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Prosak OL, Hajdu KS, Amedy A, Anesi TJ, Williams K, Jo J, Terry DP, Zuckerman SL. Sex Differences in Resource Allocation and Access to Care After Sport-Related Concussion. J Athl Train 2024; 59:785-792. [PMID: 38069828 PMCID: PMC11340675 DOI: 10.4085/1062-6050-0280.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
CONTEXT After sport-related concussion (SRC), immediate access to a certified athletic trainer (AT) is important to ensure proper treatment. However, resource allocation and coverage may differ between male and female youth sports. OBJECTIVE To compare resource allocation between male and female sports in the following areas: (1) rates of immediate on-field evaluation by an AT at the time of injury, (2) time to general health care presentation, and (3) time to SRC clinic presentation. DESIGN Retrospective cohort study. SETTING Regional sports concussion center. PATIENTS OR OTHER PARTICIPANTS Athletes aged 14 to 18 years who presented to a regional sports concussion center from November 2017 to April 2022. MAIN OUTCOME MEASURE(S) The primary exposure of interest was sex (male or female). The primary outcome was immediate on-field evaluation by an AT (yes or no). Secondary outcomes included time to general health care and SRC clinic presentation. Descriptive statistics, χ2 analyses, and linear regressions were performed. Covariates included age, history of prior concussions, and statistically significant demographics. RESULTS A total of 832 patients with SRC were included (age = 16.2 ± 1.2 years, 66.5% male). Female athletes had lower rates of attention-deficit/hyperactivity disorder (χ2 = 10.404, P = .001) and higher rates of anxiety and depression (χ2 = 12.891, P < .001) compared with male athletes. The average time to presentation to general health care and the SRC clinic did not differ between males and females, but AT on-field evaluation occurred more in male (40.3%) than female (32.3%) athletes (χ2 = 8.677, P = .013). Multivariable linear regression found that AT on-field evaluation was a significant predictor of time to general health care presentation (β = -.085, P = .015) but not SRC clinic presentation (β = -.055, P = .099). History of prior concussions was a significant predictor of time to initial health care contact (β = .083, P = .018). History of anxiety and depression (β = .136, P < .001) and initial evaluation by emergency department or urgent care (β = .305, P < .001) were significant predictors of delayed time to SRC clinic presentation. CONCLUSIONS Among 832 concussed youth athletes, female athletes were evaluated less frequently by an AT immediately after injury. Furthermore, not being evaluated by an AT on field was significantly associated with a longer time to health care presentation. Future investigations should elucidate resource equity among male and female athletes.
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Affiliation(s)
| | | | - Amad Amedy
- Vanderbilt University School of Medicine, Nashville, TN
| | | | - Kristen Williams
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jacob Jo
- Vanderbilt University School of Medicine, Nashville, TN
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Douglas P. Terry
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L. Zuckerman
- Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
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Corwin DJ, Godfrey M, Arbogast KB, Zorc JJ, Wiebe DJ, Michel JJ, Barnett I, Stenger KM, Calandra LM, Cobb J, Winston FK, Master CL. Using mobile health to expedite access to specialty care for youth presenting to the emergency department with concussion at highest risk of developing persisting symptoms: a protocol paper for a non-randomised hybrid implementation-effectiveness trial. BMJ Open 2024; 14:e082644. [PMID: 38904136 PMCID: PMC11191760 DOI: 10.1136/bmjopen-2023-082644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
