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Li W, Wittmann RA, Farias DR, Bigler ED, Martin RM. Cognitive profile of mild traumatic brain injury patients requiring acute hospitalization - A UC davis cognitive screener (UCD-Cog) study. Brain Inj 2022; 36:59-71. [PMID: 35143336 DOI: 10.1080/02699052.2022.2034968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Identification of patients with mTBI at risk for developing persistent-post concussive syndromes should begin during the ED/inpatient evaluation due to frequent lack of post-discharge follow-up. The best method for evaluating cognitive deficits in these acute settings and how to utilize this information to optimize follow-up care is a matter of ongoing research. In this descriptive study, we present the cognitive profile of 214 hospitalized patients with mTBI using a novel cognitive and behavioral screener, the UCD-Cog. METHOD A retrospective review of patients with mTBI requiring hospitalization who were enrolled in the UC Davis TBI Registry over the course of 1 year. RESULTS Reasoning, executive function, and delayed recall were the most frequently impaired cognitive domains. GCS 13-14 was associated with higher numbers of impaired cognitive domains and frequencies of impairments in domains traditionally associated with post-concussive symptoms. Patients with abnormal UCD-Cog results, regardless of GCS, were recommended higher levels of post-discharge care and supervision. CONCLUSION Inpatient cognitive profiles using the UCD-Cog were consistent with evaluations during the subacute/chronic phase of mTBI and supports the clinical utility of acute cognitive screeners for mTBI management. Future studies will determine how the acute cognitive assessments correlate with long-term mTBI outcomes.
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Affiliation(s)
- Wentao Li
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, University of California Davis, Sacramento, California, USA
| | - Rejane A Wittmann
- Department of Speech Pathology, University of California Davis, Sacramento, California, USA
| | - Dana R Farias
- Department of Speech Pathology, University of California Davis, Sacramento, California, USA
| | - Erin D Bigler
- Department of Neurology, University of California Davis, Sacramento, California, USA.,Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, Union Territory, USA.,Departments of Neurology and Psychiatry, University of Utah, Salt Lake City, Union Territory USA
| | - Ryan M Martin
- Department of Neurology, University of California Davis, Sacramento, California, USA.,Department of Neurosurgery, University of California Davis, Sacramento, California, USA
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Gozt A, Licari M, Halstrom A, Milbourn H, Lydiard S, Black A, Arendts G, Macdonald S, Song S, MacDonald E, Vlaskovsky P, Burrows S, Bynevelt M, Pestell C, Fatovich D, Fitzgerald M. Towards the Development of an Integrative, Evidence-Based Suite of Indicators for the Prediction of Outcome Following Mild Traumatic Brain Injury: Results from a Pilot Study. Brain Sci 2020; 10:brainsci10010023. [PMID: 31906443 PMCID: PMC7017246 DOI: 10.3390/brainsci10010023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/16/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Persisting post-concussion symptoms (PPCS) is a complex, multifaceted condition in which individuals continue to experience the symptoms of mild traumatic brain injury (mTBI; concussion) beyond the timeframe that it typically takes to recover. Currently, there is no way of knowing which individuals may develop this condition. Method: Patients presenting to a hospital emergency department (ED) within 48 h of sustaining a mTBI underwent neuropsychological assessment and demographic, injury-related information and blood samples were collected. Concentrations of blood-based biomarkers neuron specific enolase, neurofilament protein-light, and glial fibrillary acidic protein were assessed, and a subset of patients also underwent diffusion tensor–magnetic resonance imaging; both relative to healthy controls. Individuals were classified as having PPCS if they reported a score of 25 or higher on the Rivermead Postconcussion Symptoms Questionnaire at ~28 days post-injury. Univariate exact logistic regression was performed to identify measures that may be predictive of PPCS. Neuroimaging data were examined for differences in fractional anisotropy (FA) and mean diffusivity in regions of interest. Results: Of n = 36 individuals, three (8.33%) were classified as having PPCS. Increased performance on the Repeatable Battery for the Assessment of Neuropsychological Status Update Total Score (OR = 0.81, 95% CI: 0.61–0.95, p = 0.004), Immediate Memory (OR = 0.79, 95% CI: 0.56–0.94, p = 0.001), and Attention (OR = 0.86, 95% CI: 0.71–0.97, p = 0.007) indices, as well as faster completion of the Trails Making Test B (OR = 1.06, 95% CI: 1.00–1.12, p = 0.032) at ED presentation were associated with a statistically significant decreased odds of an individual being classified as having PPCS. There was no significant association between blood-based biomarkers and PPCS in this small sample, although glial fibrillary acidic protein (GFAP) was significantly increased in individuals with mTBI relative to healthy controls. Furthermore, relative to healthy age and sex-matched controls (n = 8), individuals with mTBI (n = 14) had higher levels of FA within the left inferior frontal occipital fasciculus (t (18.06) = −3.01, p = 0.008). Conclusion: Performance on neuropsychological measures may be useful for predicting PPCS, but further investigation is required to elucidate the utility of this and other potential predictors.
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Affiliation(s)
- Aleksandra Gozt
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (A.G.); (A.B.); (C.P.)
- Perron Institute for Neurological and Translational Science, Nedlands, WA 6009, Australia
| | - Melissa Licari
- Telethon Kids Institute, West Perth, WA 6005, Australia;
| | - Alison Halstrom
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (A.H.); (H.M.); (S.L.)
| | - Hannah Milbourn
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (A.H.); (H.M.); (S.L.)
| | - Stephen Lydiard
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (A.H.); (H.M.); (S.L.)
| | - Anna Black
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (A.G.); (A.B.); (C.P.)
