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Brooks BL, Low TA, Daya H, Khan S, Mikrogianakis A, Barlow KM. Test or Rest? Computerized Cognitive Testing in the Emergency Department after Pediatric Mild Traumatic Brain Injury Does Not Delay Symptom Recovery. J Neurotrauma 2016; 33:2091-2096. [DOI: 10.1089/neu.2015.4301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brian L. Brooks
- Department of Neurosciences (Brain Injury and Vi Riddell Rehabilitation Programs), Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Trevor A. Low
- Department of Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Hussain Daya
- Department of Psychology, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Samna Khan
- Michael G. DeGroote School of Medicine, McMaster University, Ontario, Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Section of Emergency Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Hunt AW, Paniccia M, Reed N, Keightley M. Concussion-Like Symptoms in Child and Youth Athletes at Baseline: What Is "Typical"? J Athl Train 2016; 51:749-757. [PMID: 27834505 PMCID: PMC5189228 DOI: 10.4085/1062-6050-51.11.12] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT After a concussion, guidelines emphasize that an athlete should be asymptomatic before starting a return-to-play protocol. However, many concussion symptoms are nonspecific and may be present in individuals without concussion. Limited evidence exists regarding the presence of "typical" or preinjury (baseline) symptoms in child and youth athletes. OBJECTIVE To describe the frequency of symptoms reported at baseline by child and youth athletes and identify how age, sex, history of concussion, and learning factors influence the presence of baseline symptoms. DESIGN Cross-sectional cohort study. SETTING Baseline testing was conducted at a hospital research laboratory or in a sport or school setting (eg, gym or arena). PATIENTS OR OTHER PARTICIPANTS A total of 888 child (9-12 years old, n = 333) and youth (13-17 years old, n = 555) athletes participated (46.4% boys and 53.6% girls, average age = 13.09 ± 1.83 years). MAIN OUTCOME MEASURE(S) Demographic and symptom data were collected as part of a baseline protocol. Age-appropriate versions of the Post-Concussion Symptom Inventory (a self-report concussion-symptoms measure with strong psychometric properties for pediatric populations) were administered. Demographic data (age, sex, concussion history, learning factors) were also collected. RESULTS Common baseline symptoms for children were feeling sleepier than usual (30% boys, 24% girls) and feeling nervous or worried (17% boys, 25% girls). Fatigue was reported by more than half of the youth group (50% boys, 67% girls). Nervousness was reported by 32% of youth girls. Headaches, drowsiness, and difficulty concentrating were each reported by 25% of youth boys and girls. For youths, a higher total symptom score was associated with increasing age and number of previous concussions, although these effects were small (age rs = 0.143, number of concussions rs = .084). No significant relationships were found in the child group. CONCLUSIONS Children and youths commonly experienced symptoms at baseline, including fatigue and nervousness. Whether clinicians should expect complete symptom resolution after concussion is not clear.
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Affiliation(s)
- Anne Williams Hunt
- Bloorview Research Institute, Holland Bloorview Kids Rehab Hospital, Toronto, ON, Canada
| | | | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehab Hospital, Toronto, ON, Canada
| | - Michelle Keightley
- Bloorview Research Institute, Holland Bloorview Kids Rehab Hospital, Toronto, ON, Canada
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Mitchell SH, Hildenbrand K, Pietz K. Emergency Physicians' Knowledge of Sports-Related Concussion, Referral Patterns, and Use of Return to Play Guidelines. ACTA ACUST UNITED AC 2016. [DOI: 10.3928/19425864-20160617-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hunt AW, De Feo L, Macintyre J, Greenspoon D, Dick T, Mah K, Paniccia M, Provvidenza C, Reed N. Development and feasibility of an evidence-informed self-management education program in pediatric concussion rehabilitation. BMC Health Serv Res 2016; 16:400. [PMID: 27534848 PMCID: PMC4989511 DOI: 10.1186/s12913-016-1664-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Concussion is a considerable public health problem in youth. However, identifying, understanding and implementing best evidence informed recovery guidelines may be challenging for families given the vast amount of information available in the public domains (e.g. Internet). The objective of this study was to develop, implement and evaluate the feasibility of an evidence-informed self-management education