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Li Y, Thompson WK, Reuter C, Nillo R, Jernigan T, Dale A, Sugrue LP, Brown J, Dougherty RF, Rauschecker A, Rudie J, Barch DM, Calhoun V, Hagler D, Hatton S, Tanabe J, Marshall A, Sher KJ, Heeringa S, Hermosillo R, Banich MT, Squeglia L, Bjork J, Zucker R, Neale M, Herting M, Sheth C, Huber R, Reeves G, Hettema JM, Howlett KD, Cloak C, Baskin-Sommers A, Rapuano K, Gonzalez R, Karcher N, Laird A, Baker F, James R, Sowell E, Dick A, Hawes S, Sutherland M, Bagot K, Bodurka J, Breslin F, Morris A, Paulus M, Gray K, Hoffman E, Weiss S, Rajapakse N, Glantz M, Nagel B, Ewing SF, Goldstone A, Pfefferbaum A, Prouty D, Rosenberg M, Bookheimer S, Tapert S, Infante M, Jacobus J, Giedd J, Shilling P, Wade N, Uban K, Haist F, Heyser C, Palmer C, Kuperman J, Hewitt J, Cottler L, Isaiah A, Chang L, Edwards S, Ernst T, Heitzeg M, Puttler L, Sripada C, Iacono W, Luciana M, Clark D, Luna B, Schirda C, Foxe J, Freedman E, Mason M, McGlade E, Renshaw P, Yurgelun-Todd D, Albaugh M, Allgaier N, Chaarani B, Potter A, Ivanova M, Lisdahl K, Do E, Maes H, Bogdan R, Anokhin A, Dosenbach N, Glaser P, Heath A, Casey BJ, Gee D, Garavan HP, Dowling G, Brown S. Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children. JAMA Neurol 2021; 78:578-587. [PMID: 33749724 PMCID: PMC7985817 DOI: 10.1001/jamaneurol.2021.0306] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Incidental findings (IFs) are unexpected abnormalities discovered during imaging and can range from normal anatomic variants to findings requiring urgent medical intervention. In the case of brain magnetic resonance imaging (MRI), reliable data about the prevalence and significance of IFs in the general population are limited, making it difficult to anticipate, communicate, and manage these findings. Objectives To determine the overall prevalence of IFs in brain MRI in the nonclinical pediatric population as well as the rates of specific findings and findings for which clinical referral is recommended. Design, Setting, and Participants This cohort study was based on the April 2019 release of baseline data from 11 810 children aged 9 to 10 years who were enrolled and completed baseline neuroimaging in the Adolescent Brain Cognitive Development (ABCD) study, the largest US population-based longitudinal observational study of brain development and child health, between September 1, 2016, and November 15, 2018. Participants were enrolled at 21 sites across the US designed to mirror the demographic characteristics of the US population. Baseline structural MRIs were centrally reviewed for IFs by board-certified neuroradiologists and findings were described and categorized (category 1, no abnormal findings; 2, no referral recommended; 3; consider referral; and 4, consider immediate referral). Children were enrolled through a broad school-based recruitment process in which all children of eligible age at selected schools were invited to participate. Exclusion criteria were severe sensory, intellectual, medical, or neurologic disorders that would preclude or interfere with study participation. During the enrollment process, demographic data were monitored to ensure that the study met targets for sex, socioeconomic, ethnic, and racial diversity. Data were analyzed from March 15, 2018, to November 20, 2020. Main Outcomes and Measures Percentage of children with IFs in each category and prevalence of specific IFs. Results A total of 11 679 children (52.1% boys, mean [SD] age, 9.9 [0.62] years) had interpretable baseline structural MRI results. Of these, 2464 participants (21.1%) had IFs, including 2013 children (17.2%) assigned to category 2, 431 (3.7%) assigned to category 3, and 20 (0.2%) assigned to category 4. Overall rates of IFs did not differ significantly between singleton and twin gestations or between monozygotic and dizygotic twins, but heritability analysis showed heritability for the presence or absence of IFs (h2 = 0.260; 95% CI, 0.135-0.387). Conclusions and Relevance Incidental findings in brain MRI and findings with potential clinical significance are both common in the general pediatric population. By assessing IFs and concurrent developmental and health measures and following these findings over the longitudinal study course, the ABCD study has the potential to determine the significance of many common IFs.