- Perron Institute for Neurological and Translational Science, Nedlands, WA 6009, Australia
| | - Glenn Arendts
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; (G.A.); (S.M.); (D.F.)
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, WA 6000, Australia;
| | - Stephen Macdonald
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; (G.A.); (S.M.); (D.F.)
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, WA 6000, Australia;
- Emergency Department, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Swithin Song
- Radiology Department, Royal Perth Hospital, Perth, WA 6000, Australia;
| | - Ellen MacDonald
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, WA 6000, Australia;
- Emergency Department, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Philip Vlaskovsky
- School of Medicine, The University of Western Australia, Crawley, WA 6009, Australia; (P.V.); (S.B.)
| | - Sally Burrows
- School of Medicine, The University of Western Australia, Crawley, WA 6009, Australia; (P.V.); (S.B.)
| | - Michael Bynevelt
- School of Surgery, The University of Western Australia, Crawley, WA 6009, Australia;
- Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gardener Hospital, Nedlands, WA 6009, Australia
| | - Carmela Pestell
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (A.G.); (A.B.); (C.P.)
- School of Psychological Science, The University of Western Australia, Crawley, WA 6009, Australia
| | - Daniel Fatovich
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; (G.A.); (S.M.); (D.F.)
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, WA 6000, Australia;
- Emergency Department, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA 6102, Australia; (A.G.); (A.B.); (C.P.)
- Perron Institute for Neurological and Translational Science, Nedlands, WA 6009, Australia
- School of Biological Sciences, The University of Western Australia, Crawley, WA 6009, Australia; (A.H.); (H.M.); (S.L.)
- Correspondence: ; Tel.: +61-467-729-300
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Recommendations for the Emergency Department Prevention of Sport-Related Concussion. Ann Emerg Med 2019; 75:471-482. [PMID: 31326205 DOI: 10.1016/j.annemergmed.2019.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 12/31/2022]
Abstract
Sport-related concussion refers to the subset of concussive injuries occurring during sport activities. Similar to concussion from nonsport mechanisms, sport-related concussion is associated with significant morbidity, including migrainous headaches, disruption in normal daily activities, and long-term depression and cognitive deficits. Unlike nonsport concussions, sport-related concussion may be uniquely amenable to prevention efforts to mitigate these problems. The emergency department (ED) visit for sport-related concussion represents an opportunity to reduce morbidity by timely diagnosis and management using best practices, and through education and counseling to prevent a subsequent sport-related concussion. This article provides recommendations to reduce sport-related concussion disability through primary, secondary, and tertiary preventive strategies enacted during the ED visit. Although many recommendations have a solid evidence base, several research gaps remain. The overarching goal of improving sport-related concussion outcome through enactment of ED-based prevention strategies needs to be explicitly studied.
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Lunter CM, Carroll EL, Housden C, Outtrim J, Forsyth F, Rivera A, Maimaris C, Boyle A, Sahakian BJ, Menon DK, Newcombe VF. Neurocognitive testing in the emergency department: A potential assessment tool for mild traumatic brain injury. Emerg Med Australas 2018; 31:355-361. [PMID: 30175893 DOI: 10.1111/1742-6723.13163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/02/2018] [Accepted: 07/19/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite mild traumatic brain injury (mTBI) accounting for 80% of head injury diagnoses, recognition of individuals at risk of cognitive dysfunction remains a challenge in the acute setting. The objective of this study was to evaluate the feasibility and potential role for computerised cognitive testing as part of a complete ED head injury assessment. METHODS mTBI patients (n = 36) who incurred a head injury within 24 h of presentation to the ED were compared to trauma controls (n = 20) and healthy controls (n = 20) on tests assessing reaction time, speed and attention, episodic memory, working memory and executive functioning. Testing occurred during their visit to the ED at a mean of 12 h post-injury for mTBI and 9.4 h for trauma controls. These tasks were part of the Cambridge Neuropsychological Test Automated Battery iPad application. Healthy controls were tested in both a quiet environment and the ED to investigate the potential effects of noise and distraction on neurocognitive function. RESULTS Reaction time was significantly slower in the mTBI group compared to trauma patients (P = 0.015) and healthy controls (P = 0.011), and deficits were also seen in working memory compared to healthy controls (P ≤ 0.001) and in executive functioning (P = 0.021 and P < 0.001) compared to trauma and healthy controls. Performances in the control group did not differ between testing environments. CONCLUSION Computerised neurocognitive testing in the ED is feasible and can be utilised to detect deficits in cognitive performance in the mTBI population as part of a routine head injury assessment.
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Affiliation(s)
- Catherine M Lunter
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Ellen L Carroll
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | | | - Joanne Outtrim
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Faye Forsyth
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Annie Rivera
- National Institute of Health Research/Wellcome Trust Clinical Research Facility, Cambridge, UK
| | - Chris Maimaris
- Department of Emergency Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Adrian Boyle
- Department of Emergency Medicine, Addenbrooke's Hospital, Cambridge, UK
| | | | - David K Menon
- University Division of Anaesthesia, University of Cambridge, Cambridge, UK
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Incorporating a Computerized Cognitive Battery Into the Emergency Department Care of Pediatric Mild Traumatic Brain Injuries-Is It Feasible? Pediatr Emerg Care 2018; 34:501-506. [PMID: 28030519 DOI: 10.1097/pec.0000000000000959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The use of computers to test cognitive function acutely after a concussion is becoming increasingly popular, especially after sport-related concussion. Although commonly performed in the community, it is not yet performed routinely in the emergency department (ED), where most injured children present. The challenges of performing computerized cognitive testing (CCT) in a busy ED are considerable. The aim of this study was to evaluate the feasibility of CCT in the pediatric ED after concussion. METHODS Children, aged 8 to 18 years with mild traumatic brain injury, presenting to the ED were eligible for this prospective study. Exclusion criteria included the use of drugs, alcohol, and/or physical injury, which could affect CCT performance. A 30- or 15-minute CCT battery was performed. Feasibility measures included environmental factors (space, noise, waiting time), testing factors (time, equipment reliability, personnel), and patient factors (age, injury characteristics). RESULTS Forty-nine children (28 boys; mean age, 12.6; SD, ± 2.5) participated in the study. All children completed CCT. Mean testing times for the 30- and 15-minute battery were 29.7 and 15.2 minutes, respectively. Noise-cancelling headphones were well tolerated. A shorter CCT was more acceptable to families and was associated with fewer noise disturbances. There was sufficient time to perform testing after triage and before physician assessment in over 90% of children. CONCLUSIONS Computerized cognitive testing is feasible in the ED. We highlight the unique challenges that should be considered before its implementation, including environmental and testing considerations, as well as personnel training.
