Laura Pliego was standing on the sidelines, as she had so many afternoons since her daughter Cristina Renée began playing soccer. She was talking to a friend when she heard the impact. "Even across the field, it sounded like a bowling ball striking a pin," she says. It took her a few seconds to realize that the sound she heard was her daughter’s forehead crashing into the skull of an opposing player as they raced to head the ball.
A member of the Montclair High School Varsity Girls Soccer team, Cristina Renée seemed surprisingly unaffected by the collision. She kept on her feet and shrugged off the blow. Her coaches took her out of the game, conducted an assessment, and sat her down on the bench with an icepack on her head. She showed no signs of dizziness as she talked with her teammates. "She looked and sounded completely normal, except for the growing bump on her forehead," Laura says.
After the game, Laura and her daughter were heading home, when Laura decided to check with Cristina Renée’s primary care physician. Her doctor advised them, just to be on the safe side, to go to the Emergency Department at HackensackUMC Mountainside. Upon their arrival, the triage nurse assigned Cristina Renée to the department’s Fast Track area, used for minor medical issues. That’s where the Pliegos met Diana Mendez, a physician assistant, and Dr. Marjory Langer, the Emergency Department’s medical director.
The dilemma the women faced was one that medical professionals encounter frequently: how to reconcile seemingly contradictory information. On the one hand, Cristina Renée was asymptomatic. On the other, the sound of the collision made an indelible impression on Laura.
The evident force of the impact, as Laura described it, ultimately made Mendez uneasy, and she asked Dr. Langer to examine the teen. "I came away with the same feeling that Diana had," Langer says. "Even though none of her symptoms called for a CT scan, which we are reluctant to order for growing children, I thought I would sleep better if I prescribed one anyway."
It was the right call. The scan revealed a small fracture of the skull base. Within four hours, Cristina Renée was on her way to the pediatric intensive care unit at HackensackUMC. "The transfer process with HackensackUMC is seamless," Langer says. "One call to the Transfer Center and they take charge of the handoff and keeping everyone updated on their progress. It’s a great system."
At HackensackUMC, Dr. Harshpal Singh, a neurosurgeon, monitored Cristina Renée’s care. She developed a small cerebral spinal fluid leak through the break, but fortunately it resolved on its own. "Cristina Renée was a very brave and matter-of-fact patient," Singh says. "If we had to fix the leak surgically, it would have been a serious procedure, but she was all for doing what needed to be done to fix it."