Dr. Lumba-Brown is a pediatric emergency medicine physician with expertise in traumatic brain injury and neurocritical emergencies. She is the co-director of the Stanford Concussion and Brain Performance Center.
Clinical Assistant Professor, Emergency Medicine
Clinical Assistant Professor, Pediatrics
Co-Director, Stanford Concussion and Brain Performance Center (2018 - Present)
Co-Investigator, Stanford Brain Trauma Evidence-Based Consortium (2017 - Present)
Boards, Advisory Committees, Professional Organizations
Workgroup to Improve the Clinical Care of Youth with Mild TBI, Centers for Disease Control and Injury Prevention (2011 - Present)
Chair, Committee for the Future, Section on Emergency Medicine, American Academy of Pediatrics (2015 - 2017)
Board Certification, American Board of Pediatrics, Pediatric Emergency Medicine (2013)
PEM Fellowship, University of California San Diego, Rady Children's Hospital, Pediatric Emergency Medicine (2012)
Board Certification, American Board of Pediatrics, General Pediatrics (2009)
Residency, New York Medical College, Maria Fareri Children's Hospital, Pediatrics (2007)
Internship, New York Medical College, Maria Fareri Children's Hospital, Pediatrics (2006)
Medical Doctor (MD), St. George's University Medical School, Medicine (2006)
Community and International Work
Stanford Sports Concussion Summit
Opportunities for Student Involvement
CDC Head Up Educational Materials
Centers for Disease Control and Injury Prevention
Opportunities for Student Involvement
Vijay Lumba, Irwin Wunderman, Mearl Naponic, John Missanelli, Angela Lumba. "United States Patent US 20040082842 Lumba VK, Wunderman I, Naponic M, Missanelli J, Lumba AK. “System for Monitoring Fetal Status” Patent US 20040082842. April 2004.", Vijay Lumba, Apr 29, 2004
Current Research and Scholarly Interests
I am a trained, board-certified pediatric emergency medicine physician and work clinically in the Stanford Emergency Department. I also co-direct the Stanford Concussion and Brain Performance Center.
My research focus in on traumatic brain injury and brain performance. My previous studies include a prospective, double-blinded, randomized controlled trial evaluating therapeutic intervention in acute pediatric concussion (Peds Em Care 2014), complicated mild TBI risk score development (Pediatrics and others 2017), and a large systematic review and CDC guideline publication (JAMA Peds and others 2018). My areas of active research include investigations of diagnosis, management, and therapeutic intervention in mild traumatic brain injury, subtype classification of concussion, and the pre-hospital management of severe TBI. I also study brain performance via sensorimotor and sensory-cognitive synchronization.
I am a co-investigator of the Stanford Brain Trauma Evidence-Based Consortium, a DoD funded collaborative endeavor with the purpose of developing an evidence-based classification for the spectrum of traumatic brain injury, and to model post-TBI trajectories and outcomes.
Hypertonic Saline as Therapy for Pediatric Concussion
This single center, blinded, randomized controlled trial evaluated the use of hypertonic saline versus normal saline as therapy for the symptoms of pediatric concussion post head injury. The study hypothesis was that hypertonic saline would improve symptoms of pediatric concussion following head injury as measured on the self-reported Wong Baker Faces Pain Scale as compared to normal saline. The null hypothesis was that there would be no difference in change of reported pain in either group.
Stanford is currently not accepting patients for this trial.
Strengthening the Evidence Base: Recommendations for Future Research Identified Through the Development of CDC's Pediatric Mild TBI Guideline.
The Journal of head trauma rehabilitation
OBJECTIVE: The recently published Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury (mTBI) was developed following an extensive review of the scientific literature. Through this review, experts identified limitations in existing pediatric mTBI research related to study setting and generalizability, mechanism of injury and age of cohorts studied, choice of control groups, confounding, measurement issues, reporting of results, and specific study design considerations. This report summarizes those limitations and provides a framework for optimizing the future quality of research conduct and reporting.RESULTS: Specific recommendations are provided related to diagnostic accuracy, population screening, prognostic accuracy, and therapeutic interventions.CONCLUSION: Incorporation of the recommended approaches will increase the yield of eligible research for inclusion in future systematic reviews and guidelines for pediatric mTBI.
