Minutes Count When Your Child’s Bump on the Head Becomes Life-threatening

Landon’s injury at first seemed minor, a small bump on the head during a harmless game in his elementary school gymnasium.

It was a typical Tuesday afternoon and the 7-year-old had been playing “four corners” during his school P.E.  class when his feet became tangled with a classmate’s, and he fell to the ground fast, striking his head against the gym floor.

His classmate and a coach helped Landon to his feet. The boy seemed shaken and a little unsteady, but otherwise fine. Out of an abundance of caution, the school nurse called home to tell Landon’s parents about the incident.

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Then, in a moment, everything changed.

Landon began projectile vomiting and slipping in and out of consciousness, his father, Stephen Courtney, said. The school nurse called Landon’s parents again, this time with panic in her voice. Courtney raced to his car to meet his son as the boy was rushed in an ambulance to the local emergency room in his hometown of Lufkin in East Texas.

“Despite the turn for the worse, Landon still seemed to be OK,” Courtney recalled. “He was definitely hurting but it didn’t seem too serious. We thought, ‘Maybe he has a bad concussion?’”

Emergency staff took him to the back for a CT scan, and while they initially seemed confident that Landon’s injury wasn’t life-threatening, the look on the doctor’s face after reading Landon’s scans said otherwise. Landon’s injury had caused bleeding on his brain, the physician told Landon’s parents. Without emergency brain surgery, Landon would surely die. And the nearest facility able to perform such a procedure was 120 miles away in Houston.

It was a typical Tuesday evening and Dr. David Sandberg had just finished seeing outpatients in clinic, when he got the call from the trauma team that a 7-year-old boy with a large epidural hematoma was en route to the hospital. Given the diagnosis, Dr. Sandberg knew the case was critical.

Dr. Sandberg, who is the director of pediatric neurosurgery at Children’s Memorial Hermann HospitalMemorial Hermann Mischer Neuroscience Institute at the Texas Medical Center and McGovern Medical School at UTHealth, sprung into action, racing to the Level I Trauma Center at the Memorial Hermann Red Duke Trauma Institute to meet Landon the instant he arrived.

And as soon as paramedics from Landon’s air ambulance wheeled the boy through the doors, Dr. Sandberg knew something was seriously wrong.

“In front of my eyes, one of his pupils started to dilate,” Dr. Sandberg recalled. “What that means is that his brain is shifting over from the blood clot and the patient is at risk of death or permanent disability without immediate intervention. It’s a life-threatening emergency. You have to move quickly.”

It’s no easy feat to mobilize an emergency brain surgery.  Staff must be available at a moment’s notice and an operating room must be prepared with appropriate equipment ready to go. Patients must be entered into the system, hooked up to machines that monitor vital signs, and have appropriate intravenous and arterial lines placed.   The patient then needs to be positioned for the procedure and have his or her scalp prepped. It’s a process that takes time, but given how dire Landon’s situation was, Dr. Sandberg and the neurosurgery team knew they had no time to waste.

“We move quickly – that’s what we do at Children’s Memorial Hermann Hospital, and I think we do it as well as or better than any other hospital in the country,” Dr. Sandberg said. “Because we’re an experienced and busy trauma center, there’s a common sense of purpose and knowledge that drives our staff to move quickly without sacrificing safety.”

As the operating room was being prepared, Dr. Sandberg called the boy’s parents.  He explained the procedure and the considerable risks, and he warned Landon’s parents, both pastors at a church in Lufkin, that he couldn’t guarantee a favorable outcome.

Landon

“It was so scary to hear, but we appreciated his honesty,” Courtney said. “As we were speeding from Lufkin to Houston, me and my wife, we were just praying and crying. And I was reminded as a father that the Lord gives us children to raise and take care of and to love, but at that moment, I couldn’t do any of that. Only pray for my son.”

Within nine minutes of arriving at the hospital, Landon was on the operating room table, Dr. Sandberg at his side ready to make the first cut. He made a large incision in the shape of a reverse question mark into Landon’s scalp, extending from his ear around his neckline, and removed a large section of bone. Immediately underneath the bone, in the epidural space between his skull and the covering over his brain, Dr. Sandberg found the problem, a massive blood clot shifting the brain considerably.

Traumatic brain injuries like Landon’s are surprisingly more common than most people realize, Dr. Sandberg said, and the emergency brain surgery the boy received is fairly straightforward — remove the clot, stop the bleeding, close the skull. But speed is critical, he said.

“It’s well published that every minute counts for these types of injuries,” he said. “Had he arrived at the hospital just an hour later, or if we had delayed rushing him to the OR, he might have died or never been the same kid again. Instead, he walked out of the hospital and he’s just fine.  As a physician, Landon’s outcome is just so gratifying.  Even though we do this day in and day out, I never cease to be amazed at the teamwork that can enable a child to have life-saving surgery so quickly after they arrive at our hospital.”

Less than an hour after Landon’s parents arrived at the hospital, Dr. Sandberg met with them to share the good news: Their son had survived. Over the next few days, Landon bounced back quickly. Within hours of the operation, his breathing tube and catheter were gone, and he was able to smile and say, “Daddy.”

“That’s when I finally just lost it,” Courtney said.

Within days, Landon was eating and walking on his own. In less than a week, he was discharged and able to return home. Within three months, Landon had completely recovered, jumping on his trampoline and chasing his family around with his Nerf gun.

“I just can’t believe where he’s at today versus the kid I saw in the emergency center in Lufkin,” Courtney said. “I’m just forever grateful to Dr. Sandberg and his team and everyone who moved so quickly because time was truly of the essence.”

For more information about Children’s Memorial Hermann Hospital, visit http://childrens.memorialhermann.org/.

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