program for concussion recovery in youth. Methods Synthesis of best evidence, principles of knowledge translation and exchange, and expert opinion were integrated within a self-management program framework to develop a comprehensive curriculum. The program was implemented and evaluated in a children’s rehabilitation hospital within a universal health care system. A retrospective secondary analysis of anonymous data from a program evaluation survey was used to evaluate program feasibility, to identify features of importance to program participants and to assess changes in participants’ knowledge. Results The program, “Concussion & You” includes a comprehensive, evidence informed, population specific curriculum that teaches participants practical strategies for management of return to school and play, sleep, nutrition, relaxation and energy conservation. A ‘wheel of health’ is used to facilitate participants’ self-management action plan. Results from eighty-seven participant surveys indicate that the program is feasible and participant knowledge increased in all areas of the program with the highest changes reported in knowledge about sleep hygiene, rest and energy conservation. Conclusion Findings indicate that “Concussion & You” is a feasible program that is acceptable to youth and their families, and fills a health system service gap. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1664-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne W Hunt
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Room 4W221, Toronto, Ontario, M4G 1R8, Canada
| | - Luciano De Feo
- Department of Occupational Science & Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Jennifer Macintyre
- Department of Occupational Science & Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada
| | - Dayna Greenspoon
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Room 4W221, Toronto, Ontario, M4G 1R8, Canada
| | - Talia Dick
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Room 4W221, Toronto, Ontario, M4G 1R8, Canada
| | - Katherine Mah
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Room 4W221, Toronto, Ontario, M4G 1R8, Canada.,University of Toronto, Rehabilitation Sciences Institute, 160-500 University Ave., Toronto, Ontario, M5G 1V7, Canada
| | - Melissa Paniccia
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Room 4W221, Toronto, Ontario, M4G 1R8, Canada.,University of Toronto, Rehabilitation Sciences Institute, 160-500 University Ave., Toronto, Ontario, M5G 1V7, Canada
| | - Christine Provvidenza
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Room 4W221, Toronto, Ontario, M4G 1R8, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Room 4W221, Toronto, Ontario, M4G 1R8, Canada. .,Department of Occupational Science & Occupational Therapy, University of Toronto, 160-500 University Ave, Toronto, Ontario, M5G 1V7, Canada. .,University of Toronto, Rehabilitation Sciences Institute, 160-500 University Ave., Toronto, Ontario, M5G 1V7, Canada.
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Weerdenburg K, Schneeweiss S, Koo E, Boutis K. Concussion and its management: What do parents know? Paediatr Child Health 2016; 21:e22-6. [PMID: 27398059 DOI: 10.1093/pch/21.3.e22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To determine the sensitivity of parental suspicion of concussion relative to paediatric emergency physicians in children who presented to an emergency department (ED) with a head injury. A secondary objective was to examine the variables associated with parental suspicion of concussion concordant with that of a physician. METHODS Parents of children five to 18 years of age presenting to an urban paediatric ED with a nonstructural head injury completed a 24-item questionnaire. RESULTS Of the 577 eligible parents, 495 (85.8%) consented to participate. The sensitivity of parental suspicion for concussion was 40.0% (95% CI 33.2% to 47.2%), while the specificity was 58.3% (95% CI 52.4% to 64.0%). The variable of child age ≥10 years was associated with an increased odds (OR 3.0) of a parental suspicion of concussion concordant with that of a physician; parent age, parent sex, mechanism of head injury and history of concussion in the child were not. Although 453 (91.5%) parents would stop activity if they believed their child sustained a concussion, only 159 (32.1%) were familiar with return-to-play guidelines. CONCLUSIONS Parents often did not suspect a concussion when it was ultimately diagnosed by a paediatric emergency physician, although they were more likely to do so in older children. Only approximately one-third were aware of return-to-play guidelines. To enhance the potential for parent-driven advocacy in the recognition and management of concussion, these data support the need for increased parental education on this injury.