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Affiliation(s)
- Yi Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Wesley K. Thompson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Chase Reuter
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Ryan Nillo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Terry Jernigan
- Center for Human Development, University of California, San Diego, La Jolla
| | - Anders Dale
- Center for Human Development, University of California, San Diego, La Jolla
| | - Leo P. Sugrue
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | | | - Julian Brown
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Robert F Dougherty
- Center for Cognitive and Neurobiological Imaging, Stanford University, Stanford, California
| | - Andreas Rauschecker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Jeffrey Rudie
- Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Psychiatry, Radiology, Washington University in St Louis, St Louis, Missouri
| | - Vince Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Georgia Tech, Emory University, Atlanta
| | - Donald Hagler
- Department of Radiology, University of California, San Diego, La Jolla
| | - Sean Hatton
- Department of Neurosciences, University of California, San Diego, La Jolla
| | - Jody Tanabe
- Department of Radiology, University of Colorado Anschutz Medical Center, Aurora
| | - Andrew Marshall
- Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia
| | - Steven Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Robert Hermosillo
- Department of Behavioral Neuroscience, Oregon Health Sciences University, Portland
| | - Marie T Banich
- Institute of Cognitive Science, Department of Psychology and Neuroscience, University of Colorado, Boulder
| | - Lindsay Squeglia
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - James Bjork
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Robert Zucker
- Department of Psychiatry and Psychology, University of Michigan, Ann Arbor
| | - Michael Neale
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Megan Herting
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Chandni Sheth
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Rebeka Huber
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Gloria Reeves
- Department of Psychiatry, University of Maryland, Baltimore
| | - John M Hettema
- Department of Psychiatry, Texas A&M Health Science Center, Bryan
| | - Katia Delrahim Howlett
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Christine Cloak
- Department of Radiology and Nuclear Medicine, University of Maryland, Baltimore
| | | | - Kristina Rapuano
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Raul Gonzalez
- Department of Psychology, Florida International University, Miami
| | - Nicole Karcher
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Angela Laird
- Department of Physics, Florida International University, Miami
| | | | - Regina James
- Department of Clinical Research, 2M Research Services, Arlington, Virginia
| | - Elizabeth Sowell
- Department of Pediatrics, Children's Hospital Los Angeles/University of Southern California, Los Angeles
| | - Anthony Dick
- Department of Psychology, Florida International University, Miami
| | - Samuel Hawes
- Department of Psychology, Florida International University, Miami
| | | | - Kara Bagot
- Department of Psychiatry, Icahn School of Medicine at Mt Sinai, New York, New York
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Amanda Morris
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Martin Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma
| | - Kevin Gray
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth Hoffman
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Susan Weiss
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Nishadi Rajapakse
- Department of Scientific Programs, National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Meyer Glantz
- Department of Psychology, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Bonnie Nagel
- Department of Psychiatry, Oregon Health and Science University, Portland
| | | | | | | | | | - Monica Rosenberg
- Department of Psychology, University of Chicago, Chicago, Illinois
| | - Susan Bookheimer
- Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California, Los Angeles
| | - Susan Tapert
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Maria Infante
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Joanna Jacobus
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Jay Giedd
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Paul Shilling
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Natasha Wade
- Department of Psychiatry, University of California, San Diego, La Jolla
| | - Kristina Uban
- Department of Public Health, University of California, Irvine
| | - Frank Haist
- Department of Psychiatry and Center for Human Development, University of California, San Diego, La Jolla
| | - Charles Heyser
- Center for Human Development, University of California, San Diego, La Jolla
| | - Clare Palmer