INTRODUCTION Paediatric concussion is a common injury. Approximately 30% of youth with concussion will experience persisting postconcussion symptoms (PPCS) extending at least 1 month following injury. Recently, studies have shown the benefit of early, active, targeted therapeutic strategies. However, these are primarily prescribed from the specialty setting. Early access to concussion specialty care has been shown to improve recovery times for those at risk for persisting symptoms, but there are disparities in which youth are able to access such care. Mobile health (mHealth) technology has the potential to improve access to concussion specialists. This trial will evaluate the feasibility of a mHealth remote patient monitoring (RPM)-based care handoff model to facilitate access to specialty care, and the effectiveness of the handoff model in reducing the incidence of PPCS. METHODS AND ANALYSIS This study is a non-randomised type I, hybrid implementation-effectiveness trial. Youth with concussion ages 13-18 will be enrolled from the emergency department of a large paediatric healthcare network. Patients deemed a moderate-to-high risk for PPCS using the predicting and preventing postconcussive problems in paediatrics (5P) stratification tool will be registered for a web-based chat platform that uses RPM to collect information on symptoms and activity. Those patients with escalating or plateauing symptoms will be contacted for a specialty visit using data collected from RPM to guide management. The primary effectiveness outcome will be the incidence of PPCS, defined as at least three concussion-related symptoms above baseline at 28 days following injury. Secondary effectiveness outcomes will include the number of days until return to preinjury symptom score, clearance for full activity and return to school without accommodations. The primary implementation outcome will be fidelity, defined as the per cent of patients meeting specialty care referral criteria who are ultimately seen in concussion specialty care. Secondary implementation outcomes will include patient-defined and clinician-defined appropriateness and acceptability. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of the Children's Hospital of Philadelphia (IRB 22-019755). Study findings will be published in peer-reviewed journals and disseminated at national and international meetings. TRIAL REGISTRATION NUMBER NCT05741411.
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Affiliation(s)
- Daniel J Corwin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Melissa Godfrey
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristy B Arbogast
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph J Zorc
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Jeremy J Michel
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ian Barnett
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelsy M Stenger
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lindsey M Calandra
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Justin Cobb
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Flaura K Winston
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christina L Master
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Heyming T, Knudsen-Robbins C, Schomberg J, Hayakawa J, Lara B, Bacon K, Valdez B, Wickens M, Shelton SK, Romain J, Wallace E, Taraman S, Loudon W, Pearson R. Evaluation of Quantitative Pupillometry in Acute Postinjury Pediatric Concussion. Pediatr Neurol 2024; 153:103-112. [PMID: 38367484 DOI: 10.1016/j.pediatrneurol.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Although millions of children sustain concussions each year, a rapid and objective test for concussion has remained elusive. The aim of this study was to investigate quantitative pupillometry in pediatric patients in the acute, postinjury setting. METHODS This was a prospective case-control study of concussed patients presenting to the emergency department within 72 hours of injury. Pupillary measurements were gathered using NeurOptics' PLR 3000; evaluation included a symptom checklist and neurocognitive assessment. Data were analyzed using descriptive statistics and regression models. RESULTS A total of 126 participants were enrolled. One significant difference in pupillometry between concussed and control participants was found: left minimum pupil diameter in 12- to 18 year-olds (P = 0.02). Models demonstrating odds of a concussion revealed significant associations for time to 75% recovery (T75) of the left pupil in five- to 11-year-olds and average dilation velocity of the left pupil in 12- to 18-year-olds (P = 0.03 and 0.02 respectively). Models predicting symptom improvement showed one significant association: percent change of the right pupil in five-to-11-year-olds (P = 0.02). Models predicting neurocognitive improvement in 12- to 18-year-olds demonstrated significant association in T75 in the left pupil for visual memory, visual motor processing speed, and reaction time (P = 0.002, P = 0.04, P = 0.04). CONCLUSIONS The limited statistically significant associations found in this study suggest that pupillometry may not be useful in pediatrics in the acute postinjury setting for either the diagnosis of concussion or to stratify risk for prolonged recovery.
