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7-year-old suffers skull fracture after falling at school; mom angry at school nurse

By KBell
Sept. 27, 2011 at 4:27 a.m.
Updated Oct. 6, 2011 at 5:06 a.m.


SYMPTOMS OF SERIOUS HEAD INJURIES

Changes in, or unequal size of pupils

Chronic or severe headaches

Coma

Fluid draining from nose, mouth or ears (may be clear or bloody)

Fracture in the skull or face, bruising of the face, swelling at the site of the injury, or scalp wound

Irritability (especially in children)

Loss of consciousness, confusion or drowsiness

Loss of or change in sensation, hearing, vision, taste or smell

Low breathing rate or drop in blood pressure

Memory loss

Mood, personality or behavioral changes

Paralysis

Restlessness, clumsiness or lack of coordination

Seizures

Speech and language problems

Slurred speech or blurred vision

Stiff neck or vomiting

Symptoms improve and then, suddenly, get worse

Source: www.nlm.nih.gov

CHILDREN AT RISK FOR TRAUMATIC BRAIN INJURY

Children up to 4 years, adolescents ages 15 to 19 years, and adults 65 years and older are most likely to sustain traumatic brain injury

Almost half a million emergency department visits for traumatic brain injury are made annually by children 14 years and younger

Traumatic brain injury is a contributing factor to a third of all injury-related deaths in the United States

About 75 percent of traumatic brain injuries that occur each year are concussions or other forms of mild injury.

Source: Centers for Disease Control

An hour after he slipped on water and hit his head in a Schorlemmer Elementary School bathroom, second-grader Michael Rodriguez arrived home with a headache and feeling nauseated.

His mother, Michelle Robinson, said by the time her 7-year-old told her about the fall that Friday evening, he was slurring his words and speaking slowly.

At 6 p.m., Robinson rushed her son to the emergency room of DeTar Hospital-North.

"He was screaming 'Oh, my brain hurts, my brain hurts.' He kept saying, 'I'm going to throw up,'" Robinson, 25, recalled.

The doctor ordered a CT scan, and Robinson said she spent the rest of the weekend in the hospital alongside her son, who had suffered a cerebral contusion.

On Sept. 18, Michael was released from the hospital, and Robinson turned her attention to a school nurse, who Robinson said did not properly handle her son's injury.

"My son is now traumatized. He had to go through multiple CAT scans and IV's." she said. "He is scared of people in scrubs. He's 7 years old, and all of this, I don't want it to happen to another kid."

The mother of four said she had been having difficulties communicating with the nurse about different medical problems her son was experiencing.

"I personally went to the office and told her, 'I don't care if it's something as little as a cut on his knee, I want to know,'" Robinson said. "At that time, she pulled all my kids' emergency medical cards and wrote on there in red pen, 'Call mom for anything.' She led me to believe that communication was going to be better."

Robinson did not receive a phone call about her son's afternoon head bump.

But it was Michael's nurse's pass that really shed doubt on whether her son's head injury was addressed properly, Robinson said.

The pass, signed by the nurse, shows Michael's teacher sent him to the nurse's office at 2:10 p.m. "Says he hit his head on floor," is written above the clinic dismissal time, which is also 2:10 p.m.

Questions to the school were referred to Diane Boyett, district communications director.

Boyett confirmed the nurse was in her first year with the district and had obtained her licensed vocational nurse certification.

Boyett said she did not know exactly how long Michael was in the nurse's office, but that she was confident it was more than a minute.

"Clearly, I cannot speak to times that are hand-written on paper. I don't know if the times are based on the clock on a wall or a watch on the wrist, or even a mistaken glance at either," Boyett said in an email.

Robinson said she asked the school to review how the nurse handled the situation since her son said he was simply given an ice pack and sent back to class.

Boyett said the nurse was found to have followed protocol, but added, "Certainly, a phone call to a parent would have been appropriate."

"The nurse reported she examined the student and found no symptoms of head injury. To conduct such an examination means she would have to have followed standard protocols," Boyett said. "She states that the child had no symptoms of head injury when she sent him back to the classroom."

Standard protocol, Boyett said, includes monitoring students for approximately 20 minutes and watching out for symptoms like irregularity of speech, blurred vision and pupil reactions, among other things.

In another email, Gloria Wearden, VISD coordinator of Health Services, said, "In VISD, we use nationally accepted school nurses protocols for managing illness and injury in the nurses office. Protocols are not laws, they are suggestions for best practice in given situations. Nurses still have to make judgment calls about specific cases in the nurse office."

John McNeill, medical director and owner of Twin Fountains Walk-In Clinic, said most head injuries are mild and not associated with brain injury or long-term complications.

"Most children who do not have immediate symptoms do well. The most important thing, though, is careful observation, and what you watch for specifically is any change in mental status."

McNeill said he ensures children with head injuries can be monitored for at least 24 to 48 hours.

VISD's health services has a head injury form nurses may decide to send home with parents, which informs them the child received a head injury and explains symptoms for which to be on the look-out.

Robinson said she received no form.

The Monday after Michael was released from the hospital, Robinson withdrew her three children from Schorlemmer Elementary. The students had transferred to the school this year after the closing of Outreach Word Academy.

"My kids loved (Schorlemmer Elementary). They loved their teachers, and it was so hard to transition in from Outreach because they had been going there for years. They had to move all over again," she said.

VISD allowed Robinson to transfer her children to Crain Elementary School, where they're now settling in well, she said.

"What if it happens again? What if it happens to another child, and it's worse next time? I will be more than happy to use my son as an example and do something to reprimand this nurse, or it can happen again," Robinson said.

Boyett declined to comment on what type of actions may be taken against the nurse, citing personnel issues that are not disclosed to the public.

Wearden said she is instructing nurses to contact parents when a child reports a head injury and to send home the head injury form if the nurse feels the parent needs the information.

Robinson and her husband are exploring their legal options.

Corrected Oct. 6, 2011.

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