- Center for Human Development, University of California, San Diego, La Jolla
| | - Joshua Kuperman
- Department of Radiology, University of California, San Diego, La Jolla
| | - John Hewitt
- Institute for Behavioral Genetics, University of Colorado, Boulder
| | - Linda Cottler
- Department of Epidemiology, University of Florida, Gainesville
| | - Amal Isaiah
- Department of Otorhinolaryngology/Head and Neck Surgery and Pediatrics, University of Maryland School of Medicine, Baltimore
| | - Linda Chang
- Departments of Radiology and Neurology, University of Maryland, Baltimore
| | - Sarah Edwards
- Department of Psychiatry, University of Maryland, Baltimore
| | - Thomas Ernst
- Department of Radiology, University of Maryland, Baltimore
| | - Mary Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor
| | - Leon Puttler
- Department of Psychiatry, University of Michigan, Ann Arbor
| | | | - William Iacono
- Department of Psychology, University of Minnesota, Minneapolis
| | - Monica Luciana
- Department of Psychology, University of Minnesota, Minneapolis
| | - Duncan Clark
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Claudiu Schirda
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Foxe
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Edward Freedman
- Department of Neuroscience, University of Rochester Medical Center, Rochester, New York
| | - Michael Mason
- Center for Behavioral Health Research, University of Tennessee, Knoxville
| | - Erin McGlade
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | - Perry Renshaw
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City
| | | | | | | | - Bader Chaarani
- Department of Psychiatry, University of Vermont, Burlington
| | | | - Masha Ivanova
- Department of Psychiatry, University of Vermont, Burlington
| | - Krista Lisdahl
- Department of Psychiatry, University of Vermont, Burlington
| | - Elizabeth Do
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond
| | - Hermine Maes
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond
| | - Ryan Bogdan
- Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri
| | - Andrey Anokhin
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Nico Dosenbach
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
| | - Paul Glaser
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Andrew Heath
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Betty J Casey
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Dylan Gee
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Hugh P Garavan
- Department of Psychiatry, University of Vermont, Burlington
| | - Gaya Dowling
- Division of Extramural Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, Maryland
| | - Sandra Brown
- Department of Psychiatry and Psychology, University of California, San Diego, La Jolla
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7
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Dangouloff-Ros V, Roux CJ, Boulouis G, Levy R, Nicolas N, Lozach C, Grevent D, Brunelle F, Boddaert N, Naggara O. Incidental Brain MRI Findings in Children: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2019; 40:1818-1823. [PMID: 31624116 DOI: 10.3174/ajnr.a6281] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/03/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The detection of incidental findings on children's brain MR imaging poses various practical issues because the life-long implications of such findings may be profound. PURPOSE Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children. DATA SOURCES Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: "incidental," "findings," "brain," "MR imaging." STUDY SELECTION Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of ≥10. DATA ANALYSIS Two observers independently extracted data and assessed data quality and validity. The number and type of incidental findings were pooled. Heterogeneity was assessed using the Cochran Q statistic and the I2 statistic. DATA SYNTHESIS Seven studies were included, reporting 5938 children (mean age, 11.3 ± 2.8 years). Incidental findings were present in 16.4% (99% CI, 9.8-26.2; Q = 117.5, I2= 94.9%) of healthy children, intracranial cysts being the most frequent (10.2%, 99% CI, 3.1-28.5; Q = 306.4, I2 = 98.0%). Nonspecific white matter hyperintensities were reported in 1.9% (99% CI, 0.2-16.8; Q = 73.6, I2 = 94.6%), Chiari 1 malformation was found in 0.8% (99% CI, 0.5-1.3; Q = 7.6, I2 = 60.5%), and intracranial neoplasms were reported in 0.2% (99% CI, 0.1-0.6; Q = 3.4, I2 = 12.3%). In total, the prevalence of incidental findings needing follow-up was 2.6% (99% CI, 0.5-11.7; Q = 131.2, I2 = 95.4%). Incidental findings needing specific treatment were brain tumors (0.2%) and cavernomas (0.2%). LIMITATIONS Limitations were no age stratification or ethnicity data and variation in the design of included studies. CONCLUSIONS The prevalence of incidental findings is much more frequent in children than previously reported in adults, but clinically meaningfull incidental findings were present in <1 in 38 children.