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Affiliation(s)
- Theodore Heyming
- CHOC Children's Hospital, Orange, California; Department of Emergency Medicine, University of California, Irvine, California.
| | - Chloe Knudsen-Robbins
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | | | | | - Bryan Lara
- CHOC Children's Hospital, Orange, California
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Buckley TA, Passalugo SW, Gallo CA, Bodt B, Evans KM, Munkasy BA. Collegiate student-athletes concussion knowledge and attitudes: what a difference a decade Makes. Brain Inj 2024; 38:288-294. [PMID: 38369869 PMCID: PMC10911450 DOI: 10.1080/02699052.2024.2314549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE The purpose of this study was to assess changes in concussion knowledge and attitudes amongst incoming intercollegiate student-athletes over the course of a decade (2010-2012 vs 2021-2023). METHODS There were 592 student-athletes from 2 cohorts (2010-2012, 2021-2023) who completed the Rosenbaum Concussion Knowledge and Attitudes Survey (ROCKaS) questionnaire which is comprised of a concussion knowledge index (CKI, 0-24) and attitude index (CAI, 15-75) with higher scores reflecting better performance. A three factor ANOVA (Group, Sex, Concussion History) compared performance on the CKI and CAI. Individual questions were compared between groups with a Chi-Square analysis. RESULTS For the CKI, there was a significant main effect for Group (2010-2012: 18.5 ± 2.6, 2021-2023: 19.4 ± 2.5, p < 0.001, η 2 = 0.032 ) . For the CAI, there was also a significant main effect for group (2010-2012: 52.9 ± 6.0, 2021-2023: 62.2 ± 6.5, p < 0.001, η 2 = 0.359 ) . CONCLUSIONS The results of this study show a modest increase in concussion knowledge; however, large improvements in concussion attitudes were observed between groups. These results suggest a continued improvement in student-athlete concussion awareness and provide specific areas to continue addressing persistent misconceptions.
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Affiliation(s)
- Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Scott W Passalugo
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Caitlin A Gallo
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Barry Bodt
- College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Kelsey M Evans
- Department of General Surgery, Orlando Health, Orlando, Florida, USA
| | - Barry A Munkasy
- School of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA
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Roby PR, Mozel AE, Arbogast KB, Buckley T, Caccese JB, Chrisman SPD, Clugston JR, Eckner JT, Esopenko C, Hunt T, Kelly LA, McDevitt J, Perkins SM, Putukian M, Susmarski A, Broglio SP, Pasquina PF, McAllister TW, McCrea M, Master CL. Postinjury Outcomes After Non-Sport-Related Concussion: A CARE Consortium Study. J Athl Train 2024; 59:289-296. [PMID: 37681681 PMCID: PMC10976341 DOI: 10.4085/1062-6050-0181.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
CONTEXT Concussion research has primarily focused on sport-related mechanisms and excluded non-sport-related mechanisms. In adult populations, non-sport-related concussions (non-SRCs) demonstrated worse clinical outcomes compared with sport-related concussions (SRCs); however, investigations of non-SRCs in college-aged patients are limited. OBJECTIVES To examine clinical outcomes in collegiate athletes with non-SRCs compared with SRCs and explore sex differences in outcomes among collegiate athletes with non-SRCs. DESIGN Prospective cohort study. SETTING Clinical setting. PATIENTS OR OTHER PARTICIPANTS A total of 3500 athletes were included (n = 555 with non-SRCs, 42.5% female) from colleges or universities and service academies participating in the National Collegiate Athletic Association Department of Defense Concussion Assessment, Research and Education (CARE) Consortium. MAIN OUTCOME MEASURE(S) Dichotomous outcomes (yes or no) consisted of immediate reporting, mental status alterations, loss of consciousness, posttraumatic amnesia, retrograde amnesia, motor impairments, delayed symptom presentation, and required hospital transport. Continuous outcomes were symptom severity, days with concussion symptoms, and days lost to injury. Data were collected within 24 to 48 hours of injury and at return to play. Adjusted relative risks (ARRs) compared the likelihood of dichotomous outcomes by mechanism and by sex within patients with non-SRCs. Multivariate negative binomial regressions were used to assess group differences in continuous variables. RESULTS Athletes with non-SRCs were less likely to report immediately (ARR = 0.73, 95% CI = 0.65, 0.81) and more likely to report delayed symptom presentation (ARR = 1.17, 95% CI = 1.03, 1.32), loss of consciousness (ARR = 3.15, 95% CI = 2.32, 4.28), retrograde amnesia (ARR = 1.77, 95% CI = 1.22, 2.57), and motor impairment (ARR = 1.45, 95% CI = 1.14, 1.84). Athletes with non-SRCs described greater symptom severity, more symptomatic days, and more days lost to injury (P < .001) compared with those who had SRCs. Within the non-SRC group, female athletes indicated greater symptom severity, more symptomatic days, and more days lost to injury (P < .03) than male athletes. CONCLUSIONS Athletes with non-SRCs had worse postinjury outcomes compared with those who had SRCs, and female athletes with non-SRCs had worse recovery metrics than male athletes. Our findings suggest that further investigation of individuals with non-SRCs is needed to improve concussion reporting and management.
