent weight gain in hopes of finding an area of effective intervention. The study included 652 children aged 4, 6 and 8 with follow-ups every two years as well as regular community health checkpoints. The body mass index and body fat phenotypes were measured for each of the children at the beginning and throughout the study. Of the beginning 652, nine percent were overweight and just .2 percent were obese. Additionally, genetic risks for obesity were measured using a genetic risk score for 32 single-nucleotide polymorphisms. The results of the study indicated that children with a higher genetic risk for obesity gained weight and fat mass much faster than those without. The study was looking more specifically at the appetite traits of individuals with and without the genetic risk for obesity in order to eventually use this as a means of treating and preventing obesity, especially in the younger populations. The study revealed that those children with a higher genetic risk for obesity had higher levels of obesogenic appetite traits meaning that their decision making and portion control were poor in comparison to a healthy individual.

Identifying this specific problem with weight gain in the adolescent population is significant in making a future change in the developments and obesity patterns of children. Knowing what area to target for intervention can help lead to a more successful treatment plan. The results of the study ultimately lead to the idea that education is a large part of the treatment plan. Teaching families including parents and the children at risk, how to eat healthy can avoid the significant weight gain associated with the genetic risk that may be unavoidable. As my future role in the field of medicine, I can make an impact with direct patient care and counseling to aide in the education process of treating and changing the appetite traits of children with a genetic risk for obesity.

JAMA Pediatrics. 2016;170(2)

Quality of Care in Adolescent Depression

12% of adolescents are diagnosed with depression. Depression is a chronic condition that impairs functioning and causes long-term outcomes to decline. Suicide is also a serious problem in this age group, because 8% of the adolescents with depression commit suicide. Depression can be treated with medications and therapy; however, up to 80% of adolescents that need help managing their depression do not receive quality care. This study seeks to determine how follow up care for adolescents with depression should be conducted, since there is a gap between initial treatment and follow-up visits.

The study was conducted with 4612 patients with an average age around 16 years old. 66% of these participants were females. It was a retrospective study from electronic health records. The data was collected from an initial date and then to three months later to determine if any follow-up visits occurred.

The results were that 68% of adolescents diagnosed with depression did not have a follow up symptom assessment and 19% did not receive any follow-up care. 40% of adolescents that were prescribed antidepressants didn’t have a follow-up documented for three months later in their original work-up. All the different health care sites also had completely different rates of going about their follow-ups if they were conducted.

I feel that this condition should definitely have follow up visits, especially when it is presented in adolescents. Follow-ups for drug related therapies are extremely important, because it is often hard to find the right dose and type of antidepressant that works well for the patient. Teenagers are also at a higher risk of suicide due to antidepressants, so they need to be watched closely. A better system that is universal should be implemented for adolescent depression. They should receive high quality of care, and they should be able to have this care universally. What are some ways we can spread awareness of depression in adolescents?

O’Connor BC, Lewandowski R, Rodriguez S, et al. Usual Care for Adolescent Depression From Symptom Identification Through Treatment Initiation. JAMA Pediatr. Published online February 01, 2016. doi:10.1001/jamapediatrics.2015.4158.