View details for DOI 10.1097/HTR.0000000000000455
View details for PubMedID 30608306
- Concussion Subtype Identification With the Rivermead Post-concussion Symptoms Questionnaire FRONTIERS IN NEUROLOGY 2018; 9
CDC Guideline on Mild Traumatic Brain Injury in Children: Important Practice Takeaways for Sports Medicine Providers.
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine
OBJECTIVES: The Centers for Disease Control and Prevention (CDC) published an evidence-based guideline on the diagnosis and management of pediatric mild traumatic brain injury (mTBI) in 2018. This commentary provides key practice takeaways for sports medicine providers outlined in the Guideline recommendations.DATA SOURCES: The CDC Pediatric mTBI Guideline was developed through a rigorous scientific process using a modified Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. A systematic review of the scientific literature published over a 25-year period for all causes of pediatric mTBI formed the basis of the Guideline.MAIN RESULTS: The key practice takeaways for sports medicine providers focus on preseason evaluations, neuroimaging, symptom-based assessment, managing recovery, monitoring for persistent symptoms, and return to activity, including sport and school.CONCLUSIONS: Sports medicine providers play an integral part in the implementation of evidence-based practices that promote appropriate diagnosis and management of mTBI in children. This commentary highlights key practice takeaways that sports medicine providers can implement.
View details for DOI 10.1097/JSM.0000000000000704
View details for PubMedID 30489330
- Pediatric hypertonic saline use in emergency departments. The American journal of emergency medicine 2018
Centers for Disease Control and Prevention Guideline on the Diagnosis and Management of Mild Traumatic Brain Injury Among Children.
Importance: Mild traumatic brain injury (mTBI), or concussion, in children is a rapidly growing public health concern because epidemiologic data indicate a marked increase in the number of emergency department visits for mTBI over the past decade. However, no evidence-based clinical guidelines have been developed to date for diagnosing and managing pediatric mTBI in the United States.Objective: To provide a guideline based on a previous systematic review of the literature to obtain and assess evidence toward developing clinical recommendations for health care professionals related to the diagnosis, prognosis, and management/treatment of pediatric mTBI.Evidence Review: The Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control Board of Scientific Counselors, a federal advisory committee, established the Pediatric Mild Traumatic Brain Injury Guideline Workgroup. The workgroup drafted recommendations based on the evidence that was obtained and assessed within the systematic review, as well as related evidence, scientific principles, and expert inference. This information includes selected studies published since the evidence review was conducted that were deemed by the workgroup to be relevant to the recommendations. The dates of the initial literature search were January 1, 1990, to November 30, 2012, and the dates of the updated literature search were December 1, 2012, to July 31, 2015.Findings: The CDC guideline includes 19 sets of recommendations on the diagnosis, prognosis, and management/treatment of pediatric mTBI that were assigned a level of obligation (ie, must, should, or may) based on confidence in the evidence. Recommendations address imaging, symptom scales, cognitive testing, and standardized assessment for diagnosis; history and risk factor assessment, monitoring, and counseling for prognosis; and patient/family education, rest, support, return to school, and symptom management for treatment.Conclusions and Relevance: This guideline identifies the best practices for mTBI based on the current evidence; updates should be made as the body of evidence grows. In addition to the development of the guideline, CDC has created user-friendly guideline implementation materials that are concise and actionable. Evaluation of the guideline and implementation materials is crucial in understanding the influence of the recommendations.
View details for DOI 10.1001/jamapediatrics.2018.2853
View details for PubMedID 30193284
Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review.
