Eye tracking to help determine concussion severity

Using an eye-tracking method may help spot concussions and help determine their severity.

A new eye-tracking method might help determine the severity of concussions, researchers report.They said the simple approach can be used in emergency departments and, perhaps one day, on the sidelines at sporting events.

"Concussion is a condition that has been plagued by the lack of an objective diagnostic tool, which in turn has helped drive confusion and fears among those affected and their families," said lead investigator Dr. Uzma Samadani. She is an assistant professor in the departments of neurosurgery, neuroscience and physiology at NYU Langone Medical Center in New York City.

"Our new eye-tracking methodology may be the missing piece to help better diagnose concussion severity, enable testing of diagnostics and therapeutics, and help assess recovery, such as when a patient can safely return to work following a head injury," she explained in an NYU news release.

According to researchers, it's believed that up to 90 percent of patients with concussions or blast injuries have eye movement problems. But the current method of assessing eye movement is asking a patient to track a doctor's finger, Samadani said.

The new method was originally developed by Samadani and her colleagues to assess eye movement in U.S. military personnel believed to have concussion or other types of brain injuries.

The researchers compared 75 trauma injury patients and a control group of 64 healthy people. The movements of the participants' pupils were tracked while they watched a music video for a few minutes.

Thirteen trauma patients who hit their heads and had CT scans showing new brain damage, and 39 trauma patients who hit their heads and had normal CT scans, were much less able to coordinate their eye movements than trauma patients who hadn't hit their heads and those in the control group.

The more severe the concussion, the worse a patient's eye movement problems, according to the study. Results were published online Jan. 29 in the Journal of Neurotrauma.

Dr. M. Sean Grady, chair of the neurosurgery department at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, said, "The importance of this study is that it establishes a reliable test and a 'biological' marker for detecting concussion." He was not involved in the study.

"Since concussion can occur without loss of consciousness, this can be particularly important in sideline evaluations in athletics or in military settings where individuals are highly motivated to return to activity and may minimize their symptoms. More work is needed to establish its sensitivity and specificity, but it is very promising," Grady said.

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Reducing severity of brain injury in children - Recreational Safety

A study of brain injury in children indicated that education and attempts at prevention can reduce the severity of a brain injury.

An exhaustive analysis of data from more than 40,000 cases of brain trauma in children -- published by the New England Journal of Medicine -- provides convincing evidence that protecting children in advance from head injuries is the key to reducing their severity.

The new findings, obtained during one of the largest multi-center prospective studies of its kind ever conducted in the United States, show that the most common cause of brain injury among children younger than 12 is falling -- typically from a moving bicycle, scooter or other wheeled device. Among U.S. adolescents, the three major causes of brain trauma are automobile accidents, assaults and sports-related injuries. Based on a previous study of pediatric brain trauma that studied children's medical histories at 25 sites in the Pediatric Emergency Care Applied Research Network (PECARN), the newly-released findings send a clear safety message to parents and caregivers alike, said Children's Hospital of Michigan Division Chief and Research Director of Emergency Medicine Prashant V. Mahajan, M.D., one of the authors.

"We studied a very large cohort of patients in our secondary analysis of this previously collected data," said Dr. Mahajan, professor of pediatrics and emergency medicine at the Wayne State University School of Medicine, "and the good news for all of us is that they demonstrate clearly the importance of prevention in protecting children from brain trauma. The bottom line on this prospective study of more than 43,000 pediatric brain injuries is that it identifies falls -- often from bicycles -- as the major cause of trauma in children under age 12. Knowing that, we're now better able to help educate parents and policymakers alike about the great value of safety helmets for this population of kids."

Dr. Mahajan said the data on adolescent brain trauma similarly underlines the vital importance of providing sports safety equipment and automobile seatbelts for teenagers.

"Once again, the implications of this very large study are crystal clear," said Dr. Mahajan, who has spent the past 18 years treating injured tots and teenagers at the Children's Hospital of Michigan, part of the Detroit Medical Center. "Our study really emphasizes the importance for pediatricians of educating parents as a key strategy for reducing the severity of such brain injuries among children everywhere."

Dr. Mahajan said his 18 years in pediatric emergency rooms have shown him the importance of prevention, and sometimes in very dramatic fashion. "As a specialist in emergency medicine, I've seen how important such preventive measures as bike safety helmets and automobile seatbelts truly are."

"On several occasions," he added, "I've treated injured children who had been protected by safety equipment and also injured children who have not been protected, during the same eight-hour shift in the emergency room. In most cases, the children who had benefited from wearing the helmets or seatbelts sustained less severe injuries.

"That's the lifesaving message contained in this study -- and it's the message I want to convey to parents and pediatricians everywhere, as a doctor who cares passionately about preventing fatal or disabling brain trauma in children."

Dr. Steven E. Lipshultz, pediatrician-in-chief at the Children's Hospital of Michigan and chair of pediatrics for the Wayne State University School of Medicine, noted, "Dr. Mahajan has long been a dedicated researcher with a great passion for conducting clinical studies that help improve patient care. As his new study reveals in compelling detail, the knowledge that our Children's Hospital of Michigan researchers gain every day is extremely important in improving the quality of the health care we provide to children day in and day out."

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