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Affiliation(s)
- Kirstin Weerdenburg
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Suzan Schneeweiss
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Ellen Koo
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Kathy Boutis
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
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Arbogast KB, Curry AE, Pfeiffer MR, Zonfrillo MR, Haarbauer-Krupa J, Breiding MJ, Coronado VG, Master CL. Point of Health Care Entry for Youth With Concussion Within a Large Pediatric Care Network. JAMA Pediatr 2016; 170:e160294. [PMID: 27244368 PMCID: PMC6025897 DOI: 10.1001/jamapediatrics.2016.0294] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Previous epidemiologic research on concussions has primarily been limited to patient populations presenting to sport concussion clinics or to emergency departments (EDs) and to those high school age or older. By examining concussion visits across an entire pediatric health care network, a better estimate of the scope of the problem can be obtained. OBJECTIVE To comprehensively describe point of entry for children with concussion, overall and by relevant factors including age, sex, race/ethnicity, and payor, to quantify where children initially seek care for this injury. DESIGN, SETTING, AND PARTICIPANTS In this descriptive epidemiologic study, data were collected from primary care, specialty care, ED, urgent care, and inpatient settings. The initial concussion-related visit was selected and variation in the initial health care location (primary care, specialty care, ED, or hospital) was examined in relation to relevant variables. All patients aged 0 to 17 years who received their primary care from The Children's Hospital of Philadelphia's (CHOP) network and had 1 or more in-person clinical visits for concussion in the CHOP unified electronic health record (EHR) system (July 1, 2010, to June 30, 2014) were selected. MAIN OUTCOMES AND MEASURES Frequency of initial concussion visits at each type of health care location. Concussion visits in the EHR were defined based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes indicative of concussion. RESULTS A total of 8083 patients were included (median age, 13 years; interquartile range, 10-15 years). Overall, 81.9% (95% CI, 81.1%-82.8%; n = 6624) had their first visit at CHOP within primary care, 5.2% (95% CI, 4.7%-5.7%; n = 418) within specialty care, and 11.7% (95% CI, 11.0%-12.4%; n = 947) within the ED. Health care entry varied by age: 52% (191/368) of children aged 0 to 4 years entered CHOP via the ED, whereas more than three-quarters of those aged 5 to 17 years entered via primary care (5-11 years: 1995/2492; 12-14 years: 2415/2820; and 15-17 years: 2056/2403). Insurance status also influenced the pattern of health care use, with more Medicaid patients using the ED for concussion care (478/1290 Medicaid patients [37%] used the ED vs 435/6652 private patients [7%] and 34/141 self-pay patients [24%]). CONCLUSIONS AND RELEVANCE The findings suggest estimates of concussion incidence based solely on ED visits underestimate the burden of injury, highlight the importance of the primary care setting in concussion care management, and demonstrate the potential for EHR systems to advance research in this area.
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Affiliation(s)
- Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania2University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Allison E. Curry
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa R. Pfeiffer
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark R. Zonfrillo
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania2University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Juliet Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J. Breiding
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Victor G. Coronado
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina L. Master
- University of Pennsylvania Perelman School of Medicine, Philadelphia4Sports Medicine and Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bryan MA, Rowhani-Rahbar A, Comstock RD, Rivara F. Sports- and Recreation-Related Concussions in US Youth. Pediatrics 2016; 138:peds.2015-4635. [PMID: 27325635 DOI: 10.1542/peds.2015-4635] [Citation(s) in RCA: 364] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The incidence of sports- and recreation-related concussions (SRRCs) in the United States is unknown. More than 44 million youth participate in sports annually, thus understanding the frequency of SRRCs in children is important on a population level. Our objective was to determine the number of SRRCs occurring annually among US youth ≤18 years old. METHODS We identified SRRCs using 3 national databases: MarketScan, National Electronic Injury Surveillance System, and National High School Sports Related Injury Surveillance System, Reporting Injury Online. We determined the number of SRRCs seen in health care settings (outpatient, inpatient, and emergency department) and SRRCs reported to certified high school athletic trainers (ATCs). We used these data and findings in recently published literature to generate a national estimate of SRRCs. RESULTS We estimate that between 1.1 and 1.9 million SRRCs occur annually in US children aged ≤18 years. Most children with SRRCs, 511 590 to 1 240 972, were not seen in health care settings. Of children with SRRCs seen in health care settings, most were seen as outpatients with 377 978 visits, compared with between 115 479 and 166 929 ED visits, and between 2886 and 4936 hospitalizations. CONCLUSIONS This study provides the most accurate and precise estimate to date of the number of concussions among US children annually. SRRCs are a common injury in children. Providers in all health care settings need to be trained in concussion care. There is a need for better surveillance to enhance our understanding of the epidemiology of concussions in youth.
