www.aapnews.org
Volume 32 • Number 7 • July 2011
Focus On Subspecialties
Chapters Views and News
Are you ready for the ‘silent epidemic’?
Wave of legislation on sports concussions portends
greater involvement of physicians in injury management
AAP continues to fight
gag legislation on
firearm safety counseling
by Philipp R. Aldana, M.D., FAAP, and
Mark S. Dias, M.D., FAAP
Traumatic brain injury (TBI) has long been referred
to as the “silent epidemic.” Although TBI is quite prevalent, individuals who suffer from
its disabling symptoms often do
not show any outward signs of
trauma.
Concussions are the mildest
and most common form of TBI,
resulting in 144,000 emergency
department visits annually (
Mee-han WP, Mannix R. J Pediatr.
2010; 157:889-893).
Recent media coverage on
TBI, especially in young athletes,
has elevated the public’s awareness regarding such
injuries. Of significant importance to any medical professional caring for children with concussions are the
recent efforts of organized sports governing bodies and
state and federal legislators to mandate standardized
management of the amateur athlete who suffers a sport-related concussion.
The TBI suffered by Zackery Lystedt, a high school
football player in Washington state, precipitated the
recent spate of regulations. In 2006, the 13-year-old
sustained a mild TBI (likely a concussion) at a football
game. After he “shook off” his symptoms, he was allowed
to return to play in the second half of the game and sub-
sequently collapsed. He developed severe brain edema,
required emergent decompressive brain surgery, and
suffered numerous strokes and a prolonged coma fol-
lowed by significant physical and cognitive disability
In May 2009, the state of
Washington passed the Lystedt
law, which mandates that
schools take specific steps in the
management of the youth ath-
lete who has sustained a concus-
sion during play to prevent any
further brain injury due to a pre-
mature return to play. Since
then, 20 additional states have passed similar sports-
related concussion laws, and 21 more have pending leg-
islation ( www.sportsconcussions.org/laws.html). In
addition, a similar bill was introduced this year in the
U.S. Congress ( http://timbishop.house.gov/index.
cfm?sectionid=79§iontree= 3,79&itemid=1841).
(see www.cdc.gov/media/sub
topic/matte/pdf/031210-Zack-
story.pdf for details).
from the AAP Department of
Community, Chapter and State Affairs
See Concussions, page 13
ID Snapshot What’s the Dx? The negative stain electron micrograph above shows the virus detected in the stool of an 11-month-old with a history of vomiting and diarrhea. What is the cause of the infection? See page 6.
After Florida Gov. Rick Scott signed controversial legislation to restrict physician counseling
on firearms, the AAP Florida Chapter/Florida
Pediatric Society filed an injunction to stop the
law from taking effect.
The law limits the ability of physicians, nurses
and other medical staff to ask patients, or in the
case of children, a parent about guns in the home
under threat of sanction by the state’s board of
medicine. Florida became the first state to restrict
physician counseling on firearms.
The injunction, which cites a violation of a
physician’s First Amendment right to free speech
among its legal arguments, also was supported
by the Florida chapters of the American Academy
of Family Physicians and the American College
of Physicians.
“This law severely limits vital conversations
that a physician may have with his or her patient
about an important safety issue,” said Bruce
Manheim, J.D., a partner in the Washington,
D.C., office of Ropes & Gray, who serves as lead
counsel on the case. “The court should strike
down the Florida statute since it constitutes a
blatant violation of the rights of both physicians
and their patients under the First Amendment.”
The Florida Pediatric Society opposed HB
155 from its introduction in January.
“We had heard rumblings about this bill from
Florida legislators before the session even started,”
said Lisa Cosgrove, M.D., FAAP, president of
the Florida Pediatric Society. “Even before it was
introduced, we were in high gear working within
a coalition of medical specialty societies and like-
See Counseling, page 7
In this issue
Up close and personal
Meet your candidates for AAP pres-
ident-elect, Mary P. Brown, M.D.,
FAAP (top), and Thomas K. McInerny,
M.D., FAAP (bottom).
Pages 10-11
