Tuesday, March 24, 2009

Shining more light on pediatric trauma

It was just another soccer tournament for 14-year-old Megan Lund, a freshman at Needham High School, as she played on a field in Florida this past fall. That is, until the final two minutes of the game when Megan knocked heads with the goalie and then hit her head on the ground after falling back from the impact. After being rushed to an emergency room in a Florida hospital, she was not told she had a concussion. Still, she returned home with unwanted souvenirs: paralyzing headaches, dizziness and drowsiness. Her mother, Sharon Lund, knew something wasn’t right.

“We took her to her pediatrician, who gave her pain medication,” she says, “but that actually made her headaches worse, and she wasn’t able to go to school while she was on narcotics.”

Lund’s mother describes feeling helpless until she found out from a “soccer dad” that there was a pediatric trauma clinic at MassGeneral Hospital for Children (MGHfC) that saw patients just like Megan.

Help is just a phone call away

One phone call later, Megan was scheduled for an appointment with Caren Harris, PNP, the pediatric nurse practitioner who runs the clinic every Tuesday. Harris started the clinic with pediatric trauma surgeon Peter Masiakos, MD, to meet the needs of patients who receive traumatic injuries but, more often than not, go without necessary follow-up consultations to ensure proper healing.

“Sometimes if you dig deeper you find out there’s more going on,” says Harris, who often finds her patients’ injuries to be more complex than they realize. “This clinic provides the opportunity to help identify any ongoing issues and work with the children to optimize their recovery.”

After examining Lund, Harris knew she had suffered a concussion and that it would take awhile for her brain to heal – requiring a lot of rest. She scheduled follow-up visits and reached out to Lunds’s school to make sure she wasn’t going to overexert herself, which would be detrimental to the healing process. She worked with Megan’s school to reduce her course load, incorporating necessary time for rest and extra time for test-taking to reduce stress, which affects the brain and contributes to headaches. Lund was not allowed to participate in any physical education classes or sports until Harris gave the green light. “She wasn’t even allowed to go for a walk with me,” Lund’s mother says, “and she wasn’t able to watch TV or use the computer.”

Though Megan was afraid of falling behind in classes and wanted to do normal things her friends were doing, Harris taught her to regulate her activity in order to reduce and eventually entirely eliminate her headaches.

Healing is an evolution

“It’s an evolution,” says Harris, “And helping families through that evolution is part of the process.”

The Pediatric Trauma Follow-Up Clinic at MGHfC provides comprehensive evaluation and timely specialty referrals for children who have sustained a traumatic injury and previously undergone evaluation and treatment in a hospital or ambulatory setting. The clinic sees patients who have experienced trauma such as concussions, sports injuries, motor vehicle accidents, stab and gunshot wounds and physical abuse. Some injuries require multiple-specialty involvement and, when indicated, referrals to MGHfC specialists – from neurologists to physical therapists – are provided to ensure that each patient receives the best possible treatment plan to ensure a quick, successful recovery.

Masiakos says the idea for the clinic has stemmed from years of service as a pediatric trauma surgeon where he found that many patients had no place to go for effective follow-up after their initial surgery or treatment.

“I’ve seen a lot of kids who experienced various traumatic injuries who were evaluated and released with no plan for return to a physician.” he says. “I heard parents say that after a severe head injury, their kids were not the same and that their schoolwork was suffering. Caren and I envisioned the clinic providing services these kids weren’t getting elsewhere.”

The clinic is living up to its expectations. Today, Megan is back to her normal self, taking all of her regular classes and practicing on the indoor soccer field.

“Caren was wonderful,” says Lund’s mother. “Before we went to see her my daughter was on a rollercoaster ride. Not only did I really trust her advice, but her school relied on her as well. With her help, we saw her progression finally going in the right direction.”

Learn more about the Pediatric Trauma Follow-Up Clinic

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