Importance: In recent years, there has been an exponential increase in the research guiding pediatric mild traumatic brain injury (mTBI) clinical management, in large part because of heightened concerns about the consequences of mTBI, also known as concussion, in children. The CDC National Center for Injury Prevention and Control's (NCIPC) Board of Scientific Counselors (BSC), a federal advisory committee, established the Pediatric Mild TBI Guideline workgroup to complete this systematic review summarizing the first 25 years of literature in this field of study.Objective: To conduct a systematic review of the pediatric mTBI literature to serve as the foundation for an evidence-based guideline with clinical recommendations associated with the diagnosis and management of pediatric mTBI.Evidence Review: Using a modified Delphi process, the authors selected 6 clinical questions on diagnosis, prognosis, and management or treatment of pediatric mTBI. Two consecutive searches were conducted on PubMed, Embase, ERIC, CINAHL, and SportDiscus. The first included the dates January 1, 1990, to November 30, 2012, and an updated search included December 1, 2012, to July 31, 2015. The initial search was completed from December 2012 to January 2013; the updated search, from July 2015 to August 2015. Two authors worked in pairs to abstract study characteristics independently for each article selected for inclusion. A third author adjudicated disagreements. The risk of bias in each study was determined using the American Academy of Neurology Classification of Evidence Scheme. Conclusion statements were developed regarding the evidence within each clinical question, and a level of confidence in the evidence was assigned to each conclusion using a modified GRADE methodology. Data analysis was completed from October 2014 to May 2015 for the initial search and from November 2015 to April 2016 for the updated search.Findings: Validated tools are available to assist clinicians in the diagnosis and management of pediatric mTBI. A significant body of research exists to identify features that are associated with more serious TBI-associated intracranial injury, delayed recovery from mTBI, and long-term sequelae. However, high-quality studies of treatments meant to improve mTBI outcomes are currently lacking.Conclusions and Relevance: This systematic review was used to develop an evidence-based clinical guideline for the diagnosis and management of pediatric mTBI. While an increasing amount of research provides clinically useful information, this systematic review identified key gaps in diagnosis, prognosis, and management.
View details for DOI 10.1001/jamapediatrics.2018.2847
View details for PubMedID 30193325
TEMPORARY REMOVAL: Emergency Department Implementation of theCenters for Disease Control and Prevention Pediatric Mild Traumatic Brain Injury GuidelineRecommendations.
Annals of emergency medicine
The publisher regrets that this article has been temporarily removed. A replacement will appear as soon as possible in which the reason for the removal of the article will be specified, or the article will be reinstated. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
View details for DOI 10.1016/j.annemergmed.2018.03.045
View details for PubMedID 29753521
Mentoring Pediatric Victims of Interpersonal Violence Reduces Recidivism.
Journal of interpersonal violence
Pediatric interpersonal violence is a public health crisis resulting in morbidity and mortality and recidivism. St. Louis City and surrounding areas have the highest rates of youth interpersonal violence nationally. St. Louis Children's Hospital (SLCH) Social Work in conjunction with Pediatric Emergency Medicine established a novel emergency department (ED)-initiated program to determine whether co-location of services followed by outpatient mentoring reduced the rate of morbidity, mortality, and recidivism in youths experiencing interpersonal violence. SLCH developed the "Empowering Youth Through Interpersonal Violence Prevention Program," co-locating initial social work services and emergency medical services in the pediatric ED. Youths, ages 8 to 17 years, presenting for interpersonal violence were approached for immediate social work counseling and subsequent individualized outpatient mentoring, developed from national best practices and model programs. A prospective 2:1 randomized, controlled pilot study assessing for youth morbidity, mortality, and recidivism was conducted for program service feasibility from 2012 to 2014. The study was followed by a 1-year retrospective analysis of program service integration as a hospital standard-of-care evaluating the same outcome measures. Of the 24 youths who participated in the pilot study and received the intervention, there was a 4% rate of morbidity and recidivism. Conversely, there was a 3.4% rate of mortality, 6.7% rate of morbidity, and 11.8% recidivism rate in those who refused to participate in services. EYIPP was offered as a service from 2014 to 2015 and 57 youths participated with a 3.5% rate of both morbidity and recidivism. During this time, 78 eligible youths declined services with a 1.1% rate of morbidity, and 2.3% recidivism rate. This novelprogram reduces recidivism, morbidity, and mortality in youths presenting to SLCH for interpersonal violence-related injuries suggesting that co-location of social services in the ED, followed by individualized mentoring may be important for engagement.