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Feasibility and Neurobehavioral Changes of 10-Day Simulated Microgravity in Acute Ischemic Stroke Patients. Am J Phys Med Rehabil 2017; 96:838-842. [PMID: 28604410 DOI: 10.1097/phm.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the study was to investigate feasibility and functional changes of simulated microgravity with 6-degree head-down-tilt (HDT) bed rest in acute ischemic stroke. DESIGN Patients without lesions in the cingulate cortex and/or cerebellum were enrolled. They underwent HDT for 30 minutes twice per day for 10 weekdays. Systolic blood pressure, diastolic blood pressure, and heart rate were measured before the HDT, immediately after, and also 30 minutes after the stop. Mini-Mental State Examination, Geriatric Depression Scale, Neurobehavioral Tests (i.e., span test, finger-tapping test, continuous performance test, and trail-making test) were conducted before and after the 10-day HDT. RESULTS One male and four female patients (median age = 64.6 yrs [SD = 10.5 yrs]) were recruited. Changes in the finger-tapping test (57.80 [SD = 40.96 ] vs. 85.80 [SD = 0.46], P = 0.08) and in the digit span backward test (3.60 [SD = 1.14] vs. 1.42 [SD = 1.75], P = 0.07) were noticed. Few changes were found in other scales. No significant changes in systolic blood pressure, diastolic blood pressure, or heart rate were observed, and no adverse effects occurred. CONCLUSIONS The 6-degree HDT revealed no adverse effects on the cardiovascular system, showing nonsignificant increment in the finger-tapping test (representative of motor speed and performance) and nonsignificant reduction in the digit backward span test (representative of spatial memory).
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Watson CE, Clous EA, Jaeger M, D’Amours SK. Introduction of the Abbreviated Westmead Post-Traumatic Amnesia Scale and Impact on Length of Stay. Scand J Surg 2017; 106:356-360. [DOI: 10.1177/1457496917698642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Aims: Mild traumatic brain injury is a common presentation to Emergency Departments. Early identification of patients with cognitive deficits and provision of discharge advice are important. The Abbreviated Westmead Post-traumatic Amnesia Scale provides an early and efficient assessment of post-traumatic amnesia for patients with mild traumatic brain injuries, compared with the previously used assessment, the Modified Oxford Post-traumatic Scale. Material and Methods: This retrospective cohort study reviewed 270 patients with mild traumatic brain injury assessed for post-traumatic amnesia over a 2-year period between February 2011 and February 2013. It identified those assessed with Abbreviated Westmead Post-traumatic Amnesia Scale versus Modified Oxford Post-traumatic Scale, the outcomes of these post-traumatic amnesia assessments, the hospital length of stay for patients, and their readmission rates. Results: The Abbreviated Westmead Post-traumatic Amnesia Scale was used in 91% of patient cases (and the Modified Oxford Post-traumatic Scale in 7%), and of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 94% cleared post-traumatic amnesia testing within 4 h. Of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 56% had a shorter length of stay than had they been assessed with the Modified Oxford Post-traumatic Scale, resulting in 295 bed-days saved. Verbal and written discharge advice was provided to those assessed for post-traumatic amnesia to assist their recovery. In all, 1% of patients were readmitted for monitoring of mild post-concussion symptoms. Conclusion: The Abbreviated Westmead Post-traumatic Amnesia Scale provides an effective and timely assessment of post-traumatic amnesia for patients presenting to the Emergency Department with mild traumatic brain injury compared with the previously used assessment tool. It helps identify patients with cognitive impairment and the need for admission and further investigation, resulting in appropriate access to care. It also results in a decreased length of stay and decreased hospital admissions, with subsequent cost savings to the hospital.
