A University of Florida 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 (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 is leading the group 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 abnormalities on neurological, cognitive or balance tests, symptoms or biomarkers. Joseph and the other team leaders will meet in Atlanta early next year to discuss their findings on their individual topics.
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 help ensure consistent and evidence-based care of young patients with mild TBI, according to a CDC news release.
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 are keeping an eye on symptoms and keeping TBI top of mind in treating youth patients.
Joseph’s research and professional involvement has led her into the area of youth TBI in recent years. As chair of the Pediatric Emergency Medicine sub-committee 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 presenting with possible TBI.
Joseph’s interest in the issue grew, and she’s leading two studies in Jacksonville gauging parental awareness about concussions and their symptoms. She and other researchers surveyed more than 600 parents of youth football and youth 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 neuro-imaging for youth sports concussions.
On a national level, as the chair of the Pediatric Emergency Medicine Section for the American College of Emergency Physicians, Joseph helped review the "Heads Up" campaign developed by the CDC in 2005, to educate health care providers, trainers and coaches about head injuries in youth sports. The "Heads Up" standards are the most recent standard, but Joseph said the time has come for clear-cut, clinical guidelines because of the rise in attention given to mild TBI in youth and the risk of radiation associated with computed tomography.
As a soccer parent herself, she’s pushing to get the word out and saw some results first-hand at one of her sons’ tournaments in Georgia last month. One of her son’s teammates was kicked right above the eye, opening up a deep, bloody cut.
She and other parents who happened to be doctors were looking at the boy. When the player stood up, the referee looked right past the doctors, said the boy was unsteady on his feet and 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."