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Affiliation(s)
- Mersine A Bryan
- Departments of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington;
| | - Ali Rowhani-Rahbar
- Departments of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Epidemiology, and Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - R Dawn Comstock
- Department of Epidemiology, Program for Injury Prevention Education and Research, Colorado School of Public Health at the University of Colorado Anschutz, Aurora, Colorado; and Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Frederick Rivara
- Departments of Pediatrics and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Epidemiology, and Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
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Experience with Canada's First Policy on Concussion Education and Management in Schools. Can J Neurol Sci 2016; 43:554-60. [PMID: 27142787 DOI: 10.1017/cjn.2016.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In response to the rising incidence of concussions among children and adolescents, the province of Ontario recently introduced the Ontario Policy/Program Memorandum on Concussions (PPM No. 158) requiring school boards to develop a concussion protocol. As this is the first policy of its kind in Canada, the impact of the PPM is not yet known. METHODS An electronic survey was sent to all high school principals in the Toronto District School Board 1 year after announcement of the PPM. Questions covered extent of student, parent, and staff concussion education along with concussion management protocols. RESULTS Of 109 high school principals contacted, 39 responded (36%). Almost all schools provided concussion education to students (92%), with most education delivered through physical education classes. Nearly all schools had return to play (92%) and return to learn (77%) protocols. Although 85% of schools educated staff on concussions, training was aimed at individuals involved in sports/physical education. Only 43.6% of schools delivered concussion education to parents, and many principals requested additional resources in this area. CONCLUSIONS One year after announcement of the PPM, high schools in the Toronto District School Board implemented significant student concussion education programs and management protocols. Staff training and parent education required further development. A series of recommendations are provided to aid in future concussion policy development.
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Cognition in the Emergency Department as a Predictor of Recovery after Pediatric Mild Traumatic Brain Injury. J Int Neuropsychol Soc 2016; 22:379-87. [PMID: 26786357 DOI: 10.1017/s1355617715001368] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cognitive abilities can be acutely disrupted in children and adolescents who sustain a mild traumatic brain injury (mTBI), with the potential that these disruptions may be predictive of recovery. The objective of this study was to determine if cognitive abilities in the emergency department (ED) can differentiate and predict poor symptom recovery following a pediatric mTBI. Participants included 77 male and female youth with a mTBI (mean age=13.6; SD=2.6). All participants completed computerized cognitive testing (four subtests from the CNS Vital Signs) when they presented to the ED. Symptom measurement occurred in the ED (for pre-injury), at 7-10 days, 1 month, 2 months, and 3 months post-mTBI using the post-concussion symptom inventory (PCSI). Recovery was determined using reliable change scores for symptom ratings from 28 orthopedic injury controls (mean age=13.9 years; SD=2.1). Significantly worse Reaction Time scores (i.e., rapid information processing) in the ED were found in those who remained symptomatic at 1 month. Performances on the Reaction Time and Cognitive Flexibility domain scores were predictive of symptom outcome at 1 month for youth (above and beyond sex and baseline symptom burden). Youth with low scores on Reaction Time and/or Cognitive Flexibility were nearly 15 times (95% CI=1.8-323.5) more likely to remain symptomatic at 1 month post-mTBI. No significant group differences were found at 7-10 days, 2 months, or 3 months post-injury. Rapid computerized cognitive testing in the ED following a mTBI may help clinicians predict which youth may or may not remain symptomatic at follow-up.
