When we think of “youth” and “concussion,” the first thing that likely comes to mind is a teenager engaging in a high-risk activity like football, soccer, or snowboarding. But that’s not a complete picture of brain injury among youth. There are millions of concussions reported every year, but figures put concussions related to sports and recreation at just 30%, meaning that 70% of concussions have other causes.
That’s the topic of my interview this month with Dr. Maya Evans, a physical medicine and rehabilitation (PM&R) physician at Shriners Hospital for Children – Northern California in Sacramento where she leads the spina bifida program. Dr. Evans is also an assistant clinical professor in the University of California – Davis Department of Physical Medicine and Rehabilitation. She’s board certified in PM&R, brain injury medicine, and pediatric rehabilitation medicine and her clinical interests include treating children with brain injury. You can watch that interview here.
As an introduction to the topic, I wanted to cover the most common causes of traumatic brain injury (TBI) and concussion (also known as mild TBI, or mTBI) in children and adolescents to show that the topic of youth and brain injury goes well beyond the high school football or soccer field.
The Top Four Causes of Brain Injury in Children and Adolescents
The CDC gathered statistics from 2000-2010 on TBI-related emergency department (ED) visits, hospitalizations, and deaths according to age group and cause of injury. Rates of TBI-related ED visits increased for all age groups during that period. The rates of TBI-related ED visits increased the most for youth four years of age and younger. From 2007–2008 to 2009–2010, the rates of TBI-related ED visits in this group increased by more than 50%. Children 0 to 4 years of age had the highest rates of any age group, typically with almost twice the rate of those in the next highest age group (15–24 year-olds).
Here are the top causes of brain injuries, including concussions, as reported by the CDC in children and adolescents.
Falls are by far the leading cause of TBI-related visits to the ED among children 0-4, eclipsing all other causes. They’re also the leading cause of ED visits among children 5-14. While falls are common causes of ED visits and hospitalizations among children, they are not a leading cause of TBI-related death.
Motor vehicle accidents
Motor vehicle accidents are much more likely to be the cause of TBI-related deaths, responsible for a little under half of all TBI-related deaths in children and adolescents. In comparison, falls are responsible for less than 5% of deaths across these age categories.
Motor vehicle accidents are the #1 cause of TBI-related deaths among children 5-14 and are the #1 cause of TBI-related ED visits and hospitalizations for older teens.
Struck by or against
This category describes brain injuries that occur from being hit on the head by an object or from running into an object. This is the second leading cause of TBI, accounting for about 15% of TBI-related ED visits, hospitalizations, and deaths in the United States in 2013. Injuries caused by being struck by/against an object account for 35% of injuries in youth 5–14 years of age who are diagnosed with a TBI during an ED visit. Like falls, this category of injury is more likely to result in ED visits than in death.
Assault is the leading cause of TBI-related death among children 0-4. It’s also a common cause of TBI-related ED visits and hospitalizations in older teens.
Learn More About TBI and Concussion in Children
In this month’s interview, I go much further in depth on the topic of children and brain injury with Dr. Maya Evans. We discuss the consequences of brain injury in children, some ways to prevent them, how evaluation and treatment differs between children and adults, and much, much more. Don’t forget to watch that interview here.