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Affiliation(s)
- C. E. Watson
- Occupational Therapy Department, Liverpool Hospital, Liverpool, NSW, Australia
| | - E. A. Clous
- Trauma Department, Liverpool Hospital, Liverpool, NSW, Australia
- Trauma Unit, Department of Surgery, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - M. Jaeger
- Neurosurgery Department, Liverpool Hospital, Liverpool, NSW, Australia
- Neurosurgery Department, Wollongong Hospital, Wollongong, NSW, Australia
| | - S. K. D’Amours
- Trauma Department, Liverpool Hospital, Liverpool, NSW, Australia
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Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools Part 2: Utility for Assessment of Mild Traumatic Brain Injury in Emergency Department Patients. J Int Neuropsychol Soc 2017; 23:293-303. [PMID: 28343463 PMCID: PMC6637940 DOI: 10.1017/s1355617717000157] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the reliability and validity of three computerized neurocognitive assessment tools (CNTs; i.e., ANAM, DANA, and ImPACT) for assessing mild traumatic brain injury (mTBI) in patients recruited through a level I trauma center emergency department (ED). METHODS mTBI (n=94) and matched trauma control (n=80) subjects recruited from a level I trauma center emergency department completed symptom and neurocognitive assessments within 72 hr of injury and at 15 and 45 days post-injury. Concussion symptoms were also assessed via phone at 8 days post-injury. RESULTS CNTs did not differentiate between groups at any time point (e.g., M 72-hr Cohen's d=-.16, .02, and .00 for ANAM, DANA, and ImPACT, respectively; negative values reflect greater impairment in the mTBI group). Roughly a quarter of stability coefficients were over .70 across measures and test-retest intervals in controls. In contrast, concussion symptom score differentiated mTBI vs. control groups acutely), with this effect size diminished over time (72-hr and day 8, 15, and 45 Cohen's d=-.78, -.60, -.49, and -.35, respectively). CONCLUSIONS The CNTs evaluated, developed and widely used to assess sport-related concussion, did not yield significant differences between patients with mTBI versus other injuries. Symptom scores better differentiated groups than CNTs, with effect sizes weaker than those reported in sport-related concussion studies. Nonspecific injury factors, and other characteristics common in ED settings, likely affect CNT performance across trauma patients as a whole and thereby diminish the validity of CNTs for assessing mTBI in this patient population. (JINS, 2017, 23, 293-303).
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Bloom BM, Kinsella K, Pott J, Patel HC, Harris T, Lecky F, Pearse R. Short-term neurocognitive and symptomatic outcomes following mild traumatic brain injury: A prospective multi-centre observational cohort study. Brain Inj 2017; 31:304-311. [PMID: 28156140 DOI: 10.1080/02699052.2016.1256501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine the short-term cognitive and symptomatic outcome following mild traumatic brain injury. METHODS Setting: Emergency Departments of two UK tertiary referral hospitals. PARTICIPANTS Adult patients presenting to the Emergency Departments of the Royal London Hospital and Salford Royal Hospital with suspected traumatic brain injury within 24 hours and Glasgow Coma Score > 8. A non-TBI comparison group included adult patients with no head or neck injury. DESIGN Prospective multi-centre cohort study. MAIN MEASURES The Standardized Assessment of Concussion (SAC), the Concussion Symptom Inventory (CSI) and total number of symptoms, measured at baseline and 72 hours. RESULTS This study enrolled 189 patients with and 51 patients without TBI. Patients with TBI had marked cognitive impairment which persisted at 72 hours (SAC score at baseline = 25 [23-27] vs 72 hours = 25 [22-27]; p = 0.1). Patients with TBI had persistent high symptom severity, although this had decreased at 72 hours (CSI score at baseline = 9 [4-22] vs 72 hours = 5 [1-19], p = 0.002). A similar pattern was observed with the total number of symptoms (baseline = 4 [2-8] vs 72 hours = 0 [0-4]; p < 0.001). Patients with TBI had worse neurocognitive function, higher overall symptom severity and higher total number of symptoms compared with patients without TBI. Patients without TBI' neurocognitive function and symptom severity remained constant, but the number of symptoms reduced between baseline and 72 hours. CONCLUSION There is a cognitive deficit and symptom burden in patients with mild TBI presenting to the Emergency Department which persists at 72 hours.
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Affiliation(s)
- Benjamin M Bloom
- a William Harvey Institute , Queen Mary University of London , London , UK.,b Department of Emergency Medicine , Royal London Hospital , London , UK
| | - Kathryn Kinsella
- c Department of Emergency Medicine, Salford Healthcare Directorate , Salford Royal Foundation Trust , Salford , UK
| | - Jason Pott
- b Department of Emergency Medicine , Royal London Hospital , London , UK
| | - Hiren C Patel
- d Department of Neurosurgery , Salford Royal NHS Foundation Trust , Salford , UK
| | - Tim Harris
- a William Harvey Institute , Queen Mary University of London , London , UK.,b Department of Emergency Medicine , Royal London Hospital , London , UK
| | - Fiona Lecky
- c Department of Emergency Medicine, Salford Healthcare Directorate , Salford Royal Foundation Trust , Salford , UK.,e School of Health and Related Research , University of Sheffield , Sheffield , UK.,f Trauma Audit and Research Network, Institute of Population Health , University of Manchester , Manchester , UK
| | - Rupert Pearse
- a William Harvey Institute , Queen Mary University of London , London , UK
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Röding F, Lindkvist M, Bergström U, Svensson O, Lysholm J. Trauma recidivism at an emergency department of a Swedish medical center. Inj Epidemiol 2016; 3:22. [PMID: 27747558 PMCID: PMC5018470 DOI: 10.1186/s40621-016-0087-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/17/2016] [Indexed: 01/05/2023] Open
Abstract
Background To inform targeted prevention, we studied patterns of trauma recidivism and whether a first injury predicts the risk for a recurrent injury. Methods In a population-based study of 98,502 adult injury events 1999–2012, at the emergency department of Umeå University Hospital, Sweden, we compared non-recidivists with recidivists in terms of patients’ sex, age, type of injury and severity of the injury. Results Thirty-six percent of all patients suffered recurrent injuries, which were associated with a higher proportion of inpatient care and more hospital days. Young men and elderly women were at the highest risk for trauma recidivism. At 20 to 24 years, men had a 2.4 (CI 95 % 2.3–2.5) higher risk than women, a 90 years old woman had almost a 10-fold higher risk for another moderate/severe injury than a 20 years old one. A fracture were associated with a hazard ratio of 1.28 (CI 95 % 1.15–1.42) among men younger than 65 years and 1.31 (CI 95 % 1.12–1.54) for men older than 65 years for a subsequent moderate/severe injury. For women younger than 65 years a fracture was associated with a hazard ratio of 1.44 (CI 95 % 1.28–1.62) for a subsequent moderate/severe injury. A sprain carries a higher risk for a new moderate/severe injury for both men and women and in both age groups; the hazard ratio was 1.13 (CI 95 % 1.00–1.26) for men younger than 65 years, 1.42 (CI 95 % 1.01–1.99) for men older than 65 years, 1.19 (CI 95 % 1.05–1.35) for women younger than 65 years and 1.26 (CI 95 % 1.02–1.56) for women older than 65 years. A higher degree of injury severity was associated with a higher risk for a new moderate/severe injury. Conclusion Trauma recidivism is common and represents a large proportion of all injured. Age and sex are associated with the risk for new injury. Injury types and severity, also have implications for future injury.