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Affiliation(s)
- V Dangouloff-Ros
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - C-J Roux
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - G Boulouis
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
- Neuroradiology Department (G.B., O.N.), Centre Hospitalier Sainte-Anne, Paris, France
| | - R Levy
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - N Nicolas
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - C Lozach
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - D Grevent
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - F Brunelle
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - N Boddaert
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - O Naggara
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
- Neuroradiology Department (G.B., O.N.), Centre Hospitalier Sainte-Anne, Paris, France
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8
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Mayer AR, Cohen DM, Wertz CJ, Dodd AB, Shoemaker J, Pluto C, Zumberge NA, Park G, Bangert BA, Lin C, Minich NM, Bacevice AM, Bigler ED, Campbell RA, Hanlon FM, Meier TB, Oglesbee SJ, Phillips JP, Pottenger A, Shaff NA, Taylor HG, Yeo RA, Arbogast KB, Leddy JJ, Master CL, Mannix R, Zemek RL, Yeates KO. Radiologic common data elements rates in pediatric mild traumatic brain injury. Neurology 2019; 94:e241-e253. [PMID: 31645467 DOI: 10.1212/wnl.0000000000008488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The nosology for classifying structural MRI findings following pediatric mild traumatic brain injury (pmTBI) remains actively debated. Radiologic common data elements (rCDE) were developed to standardize reporting in research settings. However, some rCDE are more specific to trauma (probable rCDE). Other more recently proposed rCDE have multiple etiologies (possible rCDE), and may therefore be more common in all children. Independent cohorts of patients with pmTBI and controls were therefore recruited from multiple sites (New Mexico and Ohio) to test the dual hypothesis of a higher incidence of probable rCDE (pmTBI > controls) vs similar rates of possible rCDE on structural MRI. METHODS Patients with subacute pmTBI (n = 287), matched healthy controls (HC; n = 106), and orthopedically injured (OI; n = 71) patients underwent imaging approximately 1 week postinjury and were followed for 3-4 months. RESULTS Probable rCDE were specific to pmTBI, occurring in 4%-5% of each sample, rates consistent with previous large-scale CT studies. In contrast, prevalence rates for incidental findings and possible rCDE were similar across groups (pmTBI vs OI vs HC). The prevalence of possible rCDE was also the only finding that varied as a function of site. Possible rCDE and incidental findings were not associated with postconcussive symptomatology or quality of life 3-4 months postinjury. CONCLUSION Collectively, current findings question the trauma-related specificity of certain rCDE, as well how these rCDE are radiologically interpreted. Refinement of rCDE in the context of pmTBI may be warranted, especially as diagnostic schema are evolving to stratify patients with structural MRI abnormalities as having a moderate injury.
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Affiliation(s)
- Andrew R Mayer
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada.
| | - Daniel M Cohen
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Christopher J Wertz
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Andrew B Dodd
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Jody Shoemaker
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Charles Pluto
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Nicholas A Zumberge
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Grace Park
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Barbara A Bangert
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Cindy Lin
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Nori M Minich
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Ann M Bacevice
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Erin D Bigler
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Richard A Campbell
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Faith M Hanlon
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Timothy B Meier
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Scott J Oglesbee
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - John P Phillips
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Amy Pottenger
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Nicholas A Shaff
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - H Gerry Taylor
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Ronald A Yeo
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Kristy B Arbogast
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - John J Leddy
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Christina L Master
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Rebekah Mannix
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Roger L Zemek
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
| | - Keith Owen Yeates
- From The Mind Research Network/Lovelace Biomedical and Environmental Research Institute (A.R.M., C.J.W., A.B.D., J.S., F.M.H., J.P.P., N.A.S.); Departments of Psychiatry and Behavioral Sciences (A.R.M.), Psychology (A.R.M., R.A.C., R.A.Y.), and Neurology (A.R.M., J.P.P.), University of New Mexico, Albuquerque; Department of Pediatrics (D.M.C., H.G.T.), The Ohio State University, Columbus; Division of Emergency Medicine (D.M.C.) and Department of Radiology (N.A.Z.), Nationwide Children's Hospital, Columbus, OH; Radiology Associates of Albuquerque (C.P.); Emergency Medicine (G.P., S.J.O., A.P.), University of New Mexico Hospital, Albuquerque; Department of Radiology (B.A.B.), Case Western Reserve University School of Medicine, Cleveland, OH; The Research Institute at Nationwide Children's Hospital (C.L.), Columbus, OH; Department of Pediatrics, Rainbow Babies and Children's Hospital (N.M.M., A.M.B.), Case Western Reserve University, Cleveland, OH; Department of Psychology (E.D.B.), Brigham Young University, Provo, UT; Departments of Neurosurgery (T.B.M.), Cell Biology, Neurobiology and Anatomy (T.B.M.), and Biomedical Engineering (T.B.M.), Medical College of Wisconsin, Milwaukee; Center for Injury Research and Prevention (K.B.A., C.L.M.) and Division of Orthopedic Surgery (C.L.M.), Children's Hospital of Philadelphia; Department of Pediatrics (K.B.A., C.L.M.), University of Pennsylvania, Philadelphia; UBMD Department of Orthopaedics and Sports Medicine (J.J.L.), Jacobs School of Medicine, University at Buffalo, NY; Division of Emergency Medicine (R.M.), Boston Children's Hospital, MA; Department of Pediatrics and Emergency Medicine (R.L.Z.), Children's Hospital of Eastern Ontario Research Institute, University of Ottawa; and Department of Psychology (K.O.Y.), Alberta Children's Hospital Research Institute (K.O.Y.), and Hotchkiss Brain Institute (K.O.Y.), University of Calgary, Canada
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