Correct seat belt use saves children's lives

Nine out of ten children are seriously or fatally injured in traffic accidents because they are incorrectly restrained or because of loose objects in cars. Credit: Marianne Skjerven-Martinsen, NIPH

Nine out of ten children are seriously or fatally injured in traffic accidents because they are incorrectly restrained or because of loose objects in cars. Correct use of safety equipment will save more lives, according to a new study from the Norwegian Institute of Public Health (NIPH).

Why are some children seriously or fatally injured in traffic accidents while other children in the same vehicle walk away without physical injury? This is one of the main questions Dr Marianne Skjerven-Martinsen at the NIPH studied as part of her doctoral dissertation.

The study is part of the research project 'Barn i bil' (Eng: Children in cars), a collaboration between the NIPH and Oslo University Hospital. As part of the project, a roadside study of normal traffic on Norwegian high-speed roads also took place which showed that every third child was incorrectly restrained.

Correct seat belt use is crucial

By investigating traffic accidents in Norway, Skjerven-Martinsen and her colleagues documented that incorrect restraint and loose objects in cars play a significant role in the number of deaths and injuries among children.

The results show that:

• Accidents where children are seriously injured mainly occur on high speed roads, in weekend traffic and most often follow frontal collisions on roads without crash barriers between carriageways.
• More than 9 out of 10 children who were seriously or fatally injured in traffic accidents were incorrectly restrained or were hit by loose objects in the car.
• The most common error is that the seatbelt is misplaced, with the shoulder belt under the arm or behind the back, or the lap belt is placed too high on the abdomen.
• Loose objects also cause damage to passengers, often indirectly when heavy luggage shifts, displacing the rear seat where the child is sitting.
• Correctly secured children have a low risk of injury, even in a heavy collision.

Children over 4 years are injured most frequently and the most common injuries are to the head, face, chest and abdomen.

For younger children, the most common errors are loose or misplaced straps.

Learn from experience

"We see that adults want to protect their children but they may lack knowledge of what can happen if the equipment is not used properly. The aim of this study was to evaluate the incorrect usage of child restraint in the vehicle, related to the child's height, age and type of equipment. In this way, we can give advice to parents, authorities and particularly the motor industry," says Skjerven-Martinsen.

In her thesis, she also described how children of different ages should be secured to prevent serious injury in car accidents. The findings provide a scientific basis for targeted prevention.

Source: Norwegian Institute of Public Health

Football players found to have brain damage from mild 'unreported' concussions

The images from the Ben-Gurion University of the Negev JAMA Neurology study represent Blood-Brain Barrier (BBB) Permeability in Football Players (A) vs. a control group (B). The players in the pathological-BBB group (B) presented focal BBB lesions in different cortical regions including the temporal (player 4), frontal (player 5), and parietal (player 6) lobes. Both gray and white matter were involved. Credit: Image courtesy of American Associates, Ben-Gurion University of the Negev

A new, enhanced MRI diagnostic approach was, for the first time, able to identify significant damage to the blood-brain barrier (BBB) of professional football players following "unreported" trauma or mild concussions. Published in the current issue of JAMA Neurology, this study could improve decision making on when an athlete should "return to play."

According to Prof. Alon Friedman, from the Ben-Gurion University Brain Imaging Research Center and discoverer of the new diagnostic, "until now, there wasn't a diagnostic capability to identify mild brain injury early after the trauma. In the NFL, other professional sports and especially school sports, concern has grown about the long-term neuropsychiatric consequences of repeated mild Traumatic Brain Injury (mTBI) and specifically sports-related concussive and sub-concussive head impacts."

The paper, published by researchers at Ben-Gurion University of the Negev (BGU) and Soroka University Medical Center, describes a new diagnostic approach using Magnetic Resonance Imaging (MRI) for detection and localization of vascular pathology and blood-brain barrier breakdown in football players.

The images from the Ben-Gurion University of the Negev JAMA Neurology study represent Blood-Brain Barrier (BBB) Permeability in Football Players (A) vs. a control group (B). The players in the pathological-BBB group (B) presented focal BBB lesions in different cortical regions including the temporal (player 4), frontal (player 5), and parietal (player 6) lobes. Both gray and white matter were involved.

"The goal of our study was to use our new method to visualize the extent and location of BBB dysfunction in football players using Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) on a Phillips 3-T Ingenia. Specifically, it generates more detailed brain maps showing brain regions with abnormal vasculature, or a 'leaky BBB.' "

Study participants included 16 football players from Israel's professional football team, Black Swarm, as well as 13 track and field athletes from Ben-Gurion University who served as controls. All underwent the newly developed MRI-based diagnostic.

The DCE-MRIs were given between games during the season and revealed significant damage.

Forty percent of the examined football players with unreported concussions had evidence of "leaky BBB" compared to 8.3 percent of the control athletes.

"The group of 29 volunteers was clearly differentiated into an intact-BBB group and a pathological-BBB group," Friedman explains. "This showed a clear association between football and increased risk for BBB pathology that we couldn't see before. In addition, high-BBB permeability was found in six players and in only one athlete from the control group."

Friedman also explains that not all the players showed pathology. This indicates that repeated, mild concussive events might impact some players differently than others. This level of diagnosis of individual players can provide the basis of more rational decision making on "return to play" for professionals as well amateurs of any age.

"Generally, players return to the game long before the brain's physical healing is complete, which could exacerbate the possibility of brain damage later in life," says Friedman.

A decade of research in the BGU Laboratory for Experimental Neurosurgery has shown that vascular pathology, and specifically dysfunction of the blood-brain barrier (BBB), plays a key role in brain dysfunction and degeneration, and may be an underlying cause of neurodegenerative complications after brain injuries.

The BBB is a highly selective permeable membrane that separates circulating blood from extracellular fluid. It protects the brain by preventing many dangerous substances from penetrating, and therefore is not meant to be damaged.

Medical researchers, including Friedman's group at BGU, are working to find ways to find drugs that will target the BBB and facilitate its repair, allowing for the prevention of Alzheimer's disease and other brain-related disease.

"Prof. Friedman has been able to conduct this breakthrough brain research using the state-of-the-art MRI machine donated as a result of contributions from American Associates, Ben-Gurion University of the Negev (AABGU)," explains Doron Krakow, AABGU executive vice president. "We believe that with continued support, Prof. Friedman and the DCE-MRI can help render more accurate and informed decisions by athletes and others exposed to mild concussions about when to resume activities."

Source: American Associates, Ben-Gurion University of the Negev