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Affiliation(s)
- Fredrik Röding
- Division of Surgery and Perioperative Sciences, Department of Orthopaedics, Umea University, 90187, Umea, Sweden.
| | - Marie Lindkvist
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umea University, 90187, Umea, Sweden.,Umea School of Business and Economics, Department of Statistics, Umea University, 90187, Umea, Sweden
| | - Ulrica Bergström
- Division of Surgery and Perioperative Sciences, Department of Orthopaedics, Umea University, 90187, Umea, Sweden
| | - Olle Svensson
- Division of Surgery and Perioperative Sciences, Department of Orthopaedics, Umea University, 90187, Umea, Sweden
| | - Jack Lysholm
- Division of Surgery and Perioperative Sciences, Department of Orthopaedics, Umea University, 90187, Umea, Sweden.,Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Centre of Quality Registries North Sweden, Umea University, 90187, Umea, Sweden
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Sun J, Jacobs KM. Knockout of Cyclophilin-D Provides Partial Amelioration of Intrinsic and Synaptic Properties Altered by Mild Traumatic Brain Injury. Front Syst Neurosci 2016; 10:63. [PMID: 27489538 PMCID: PMC4951523 DOI: 10.3389/fnsys.2016.00063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 07/07/2016] [Indexed: 01/01/2023] Open
Abstract
Mitochondria are central to cell survival and Ca2+ homeostasis due to their intracellular buffering capabilities. Mitochondrial dysfunction resulting in mitochondrial permeability transition pore (mPTP) opening has been reported after mild traumatic brain injury (mTBI). Cyclosporine A provides protection against the mPTP opening through its interaction with cyclophilin-D (CypD). A recent study has found that the extent of axonal injury after mTBI was diminished in neocortex in cyclophilin-D knockout (CypDKO) mice. Here we tested whether this CypDKO could also provide protection from the increased intrinsic and synaptic neuronal excitability previously described after mTBI in a mild central fluid percussion injury mice model. CypDKO mice were crossed with mice expressing yellow fluorescent protein (YFP) in layer V pyramidal neurons in neocortex to create CypDKO/YFP-H mice. Whole cell patch clamp recordings from axotomized (AX) and intact (IN) YFP+ layer V pyramidal neurons were made 1 and 2 days after sham or mTBI in slices from CypDKO/YFP-H mice. Both excitatory post synaptic currents (EPSCs) recorded in voltage clamp and intrinsic cellular properties, including action potential (AP), afterhyperpolarization (AHP), and depolarizing after potential (DAP) characteristics recorded in current clamp were evaluated. There was no significant difference between sham and mTBI for either spontaneous or miniature EPSC frequency, suggesting that CypDKO ameliorates excitatory synaptic abnormalities. There was a partial amelioration of intrinsic properties altered by mTBI. Alleviated were the increased slope of the AP frequency vs. injected current plot, the increased AP, AHP and DAP amplitudes. Other properties that saw a reversal that became significant in the opposite direction include the current rheobase and AP overshoot. The AP threshold remained depolarized and the input resistance remained increased in mTBI compared to sham. Additional altered properties suggest that the CypDKO likely has a direct effect on membrane properties, rather than producing a selective reduction of the effects of mTBI. These results suggest that inhibiting CypD after TBI is an effective strategy to reduce synaptic hyperexcitation, making it a continued target for potential treatment of network abnormalities.
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Affiliation(s)
- Jianli Sun
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Richmond, VA, USA
| | - Kimberle M Jacobs
- Department of Anatomy and Neurobiology, Virginia Commonwealth University Richmond, VA, USA
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Mercier E, Mitra B, Cameron PA. Challenges in assessment of the mild traumatic brain injured geriatric patient. Injury 2016; 47:985-7. [PMID: 27125183 DOI: 10.1016/j.injury.2016.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Eric Mercier
- School of Public Health and Preventive Medicine, Monash University, Australia; Emergency and Trauma Centre, The Alfred Hospital, Alfred Health, Australia; Department of General Family Medicine and Emergency Medicine, Laval University, Canada.