View details for DOI 10.1177/0886260517705662
View details for PubMedID 29294791
Development and Internal Validation of a Clinical Risk Score for Treating Children With Mild Head Trauma and Intracranial Injury.
The appropriate treatment of children with mild traumatic brain injury (mTBI) and intracranial injury (ICI) on computed tomographic imaging remains unclear. Evidence-based risk assessments may improve patient safety and reduce resource use.To derive a risk score predicting the need for intensive care unit observation in children with mTBI and ICI.This retrospective analysis of the prospective Pediatric Emergency Care Applied Research Network (PECARN) head injury cohort study included patients enrolled in 25 North American emergency departments from 2004 to 2006. We included patients younger than 18 years with mTBI (Glasgow Coma Scale [GCS] score, 13-15) and ICI on computed tomography. The data analysis was conducted from May 2015 to October 2016.The primary outcome was the composite of neurosurgical intervention, intubation for more than 24 hours for TBI, or death from TBI. Multivariate logistic regression was used to predict the outcome. The C statistic was used to quantify discrimination, and model performance was internally validated using 10-fold cross-validation. Based on this modeling, the Children's Intracranial Injury Decision Aid score was created.Among 15 162 children with GCS 13 to 15 head injuries who received head computed tomographic imaging in the emergency department, 839 (5.5%) had ICI. The median ages of those with and without a composite outcome were 7 and 5 years, respectively. Among those patients with ICI, 8.7% (n = 73) experienced the primary outcome, including 8.3% (n = 70) who had a neurosurgical intervention. The only clinical variable significantly associated with outcome was GCS score (odds ratio [OR], 3.4; 95% CI, 1.5-7.4 for GCS score 13 vs 15). Significant radiologic predictors included midline shift (OR, 6.8; 95% CI, 3.4-13.8), depressed skull fracture (OR, 6.5; 95% CI, 3.7-11.4), and epidural hematoma (OR, 3.4; 95% CI, 1.8-6.2). The model C statistic was 0.84 (95% CI, 0.79-0.88); the 10-fold cross-validated C statistic was 0.83. Based on this modeling, we developed the Children's Intracranial Injury Decision Aid score, which ranged from 0 to 24 points. The negative predictive value of having 0 points (ie, none of these risk factors) was 98.8% (95% CI, 97.3%-99.6%).Lower GCS score, midline shift, depressed skull fracture, and epidural hematoma are key risk factors for needing intensive care unit-level care in children with mTBI and ICI. Based on these results, the Children's Intracranial Injury Decision Aid score is a potentially novel tool to risk stratify this population, thereby aiding management decisions.
View details for DOI 10.1001/jamapediatrics.2016.4520
View details for PubMedID 28192567
Service Delivery in the Healthcare and Educational Systems for Children Following Traumatic Brain Injury: Gaps in Care.
The Journal of head trauma rehabilitation
To provide a review of evidence and consensus-based description of healthcare and educational service delivery and related recommendations for children with traumatic brain injury.Literature review and group discussion of best practices in management of children with traumatic brain injury (TBI) was performed to facilitate consensus-based recommendations from the American Congress on Rehabilitation Medicine's Pediatric and Adolescent Task Force on Brain Injury. This group represented pediatric researchers in public health, medicine, psychology, rehabilitation, and education.Care for children with TBI in healthcare and educational systems is not well coordinated or integrated, resulting in increased risk for poor outcomes. Potential solutions include identifying at-risk children following TBI, evaluating their need for rehabilitation and transitional services, and improving utilization of educational services that support children across the lifespan.Children with TBI are at risk for long-term consequences requiring management as well as monitoring following the injury. Current systems of care have challenges and inconsistencies leading to gaps in service delivery. Further efforts to improve knowledge of the long-term TBI effects in children, child and family needs, and identify best practices in pathways of care are essential for optimal care of children following TBI.
