EDs seeing an increase in gymnastics injuries
Nearly 27,000 gymnastics-related injuries are treated in EDs each year for children 6 to 17 years old, says a new study based on data obtained from the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission.1
Girls were more likely than boys to sustain upper extremity injuries, while head and neck injuries were more common in boys. Fractures and dislocations were most common for children 6 to 11 years of age, and strains and sprains were more frequent in the 12-17 age group.
"We are seeing an increase in injuries as more children are getting involved with gymnastics and cheerleading," says Laura Aagesen, RN, MBA, trauma coordinator for Northwest Community Hospital in Arlington Heights, IL. "The popularity of toddler gyms and tumbling classes have also attributed to this increase, along with the competition to do riskier stunts at greater heights."
To avoid complications with these injuries, do the following:
- Use RICE (Rest, Ice, Compress, Elevate) as soon as the child arrives at the ED.
"This can decrease the injury or length of recovery time," says Aagesen. "Do a thorough, hands-on evaluation of the injury, including inspecting, palpating, and auscultation."
- Immobilize extremities.
Regardless of whether your patient has a mild ankle sprain, tibia fracture, or severe knee ligament injury, extremities need to be properly immobilized, says Robert Frederick, MD, sports medicine specialist at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia. "You always have to make sure that the extremity is well perfused and document that all the nerves are functioning properly," he says.
Cervical immobilization especially is important for patients with facial trauma or a head injury, says Aagesen. "A patient should be put in a cervical collar while you are assessing the airway, with the head maintained in a straight alignment with the body," she says.
Even if a patient doesn't have neurological deficits, a cervical injury must be ruled out before the immobilization equipment is removed, cautions Aagesen. "Being diligent in cervical immobilization with a head injury is a must," says Aagesen. "Many times, the cervical spine is overlooked when a child strikes their head and the initial appearance is just a head injury."
Brain and cervical CT scans are the standard diagnostic tests when patients present with this type of injury, says Aagesen. "Overlooking a cervical injury can cause a neurological deficit, paralysis, or worsening ligamentous injury," she warns.
- Identify the mechanism of injury.
Does your patient report feeling the knee buckle and give way after dismounting from a balance beam? If so, suspect a potential injury to the ligamented structures. On the other hand, if they twisted their neck to the side when they landed, be concerned about a potential cervical spine injury and take appropriate precautions, says Frederick.
After learning exactly how the injury occurred, you'll have a sense of what structures might be at risk for injury, so attune your exam to those areas, says Frederick. "Where the child is most tender will lead you in right direction," he says.
Reference
- Singh S, Smith GA, Fields SK, et al. Gymnastics-related injuries to children treated in emergency departments in the United States, 1990-2005. Pediatrics 2008; 121:e954-e960 (doi:10.1542/peds.2007-0767).
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