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Australia; Emergency and Trauma Centre, The Alfred Hospital, Alfred Health, Australia; National Trauma Research Institute, Melbourne, Australia
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Australia; Emergency and Trauma Centre, The Alfred Hospital, Alfred Health, Australia; National Trauma Research Institute, Melbourne, Australia
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Ganti L, Daneshvar Y, Ayala S, Bodhit AN, Peters KR. The value of neurocognitive testing for acute outcomes after mild traumatic brain injury. Mil Med Res 2016; 3:23. [PMID: 27453788 PMCID: PMC4957408 DOI: 10.1186/s40779-016-0091-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/29/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Traditionally, neurocognitive testing is performed weeks to months after head injury and is mostly performed on patients who continue to have symptoms or difficulties. In this study, we sought to determine whether these tests, when administered acutely, could assist in predicting short-term outcomes after acute traumatic brain injury (TBI). METHODS This is an IRB-approved prospective study of adult patients who came to the emergency department of our Level-1 trauma center with TBI. Patients were enrolled prospectively after providing written informed consent and underwent three separate neurocognitive tests: the Galveston Orientation Amnesia Test (GOAT) the Rivermead Post-Concussion Survey Questionnaire (RPCSQ) and the Mini Mental Status Examination (MMSE). RESULTS A lower GOAT score was significantly associated with hospitalization (P = 0.0212) and the development of post-concussion syndrome (P = 0.0081) at late follow-up. A higher RPCSQ score was significantly associated with hospital admission (P = 0.0098), re-admission within 30 days of discharge (P = 0.0431) and evidence of post-concussion syndrome (PCS) at early follow-up (P = 0.0004). A higher MMSE score was significantly associated with not being admitted to the hospital (P = 0.0002) and not returning to the emergency department (ED) within 72 hours of discharge (P = 0.0078). Lower MMSE was also significantly associated with bleeding or a fracture on the brain CT (P = 0.0431). CONCLUSIONS While neurocognitive testing is not commonly performed in the ED in the setting of acute head injury, it is both feasible and appears to have value in predicting hospital admission and PCS. These data are especially important in terms of helping patients understand what to expect, thus, aiding in their recovery.
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Affiliation(s)
- Latha Ganti
- University of Central Florida College of Medicine, Orlando, Florida 32827 USA
| | | | - Sarah Ayala
- University of California, San Diego, California USA
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Nance ML, Callahan JM, Tharakan SJ, Malamet P, Houseknecht EM, Mahoney KR, Wiebe DJ. Utility of neurocognitive testing of mild traumatic brain injury in children treated and released from the emergency department. Brain Inj 2015; 30:184-90. [DOI: 10.3109/02699052.2015.1075591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hartwell JL, Spalding MC, Fletcher B, O'Mara MS, Karas C. You Cannot Go Home: Routine Concussion Evaluation is not Enough. Am Surg 2015. [DOI: 10.1177/000313481508100431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traditional care of mild traumatic brain injury (MTBI) is to discharge patients from the emergency department (ED) if they have a Glasgow Coma Score (GCS) of 15 and a normal head computed tomography (CT) scan. However, this does not address short-term neurocognitive deficits. Our hypothesis is that a notable percentage of patients will need outpatient neurocognitive therapy despite a reassuring initial presentation. This is a retrospective review of patients with MTBI at an urban Level I trauma center. Inclusion criteria were a diagnosis of MTBI in patients 14 years old or older, GCS 15, negative head CT scan, a completed neurocognitive evaluation, blunt mechanism, and no confounding psychiatric comorbidities. Six thousand thirty-two patients were admitted over 18 months. Three hundred ninety-five patients met inclusion criteria. Average age was 38 years (range, 14 to 93 years), 64 per cent were male, and mean Injury Severity Score (ISS) was 8.1. Forty-one per cent were cleared for discharge without follow-up. Twenty-seven per cent required ongoing neurocognitive therapy. Three per cent were deemed unsafe for discharge home. Of the patients cleared for discharge, 88 per cent had positive/questionable loss of consciousness (LOC), whereas 81 per cent who required additional therapy had positive/questionable LOC ( P = 0.20). Age, gender, ISS, and alcohol use were compared between the groups and not found to be statistically different rendering them poor predictors for appropriate discharge from the ED. A surprisingly high percentage (27%) of patients who would have met traditional ED discharge criteria were found to have persistent deficits after neurocognitive testing and were referred for ongoing therapy. We provide evidence to suggest that we should take pause before discharging patients with MTBI without a cognitive evaluation.
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Affiliation(s)
- Jennifer L. Hartwell
- Grant Medical Center, Columbus, Ohio
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; and the
| | - M. Chance Spalding
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; and the
- Department of General Surgery, Doctor's Hospital, Columbus, Ohio
| | | | | | - Chris Karas
- Grant Medical Center, Columbus, Ohio
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio; and the
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Adjorlolo S. Can Teleneuropsychology Help Meet the Neuropsychological Needs of Western Africans? The Case of Ghana. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 22:388-98. [PMID: 25719559 DOI: 10.1080/23279095.2014.949718] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In Ghana, the services of psychologists, particularly clinical psychologists and neuropsychologists, remain largely inaccessible to a large proportion of those in need. Emphasis has been placed on "physical wellness" even among patients with cognitive and behavioral problems needing psychological attention. The small number of clinical psychologists and neuropsychologists, the deplorable nature of road networks and transport systems, geopolitical factors, and a reliance on the face-to-face method in providing neuropsychological services have further complicated the accessibility problem. One way of expanding and making neuropsychological services available and accessible is through the use of information communication technology to provide these services, and this is often termed teleneuropsychology. Drawing on relevant literature, this article discusses how computerized neurocognitive assessment and videoconferencing could help in rendering clinical neuropsychological services to patients, particularly those in rural, underserved, and disadvantaged areas in Ghana. The article further proposes recommendations on how teleneuropsychology could be made achievable and sustainable in Ghana.