View details for DOI 10.1097/HTR.0000000000000287
View details for PubMedID 28060211
PEMNetwork Barriers and Enablers to Collaboration and Multimedia Education in the Digital Age
PEDIATRIC EMERGENCY CARE
2016; 32 (8): 565-569
In January 2005, PEMFellows.com was created to unify fellows in pediatric emergency medicine. Since then, the website has expanded, contracted, and focused to adapt to the interests of the pediatric emergency medicine practitioner during the internet boom. This review details the innovation of the PEMNetwork, from the inception of the initial website and its evolution into a needs-based, user-directed educational hub. Barriers and enablers to success are detailed with unique examples from descriptive analysis and metrics of PEMNetwork web traffic as well as examples from other online medical communities and digital education websites.
View details for Web of Science ID 000380870300019
View details for PubMedID 27490735
183 A Clinical Risk Score for Managing Children With Glasgow Coma Scale 13 to 15 Head Injuries and Intracranial Injury.
2016; 63: 172-173
Although rigorous decision tools exist to evaluate the need for commuted tomography (CT) imaging in children with Glasgow Coma Scale (GCS) score 13 to 15 head injuries, the appropriate management in children with intracranial injury (ICI) on CT remains unclear. The purpose of this study was to develop a risk score to predict neurosurgical intervention (NI), a concrete measure of neurological impairment or decline requiring intensive care unit observation.We included patients younger than 18 years with GCS score 13 to 15 that were enrolled in 1 of 25 hospitals participating in the prospective Pediatric Emergency Care Applied Research Network (PECARN) head injury study and had ICI identified on CT. We used multivariable logistic regression on 10 imputed data sets to identify independent predictors of NI, and used the model β-coefficients to develop a clinical risk score.Among 42 735 children with GCS 13 to 15 head injuries, 15 162 received a head CT scan and 846 had ICI. Among these patients, 8.3% required NI and no patients died. The most common type of ICI was subdural hematoma (24% of patients). Clinical variables independently associated with NI included palpable depressed skull fracture (odds ratio [OR] = 2.3) and GCS score of 13 (OR = 2.9) or 14 (OR = 1.2); radiological predictors included midline shift (OR = 7.2), epidural hematoma (OR = 1.3), and any skull fracture on CT (OR = 2.1). The model c-statistic was 0.81. Using the model's β-coefficients, the Children's Intracranial Injury Decision Aid (CHIIDA) score was created, which ranged from zero (2% risk of NI) to 27 (96% risk of NI) points.Midline shift, epidural hematoma, any radiological skull fracture, palpable depressed skull fracture, and GCS score accurately predict the risk of NI in children with GCS 13 to 15 head injury and ICI. Based on these results, the CHIIDA score is a novel clinical decision tool to aid physicians caring for these patients.
View details for DOI 10.1227/01.neu.0000489752.67038.e7
View details for PubMedID 27399462
Essentials of PEM Fellowship Part 2: The Profession in Entrustable Professional Activities
PEDIATRIC EMERGENCY CARE
2016; 32 (6): 410-418
This article is the second in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine (PEM) fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article describes the development of PEM entrustable professional activities (EPAs) and the relationship of these EPAs with existing taxonomies of assessment and learning within PEM fellowship. It summarizes the field in concepts that can be taught and assessed, packaging the PEM subspecialty into EPAs.
View details for DOI 10.1097/PEC.0000000000000827
View details for Web of Science ID 000378719800015
View details for PubMedID 27253361
Firearm injuries in the pediatric population: A tale of one city
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
2016; 80 (1): 64-69
Firearm-related injuries are a significant cause of morbidity and mortality in children. To determine current trends and assess avenues for future interventions, we examined the epidemiology and outcome of pediatric firearm injuries managed at our region's two major pediatric trauma centers.Following institutional review board approval, we conducted a 5-year retrospective review of all pediatric firearm victims, 16 years or younger, treated at either of the region's two Level 1 pediatric trauma centers, St. Louis Children's Hospital and Cardinal Glennon Children's Medical Center.There were 398 children treated during a 5-year period (2008-2013) for firearm-related injuries. Of these children, 314 (78.9%) were black. Overall, there were 20 mortalities (5%). Although most (67.6%) patients were between 14 years and 16 years of age, younger victims had a greater morbidity and mortality. The majority of injuries were categorized as assault/intentional (65%) and occurred between 6:00 pm and midnight, outside the curfew hours enforced by the city. Despite a regional decrease in the overall incidence of firearm injuries during the study period, the rate of accidental victims per year remained stable. Most accidental shootings occurred in the home (74.2%) and were self-inflicted (37.9%) or caused by a person known to the victim (40.4%).Despite a relative decrease in intentional firearm-related injuries, a constant rate of accidental shootings suggest an area for further intervention.Prognostic and epidemiologic study, level IV.
