Tag Archives: teen

General

National Standards for Teen Drivers?

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During a single week in April, there were 18 driving deaths in Minnesota, most of them involving teens. In at least one crash, the driver was in violation of several of the state’s graduated driver license provisions. Graduated licensing is increasingly popular across the country, and incidents like this are prompting our legislators to tighten them.

One big problem is that each state sets its own licensing standards. And since most states insist on reinventing their own wheel, a patchwork of state standards has been enacted. Some have higher age minimums for obtaining a license. Others limit night driving or number of underage passengers. Most states have addressed phoning and texting while driving.

There is now a push in the US Senate to standardize graduated licensing rules in all states so there is a more even playing field.  The proposed legislation would:

  •  Make getting a driver’s license a 3 step process, including a learner’s permit, a restricted license, and finally an unrestricted license.
  • Prohibit nighttime driving without an unrestricted license.
  • Prohibit cell phone use without an unrestricted license.

The proposed law makes sense. Accident research has shown that states that adopt a more restrictive licensing policy see a significant reduction in crashes, and a reduction in injury crashes of nearly 40%. Fatal crashes in young drivers was reduced by a whopping 75% in these states!

The major problem with the proposed legislation is that the penalties for states not complying are rather heavy-handed. Such states would face losing some of their federal highway construction funding. Many states would face this issue soon if the law was enacted as it is now written.

Concerned parents should communicate with their legislators and support these efforts to protect their children. More immediately, though, parents need to be involved in the driving decisions of their children. Don’t allow them to drive after dark. Limit the number of passengers they can carry. Require them to use their seatbelts. And make sure they understand the consequences if they choose to break these rules: immediate and non-negotiable loss of driving privileges for a set period of time.

General

Evaluation After Head Injury in Adolescents

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Traumatic brain injury (TBI) is the most common cause of death in children. Even mild concussions can cause some degree of functional impairment. Many clinicians believe that the degree of impairment correlates with the initial Glasgow Coma Scale score (GCS), although this has only been shown in adults. This has led many hospitals to perform cognitive screening selectively, usually on adolescents with lower GCS scores.

A recent study by Goold and Vane at the Cardinal Glennon Children’s Medical Center in St. Louis, and the University of Vermont College of Medicine in Burlington looked at the correlation between GCS and level of impairment, and ways to determine which groups of adolescents need more sophisticated cognitive testing to evaluate deficits.

A total of 609 young adults age 13-21 with brain injuries were identified, and a cognitive screening test was performed (Occupational Therapy Head Injury Mini Screen [OT HIMS]). There was no correlation between GCS and the components of the OT HIMS. Interestingly, the GCS did not predict which patients were discharged to rehab centers either.

The Bottom Line: Adolescents can develop significant cognitive deficits or behavior issues after any degree of head injury. Because of this, it is not possible to selectively screen for cognitive deficits. All adolescents age 13-21 should undergo screening with an instrument like the OT HIMS after head injury.

At our Level I Pediatric Trauma Center, we consider a child to have a TBI if:

  • the mechanism involves head impact and
  • any of the following apply:
    • known or suspected loss of consciousness
    • cannot remember the event
    • parents detect any change in behavior

All of these children undergo a TBI screen performed by Gillette Children’s Specialty Hospital physiatry, occupational and physical therapy services. If needed, they receive followup in the Gillette Minor Neurotrauma Clinic.

Reference: Goold D, Vane DW. Evaluation of Functionality After Head Injury in Adolescents. Journal of Trauma 2009;67:71-74.