BCCHR’s Ask an Expert Series
We asked an expert about what families need to know about brain injuries.
Awareness of brain injury in the general public remains low. Acquired brain injuries can be caused by traumatic damage, an impact from outside the body, or by something inside the body such as a disease. Traumatic injuries result from the shaking of the brain inside the skull, which can be caused by a blow to the head or body, during a fall or motor vehicle collision, or may be a result from participation in sports or recreational activities.
Knowing how to recognize brain injury as early as possible and what to do is crucial to reduce potential long-term complications. Mild traumatic brain injuries are more prevalent in children and youth than adults, often as a result of sport- and recreation-related events. For Brain Injury Awareness Month, we talked to Dr. Shelina Babul, investigator at BC Children’s Hospital Research Institute (BCCHR) and director of the BC Injury Research and Prevention Unit (BCIRPU) at BC Children’s Hospital.
Dr. Babul is also director of the BC Children’s Hospital Canadian Hospitals Injury Reporting and Prevention Program (BCCH CHIRPP) and a clinical professor in the Department of Pediatrics at the University of British Columbia. She developed the Concussion Awareness Training Tool (CATT), an online resource that provides information and free e-learning courses on concussion. We asked Dr. Babul what families need to know about brain injuries, and she shared her thoughts on awareness, prevention, research, and patient care.
What types of brain injuries are common in children and youth?
Shelina Babul: Children and youth have a higher incidence of concussions, typically from sport and recreational activities. Concussion is a term that has been used for a long time, but over the past 10 years, it has been taken more seriously and is recognized as a mild traumatic brain injury (mTBI). Children typically are more vulnerable as a result of a concussion because their brains are still developing. In infants, 0-24 months, a serious brain injury can occur when a parent or caregiver gets frustrated with a baby’s constant crying and responds by shaking the baby to stop the crying. This can cause a rapid movement of the brain inside the skull and lead to serious disabilities or death. This is known as shaken baby syndrome (SBS) or referred to as traumatic head injury/child maltreatment (THI-CM). In B.C., the Period of PURPLE Crying — a province-wide educational initiative to prevent THI-CM/SBS and help support parents to cope with uncontrollable crying — has helped reduce the number of infants who have experienced THI-CM/SBS by 35 per cent.
When a brain injury occurs, how to know when to seek immediate support?
SB: When a potential concussion-causing incident happens, immediately look for red-flag symptoms such as severe or worsening headache, confusion, nausea, vomiting, or numbness and tingling of the arms and feet, to name a few. These are common in moderate to severe brain injury but may be present in mTBIs. If these are present, seek medical attention immediately so that a physician can do a clinical evaluation and determine whether a CT scan or other imaging is needed.
If children or youth sustain a brain injury that is not recognized and they continue to participate in regular activities, their symptoms may worsen and be prolonged, and they are three times more likely to sustain a subsequent injury.
Further, if an additional injury happens and isn’t recognized, they are now nine times more likely to sustain significant brain damage and, potentially, death. Second-impact syndrome is a rare event where a second concussion occurs shortly following and before the first one has healed, leading to brain swelling. It’s important to know that mTBIs appear normal on X-rays and CT scans, unless there’s a bleed to the brain or a fracture to the skull. To date, there is no diagnostic test to identify a concussion. Currently, diagnosis is purely based on clinical assessment, which includes assessing the number and severity of symptoms present, clinical history, circumstances around the event causing the injury, cognitive and balance testing, and checking of heart rate and blood pressure to determine whether an mTBI has occurred.
Is it important to have exams that can confirm the diagnosis for mild brain injuries?
SB: Currently there is no singular diagnostic tool for concussions. Diagnosis is based on clinical evaluation by a licensed medical professional, who would conduct a thorough clinical assessment. There's a lot of research, however, being done in this area. For example, if we use functional magnetic resonance imaging (fMRI) or diffusion tensor imaging (DTI), we will see changes in the composition (microstructure) of the brain, but that's not feasible at the emergency-department level because of the high costs of conducting those scans. There’s also work being done to determine if a simple blood test can be used for the diagnosis of traumatic brain injuries, but more research is needed.
From your perspective, why does public awareness of brain injury remain low?
SB: It’s the lack of education and awareness and the “it-won’t-happen-to-me” mentality, which shifts to “if only I knew” when it does happen to that individual. We really need to improve awareness and education in this area. One important step is the discussion around Bill C-277, an act for the establishment of a national strategy on brain injuries. The bill passed the second reading in the House of Commons this month, and was unanimously voted and referred to the Standing Committee on Health for consideration. These discussions show that society is moving towards taking brain injuries more seriously.
What can we do as individuals to increase awareness?
SB: Educate yourselves! Learn about the latest evidence around preventing, recognizing, diagnosing, and treating brain injuries.
Talk about the importance of this topic and let people know about resources such as the Concussion Awareness Training Tool (CATT) that was developed at the BCIRPU here at BC Children’s Hospital.
I’ve heard countless times, “I didn’t know about this tool. Someone told me about it. Thank goodness it’s available. It’s helped me so much.”
What key information would you like to leave our readers with?
SB: Absolutely take it seriously — traumatic or non-traumatic injuries. Progressively worsening symptoms require immediate attention by your family physician or even the emergency department. Know how to recognize a brain injury and what to do. Know about resources such as CATT. Depending on who you are, what you need to know is very different. For example, physicians in the emergency department need to know how to accurately diagnose brain injuries based on the latest evidence, while parents need to know how to manage their child’s injuries, especially those who are involved in sport, both recreationally and competitively. Up to 80 per cent of mild traumatic brain injuries have a symptom resolution within four weeks, so act fast to recognize it and seek help.
