Head Injury

[frangipanni]

Being new to school nursing, I would like to know what is the current practice for managing students with head injury at school, in particular the students that get their head hit while playing on the slide, swing etc. Neuro checks are all within normal limits. I personally will request for parents to pick the student up if he/she exhibits any s/s of head injury e.g. altered neuro status, altered vision and abnormal gait or even has a visible bruise or bump. I recently took over an elementary school and the school staff has adopted the practice of sending home all kids with head injuries. I think staying at school is important if one is fine, but the other hand, the liability aspect of head injuries is making me having second thoughts.

Any insights would be appreciated and helpful!

Thanks.

[Farawyn]

Go to your state website and look up the protocol for head injury/ concussion if your school district does not have one on the books.

[cdgoldilocks]

Our policy is that any head injury that you would call home or send a note, etc would have an incident report filled out. Ours is called Confidental School something-or-other report. We inform our administrator, fill out the form, then notify parent as appropriate. We have a head injury letter that we send home with the student.

[DEgalRN]

We have no written policy right now. It's incredibly frustrating. I'm working on one based on other ones I've found, and my goal is to have it implemented after being review by basically who ever needs to review it. Basically, a phone call, letter, and observations, with specific indications for pick up is what I'm looking at.

[NutmeggeRN, BSN]

Well, staying in school (or not) really depends on what presents upon assessment of the injury. Some kids hit their heads, and have absolutely no issues. If there is any hint of a concussion a parental notification and then usually a dismissal.

Why? Because they need to see a medical provider, get out of the light, away from the noise and begin a digital detox (no TV, texting, video games etc) and lots of brain rest.

The CDC has some great information Concussion and Mild TBI: This page has moved | Concussion | Traumatic Brain Injury | CDC Injury Center and some sample protocals and information to share with parents and teachers.

I am in HS so I deal with athletes all the time. Our kids do ImPACT testing, which is a neurocognitive assessment of their ability to do certain task( all on line) with speed and accuracy. It is not the be all and end all, but a tool that helps assess whether a student is on the road to recovery.

When a concussion is diagnosed or suspected, I notify the parents, teachers and guidance as well as admin. (small school, they like to be in the loop).

I attach a list of classroom accommodations (and advise when the ImPACT test will be repeated (no sooner than 72 hours after the injury and later if they are still symptomatic).

They cannot return to athletics or phys ed unless they are no longer in need of academic accommodations, cleared by MD and parents have signed off on recognition of the risk of return to play.

[SnowyJ, RN]

We have a concussion policy, but it is only instituted with known concussion. There is a return to school/return to play protocol that we strictly follow. MD's don't like it, because it also involves clearance from them to return to gym and sports.

I have written up an IHP for students with serious concussion. It includes educational modifications as appropriate.

I do SCAT-3 assessments if I suspect a concussion. Then I refer to MD for conformation. For minor bumps, I generally do a basic neuro assessment.

I do call parents if there is a head injury. Can't be too careful.

Need to get a "head injury" letter. Great idea!

[jhlpn]

We have a head injury letter and a concussion form. I call home for every head injury. If the parent opts to leave the kid in school I document as such. If I feel the injury needs assessed by MD I don't give the parent an option of picking up the student, "It's you either come get said student or I will send to ER via ambulance." Can never be too careful with head injuries. I would prefer parents pick up all students with head injuries.

[MrNurse(x2), ADN]

Our policy is any symptom sends the kid home to be evaluated with clearance note from physician. Had extremes of a girl not reporting symptoms with a double concussion to another complaining to the point that he was getting sent to my office for a week. All head injuries get a text sent to parents with CDC link to concussion S&S site.