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Affiliation(s)
- Samuel Adjorlolo
- a Department of Psychology, Faculty of Social Studies , University of Ghana , Legon , Accra , Ghana
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Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics 2015; 135:213-23. [PMID: 25560444 DOI: 10.1542/peds.2014-0966] [Citation(s) in RCA: 350] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine if recommending strict rest improved concussion recovery and outcome after discharge from the pediatric emergency department (ED). METHODS Patients aged 11 to 22 years presenting to a pediatric ED within 24 hours of concussion were recruited. Participants underwent neurocognitive, balance, and symptom assessment in the ED and were randomized to strict rest for 5 days versus usual care (1-2 days rest, followed by stepwise return to activity). Patients completed a diary used to record physical and mental activity level, calculate energy exertion, and record daily postconcussive symptoms. Neurocognitive and balance assessments were performed at 3 and 10 days postinjury. Sample size calculations were powered to detect clinically meaningful differences in postconcussive symptom, neurocognitive, and balance scores between treatment groups. Linear mixed modeling was used to detect contributions of group assignment to individual recovery trajectory. RESULTS Ninety-nine patients were enrolled; 88 completed all study procedures (45 intervention, 43 control). Postdischarge, both groups reported a 20% decrease in energy exertion and physical activity levels. As expected, the intervention group reported less school and after-school attendance for days 2 to 5 postconcussion (3.8 vs 6.7 hours total, P < .05). There was no clinically significant difference in neurocognitive or balance outcomes. However, the intervention group reported more daily postconcussive symptoms (total symptom score over 10 days, 187.9 vs 131.9, P < .03) and slower symptom resolution. CONCLUSIONS Recommending strict rest for adolescents immediately after concussion offered no added benefit over the usual care. Adolescents' symptom reporting was influenced by recommending strict rest.
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Affiliation(s)
| | | | | | - Michael McCrea
- Neurology and Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Brooks BL, Khan S, Daya H, Mikrogianakis A, Barlow KM. Neurocognition in the Emergency Department after a Mild Traumatic Brain Injury in Youth. J Neurotrauma 2014; 31:1744-9. [DOI: 10.1089/neu.2014.3356] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brian L. Brooks
- Neurosciences (Brain Injury and Rehabilitation), Alberta Children's Hospital, Calgary, Alberta, Canada
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, Alberta, Canada
| | - Samna Khan
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Hussain Daya
- Department of Psychology, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Emergency Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Karen M. Barlow
- Neurosciences (Brain Injury and Rehabilitation), Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, Alberta, Canada
- Pediatric Neurology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Colvin JD, Thurm C, Pate BM, Newland JG, Hall M, Meehan WP. Diagnosis and acute management of patients with concussion at children's hospitals. Arch Dis Child 2013; 98:934-8. [PMID: 23852997 DOI: 10.1136/archdischild-2012-303588] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe the number of hospital admissions for concussion at paediatric hospitals in the USA. To describe the use of imaging and medications for acute concussion paediatric patients. DESIGN Cross-sectional study. SETTING Children's hospitals participating in the Pediatric Health Information System in the USA during a 10-year period. PATIENTS All emergency department (ED) visits and inpatient admissions with the primary diagnosis of concussion, defined as International Classification of Diseases, Ninth Revision, Clinical Modification codes for: (1) concussion, (2) postconcussion syndrome or (3) skull fracture without mention of intracranial injury with concussion. MAIN OUTCOME MEASURES The proportion of concussion patients who were hospitalised, underwent imaging or received medication, and the adjusted costs of visits for concussion. RESULTS The number of ED visits for concussion increased between 2001 and 2010 (2126 (0.36% of all ED visits) vs 4967 (0.62% of all ED visits); p<0.001), while the number of admissions remained stable. Of ED visits for concussion, 59.9% received CT and 47.7% received medications or intravenous fluids. Non-narcotic analgesics were the most common medication administered. Adjusted costs of patient visits were significantly higher when imaging was obtained (US$695, IQR US$472-$1009, vs US$191, IQR US$114-$287). An ED visit with CT, however, cost less than a hospitalisation without CT (US$1907, IQR US$1292-$3770). CONCLUSIONS Although the number of ED patients diagnosed with concussion has increased, the number admitted has remained stable. Concussion patients at paediatric hospitals in the USA commonly undergo CT imaging and receive medication.
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Affiliation(s)
- Jeffrey D Colvin
- Department of Pediatrics, Division of Pediatric Hospital Medicine, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City, , Kansas City, Missouri, USA
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Reuben A, Sampson P, Harris AR, Williams H, Yates P. Postconcussion syndrome (PCS) in the emergency department: predicting and pre-empting persistent symptoms following a mild traumatic brain injury. Emerg Med J 2013; 31:72-7. [DOI: 10.1136/emermed-2012-201667] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Rieger BP, Lewandowski LJ, Callahan JM, Spenceley L, Truckenmiller A, Gathje R, Miller LA. A prospective study of symptoms and neurocognitive outcomes in youth with concussion vs orthopaedic injuries. Brain Inj 2013; 27:169-78. [DOI: 10.3109/02699052.2012.729290] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Brian P. Rieger
- Department of Physical Medicine & Rehabilitation, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - James M. Callahan
- Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, PA, USA
- The Perelman School of Medicine at the University of Pennsylvania, Philadephia, PA, USA
| | - Laura Spenceley
- Psychology Department, Syracuse University, Syracuse, NY, USA
| | | | | | - Laura A. Miller
- Psychology Department, Syracuse University, Syracuse, NY, USA
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Embracing chaos: the scope and importance of clinical and pathological heterogeneity in mTBI. Brain Imaging Behav 2012; 6:255-82. [DOI: 10.1007/s11682-012-9162-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bauer RM, Iverson GL, Cernich AN, Binder LM, Ruff RM, Naugle RI. Computerized neuropsychological assessment devices: joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology. Clin Neuropsychol 2012; 26:177-96. [PMID: 22394228 PMCID: PMC3847815 DOI: 10.1080/13854046.2012.663001] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology sets forth our position on appropriate standards and conventions for computerized neuropsychological assessment devices (CNADs). In this paper, we first define CNADs and distinguish them from examiner-administered neuropsychological instruments. We then set forth position statements on eight key issues relevant to the development and use of CNADs in the healthcare setting. These statements address (a) device marketing and performance claims made by developers of CNADs; (b) issues involved in appropriate end-users for administration and interpretation of CNADs; (c) technical (hardware/software/firmware) issues; (d) privacy, data security, identity verification, and testing environment; (e) psychometric development issues, especially reliability and validity; (f) cultural, experiential, and disability factors affecting examinee interaction with CNADs; (g) use of computerized testing and reporting services; and (h) the need for checks on response validity and effort in the CNAD environment. This paper is intended to provide guidance for test developers and users of CNADs that will promote accurate and appropriate use of computerized tests in a way that maximizes clinical utility and minimizes risks of misuse. The positions taken in this paper are put forth with an eye toward balancing the need to make validated CNADs accessible to otherwise underserved patients with the need to ensure that such tests are developed and utilized competently, appropriately, and with due concern for patient welfare and quality of care.