View details for DOI 10.1097/TA.0000000000000893
View details for Web of Science ID 000367544400009
View details for PubMedID 26491805
Emergency Neurological Life Support: Traumatic Brain Injury
2015; 23: S143-S154
Traumatic Brain Injury (TBI) was chosen as an Emergency Neurological Life Support topic due to its frequency, the impact of early intervention on outcomes for patients with TBI, and the need for an organized approach to the care of such patients within the emergency setting. This protocol was designed to enumerate the practice steps that should be considered within the first critical hour of neurological injury.
View details for DOI 10.1007/s12028-015-0176-z
View details for Web of Science ID 000367463100014
Evidence-Based Assessment of Severe Pediatric Traumatic Brain Injury and Emergent Neurocritical Care
SEMINARS IN PEDIATRIC NEUROLOGY
2014; 21 (4): 275-283
Pediatric traumatic brain injury accounts for approximately 474,000 emergency department visits, 37,000 hospitalizations, and 3,000 deaths in children 14 years and younger annually in the United States. Acute neurocritical care in children has advanced with specialized pediatric trauma centers and emergency medical services. This article reviews pediatric-specific diagnosis, management, and medical decision making related to the neurocritical care of severe traumatic brain injury.
View details for DOI 10.1016/j.spen.2014.11.001
View details for Web of Science ID 000350996200006
View details for PubMedID 25727509
Hypertonic saline as a therapy for pediatric concussive pain: a randomized controlled trial of symptom treatment in the emergency department.
Pediatric emergency care
2014; 30 (3): 139-145
Three-percent hypertonic saline (HTS) is a hyperosmotic therapy used in pediatric traumatic brain injury to treat increased intracranial pressure and cerebral edema. It also promotes plasma volume expansion and cerebral perfusion pressure, immunomodulation, and anti-inflammatory response. We hypothesized that HTS will improve concussive symptoms of mild traumatic brain injury.The study was a prospective, double-blind, randomized controlled trial. Children, 4 to 7 years of age with a Glasgow Coma Scale score greater than 13, were enrolled from a pediatric emergency department following closed-head injury upon meeting Acute Concussion Evaluation criteria with head pain. Patients were randomized to receive 10 mL/kg of HTS or normal saline (NS) over 1 hour. Self-reported pain values were obtained using the Wong-Baker FACES Pain Rating Scale initially, immediately following fluids, and at 2 to 3 days of discharge. The primary outcome measure was change in self-reported pain following fluid administration. Secondary outcome measures were a change in pain and postconcussive symptoms within 2 to 3 days of fluid administration. We used an intention-to-treat analysis.Forty-four patients, ranging from 7 to 16 years of age with comparable characteristics, were enrolled in the study; 23 patients (52%) received HTS, and 21 (48%) received NS. There was a significant difference (P < 0.001) identified in the self-reported improvement of pain following fluid administration between the HTS group (mean improvement = 3.5) and the NS group (mean improvement = 1.1). There was a significant difference (P = 0.01) identified in the self-reported improvement of pain at 2 to 3 days after treatment between the HTS group (mean improvement = 4.6) and the NS group (mean improvement = 3.0). We were unable to determine a difference in other postconcussive symptoms following discharge.Three-percent HTS is more effective than NS in acutely reducing concussion pain in children.
View details for DOI 10.1097/PEC.0000000000000084
View details for PubMedID 24583571