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Fu TS, Jing R, Fu WW, Cusimano MD. Epidemiological Trends of Traumatic Brain Injury Identified in the Emergency Department in a Publicly-Insured Population, 2002-2010. PLoS One 2016; 11:e0145469. [PMID: 26760779 PMCID: PMC4720113 DOI: 10.1371/journal.pone.0145469] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/03/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine epidemiological trends of Traumatic Brain Injury (TBI) treated in the Emergency Department (ED), identify demographic groups at risk of TBI, and determine the factors associated with hospitalization following an ED visit for TBI. METHODS A province-wide database was used to identify all ED visits for TBI in Ontario, Canada between April 2002 and March 2010. Trends were analyzed using linear regression, and predictors of hospital admission were evaluated using logistic regression. RESULTS There were 986,194 ED visits for TBI over the eight-year study period, resulting in 49,290 hospitalizations and 1,072 deaths. The age- and sex-adjusted rate of TBI decreased by 3%, from 1,013.9 per 100,000 (95% CI 1,008.3-1,010.6) to 979.1 per 100,000 (95% CI 973.7-984.4; p = 0.11). We found trends towards increasing age, comorbidity level, length of stay, and ambulatory transport use. Children and young adults (ages 5-24) sustained peak rates of motor vehicle crash (MVC) and bicyclist-related TBI, but also experienced the greatest decline in these rates (p = 0.003 and p = 0.005). In contrast, peak rates of fall-related TBI occurred among the youngest (ages 0-4) and oldest (ages 85+) segments of the population, but rates remained stable over time (p = 0.52 and 0.54). The 5-24 age group also sustained the highest rates of sports-related TBI but rates remained stable (p = 0.80). On multivariate analysis, the odds of hospital admission decreased by 1% for each year over the study period (OR = 0.991, 95% CI = 0.987-0.995). Increasing age and comorbidity, male sex, and ambulatory transport were significant predictors of hospital admission. CONCLUSIONS ED visits for TBI are involving older populations with increasingly complex comorbidities. While TBI rates are either stable or declining among vulnerable groups such as young drivers, youth athletes, and the elderly, these populations remain key targets for focused injury prevention and surveillance. Clinicians in the ED setting should be cognizant of factors associated with hospitalization following TBI. LEVEL OF EVIDENCE III. STUDY DESIGN Cross-sectional.
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Affiliation(s)
- Terence S. Fu
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital; Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre; University of Toronto, Toronto, ON, Canada
| | - Ruwei Jing
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital; Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre; University of Toronto, Toronto, ON, Canada
| | - Wayne W. Fu
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital; Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre; University of Toronto, Toronto, ON, Canada
| | - Michael D. Cusimano
- Division of Neurosurgery, Department of Surgery, St. Michael’s Hospital; Injury Prevention Research Office, Li Ka Shing Knowledge Institute, Keenan Research Centre; University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Wang W, Jiang T, Li C, Chen J, Cao K, Qi LW, Li P, Zhu W, Zhu B, Chen Y. China's research status in emergency medicine: a 15-year survey of literature. Am J Emerg Med 2015; 34:392-7. [PMID: 26639456 DOI: 10.1016/j.ajem.2015.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/03/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate the research status of emergency medicine in China through literature search of international emergency medicine journals and retrospectively compare the outputs of emergency medicine articles of the 3 major regions of China-Mainland (ML), Taiwan (TW), and Hong Kong (HK). METHODS Emergency medicine journals were selected category from Science Citation Index Expand. Articles from the ML, TW, and HK were retrieved from PubMed database. The total number of articles, publication types, research contents, impact factors (IF), and articles published in each journal were conducted for quantity and quality comparisons. RESULTS A total of 1760 articles from 19 emergency medicine journals were searched, of which 395 were from ML, 1210 from TW, and 155 from HK. Accumulated IF of articles from TW (2451.109) was much higher than that of ML (851.832) and HK (328.579), whereas the average IF of articles from TW (2.02) was the lowest. The number of case reports was the highest, which was, 69 from ML, 637 from TW, and 25 from HK, respectively. Although emergency medicine was involved with multiple organs and multiple systems, the reports of trauma accounted for 25% of the research contents. CONCLUSIONS The total number of articles from both China and the rest of the world increased significantly from 2000 to 2014, especially ML. The total number of articles from TW was still much more than that of ML and HK, whereas the quality of articles from TW was not as good as ML and HK. Case report had the highest share of publication types, whereas the proportions of meta-analysis and observational study were the lowest. As for research contents, the proportion of trauma was still the highest.
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Affiliation(s)
- Weiwei Wang
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Jiang
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chunyu Li
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Chen
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kejiang Cao
- Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lian-wen Qi
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Ping Li
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Wei Zhu
- Department of Oncology, the First Affiliated Hospital of Medical University, Nanjing 210029, China.
| | - Baoli Zhu
- Institute of Occupational Disease Prevention and Treatment, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing 210028, China.
| | - Yan Chen
- Emergency Center, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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