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Bauer RM, Iverson GL, Cernich AN, Binder LM, Ruff RM, Naugle RI. Computerized neuropsychological assessment devices: joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology. Arch Clin Neuropsychol 2012; 27:362-73. [PMID: 22382386 DOI: 10.1093/arclin/acs027] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology sets forth our position on appropriate standards and conventions for computerized neuropsychological assessment devices (CNADs). In this paper, we first define CNADs and distinguish them from examiner-administered neuropsychological instruments. We then set forth position statements on eight key issues relevant to the development and use of CNADs in the healthcare setting. These statements address (a) device marketing and performance claims made by developers of CNADs; (b) issues involved in appropriate end-users for administration and interpretation of CNADs; (c) technical (hardware/software/firmware) issues; (d) privacy, data security, identity verification, and testing environment; (e) psychometric development issues, especially reliability, and validity; (f) cultural, experiential, and disability factors affecting examinee interaction with CNADs; (g) use of computerized testing and reporting services; and (h) the need for checks on response validity and effort in the CNAD environment. This paper is intended to provide guidance for test developers and users of CNADs that will promote accurate and appropriate use of computerized tests in a way that maximizes clinical utility and minimizes risks of misuse. The positions taken in this paper are put forth with an eye toward balancing the need to make validated CNADs accessible to otherwise underserved patients with the need to ensure that such tests are developed and utilized competently, appropriately, and with due concern for patient welfare and quality of care.
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Ponsford J, Cameron P, Fitzgerald M, Grant M, Mikocka-Walus A. Long-Term Outcomes after Uncomplicated Mild Traumatic Brain Injury: A Comparison with Trauma Controls. J Neurotrauma 2011; 28:937-46. [DOI: 10.1089/neu.2010.1516] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jennie Ponsford
- Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Peter Cameron
- Monash University, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Mark Fitzgerald
- Monash University, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Michele Grant
- Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
| | - Antonina Mikocka-Walus
- Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Victoria, Australia
- National Trauma Research Institute, Melbourne, Victoria, Australia
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Thomas DG, Collins MW, Saladino RA, Frank V, Raab J, Zuckerbraun NS. Identifying neurocognitive deficits in adolescents following concussion. Acad Emerg Med 2011; 18:246-54. [PMID: 21401786 PMCID: PMC3076718 DOI: 10.1111/j.1553-2712.2011.01015.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study of concussed adolescents sought to determine if a computer-based neurocognitive assessment (Immediate Postconcussion Assessment and Cognitive Test [ImPACT]) performed on patients who present to the emergency department (ED) immediately following head injury would correlate with assessments performed 3 to 10 days postinjury and if ED neurocognitive testing would detect differences in concussion severity that clinical grading scales could not. METHODS A prospective cohort sample of patients 11 to 17 years of age presenting to the ED within 12 hours of a head injury were evaluated using two traditional concussion grading scales and neurocognitive testing. ED neurocognitive scores were compared to follow-up scores obtained at least 3 days postinjury. Postconcussive symptoms, outcomes, and complications were assessed via telephone follow-up for all subjects. RESULTS Sixty patients completed phone follow-up. Thirty-six patients (60%) completed follow-up testing a median of 6 days postinjury. Traditional concussion grading did not correlate with neurocognitive deficits detected in the ED or at follow-up. For the neurocognitive domains of verbal memory, processing speed, and reaction time, there was a significant correlation between ED and follow-up scores trending toward clinical improvement. By 2 weeks postinjury, 23 patients (41%) had not returned to normal activity. At 6 weeks, six patients (10%) still had not returned to normal activity. CONCLUSIONS Immediate assessment in the ED can predict neurocognitive deficits seen in follow-up and may be potentially useful to individualize management or test therapeutic interventions. Neurocognitive assessment in the ED detected deficits that clinical grading could not and correlated with deficits at follow-up.
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Affiliation(s)
- Danny G Thomas
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Abstract
The definition of a mild traumatic brain injury (TBI) has come under close scrutiny and is changing as a result of refined diagnostic testing. Although up to 15% of patients with a mild TBI will have an acute intracranial lesion identified on head computed tomography (CT), less than 1% of these patients will have a lesion requiring a neurosurgical intervention. Evidence-based guideline methodology has assisted in generating recommendations to facilitate clinical decision making; however, no set of guidelines is 100% sensitive and specific. Evidence supports the safety of discharging patients with mild TBI who have a negative CT. However, though patients with a negative CT are at almost no risk of deteriorating from a neurosurgical lesion, a key intervention is to provide these patients at discharge from the emergency department with counseling regarding postconcussive symptoms, when to return to work, school, or sports, and when to seek additional medical care.
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Affiliation(s)
- Andy S Jagoda
- Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1620, New York, NY 10029, USA.
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