PABI Plan - The Sarah Jane Brain Project

are largely unknown. In particular, clinical grading systems are not validated and have not
allowed for clinicians, patients or families to recognize the spectrum of post-concussive
symptoms. Further, the ED setting is unique in its focus on immediate care needs and its
inherent limitations with continuity of care.
The unacceptable reality is that many children with suspected “mild” TBI do not present to the
Emergency Department or even a pediatrician’s office. Injuries occurring in the home, on the
sports and recreation fields, in the schools, or on the roads may escape appropriate diagnostic
attention. This situation is due, in part, to the “invisible” nature of a “mild” TBI (i.e., lack of
visible broken bone or bruise) but is also due to a lack of appropriate knowledge of the injury
and its signs and symptoms. Improving the knowledge and skill regarding “mild” TBI of “first
responders” such as emergency medical technicians, school nurses, athletic trainers, child care
workers, and parents can serve to improve early identification and subsequent diagnosis of an
injured child or adolescent.
Limitations to the accurate diagnosis, assessment and treatment of concussion, coupled with the
morbidity of repeat concussions, leave patients at increased risk for poor outcomes. Early
identification and diagnosis is the key issue to promoting recovery. The greatest challenge to the
medical practitioner is appropriate and timely recognition, assessment and diagnosis. Without
state-of-the-art knowledge and clinical tools, “mild” TBI may go undiagnosed and untreated,
leaving individuals who have sustained a “mild” TBI at an even more increased risk for
functional problems.
Unique Challenges in “mild” TBI service delivery
Unique problems exist for providing care to children with “mild” traumatic brain injury (“mild”
TBI) and their families. In addition to the problem of under-identification, few specialty
outpatient clinics exist for active treatment and management. Contributing to this problem, few
trained pediatric clinical specialists are available with a focus on “mild” TBI. Hampering
service, evidence-based models of pediatric “mild” TBI care are not articulated and therefore,
clinicians do not have clear guidance regarding the development of these clinical care systems
within the continuum. With a shortage of specialized clinics to treat “mild” TBI and the
requisite professional expertise, a variety of problems are evident. Most importantly, without a
specialty system in place, the clinical problems that children and families face post-injury are at
increased risk for worse outcomes including re-injury, prolonged recovery, and possible
catastrophic outcomes.
In developing a nationwide “mild” TBI care system to manage this prevalent problem, the
following problems exist and require active solutions:
1. Resource problem: Not enough “mild” TBI-specific clinicians do exist in this field.
This includes “primary care” specialists as well as specific referral sources
knowledgeable about “mild” TBI (headache management, sleep intervention,
mood/anxiety treatment, gradual return to sports protocol, etc.).
2. Training problem: Training programs in medicine, neuropsychology, and
rehabilitation specialties are not preparing people for the unique services required for
“mild” TBI, i.e. rapid, focused and repeated assessment, active community
consultation, and individualized interventions.
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