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Affiliation(s)
- Patricia R. Roby
- Center for Injury Research and Prevention, University of Pennsylvania, Philadelphia
| | - Anne E. Mozel
- Center for Injury Research and Prevention, University of Pennsylvania, Philadelphia
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, University of Pennsylvania, Philadelphia
- Division of Emergency Medicine, University of Pennsylvania, Philadelphia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Thomas Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark
| | - Jaclyn B. Caccese
- School of Health & Rehabilitation Sciences, Ohio State University College of Medicine, Columbus
| | - Sara P. D. Chrisman
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, WA
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle
| | - James R. Clugston
- Departments of Community Health & Family Medicine and Neurology, University of Florida, Gainesville
| | - James T. Eckner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
| | - Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Tamerah Hunt
- Department of Health Sciences and Kinesiology, Georgia Southern University, Statesboro
| | - Louise A. Kelly
- Department of Exercise Science, California Lutheran University, Thousand Oaks
| | - Jane McDevitt
- Department of Health and Rehabilitation Science, Temple University, Philadelphia, PA
| | - Susan M. Perkins
- Department of Biostatistics and Health Data Science, Indiana University, Bloomington
| | - Margot Putukian
- Major League Soccer, Formerly Princeton University, University Health Service, Princeton, NJ
| | | | | | - Paul F. Pasquina
- Physical Medicine & Rehabilitation, Uniformed Services University, Bethesda, MD
| | | | - Michael McCrea
- Departments of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Departments of Neurology, Medical College of Wisconsin, Milwaukee
| | - Christina L. Master
- Center for Injury Research and Prevention, University of Pennsylvania, Philadelphia
- Sports Medicine Performance Center, Children’s Hospital of Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Meyer CM, Mensch J, Battle N, Yeargin SW. Knowledge and Attitudes of Concussion Reporting Behavior Intentions in Parents of Youth Recreational Football Players. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:218-226. [PMID: 37040134 DOI: 10.1080/02701367.2023.2189444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/26/2023] [Indexed: 06/19/2023]
Abstract
Purpose: This study: (1) Described the knowledge, attitudes, and reported behavior intentions of young recreational football players' parents toward concussion. (2) Investigated associations of the previous variables with parent demographics. Materials and Methods: A cross-sectional design utilized an online platform to survey parents of children (8-14 yrs.) in three youth football leagues in the southern United States. Demographics collected included items such as sex or concussion history. Knowledge was assessed via true/false items, with higher scores (0-20) representing greater concussion understanding. 4-point Likert scales were used to describe parents attitudes (1 = not at all, 4 = very much), confidence in intended recognition/reporting (1 = not-confident, 4 = extremely confident), and agreement with intended reporting behaviors (1 = strong- disagreement, 4 = strong-agreement). Descriptive statistics were calculated for demographics. Mann-Whitney U test or Kruskal-Wallis Tests examined survey responses across demographics. Results: Respondents (n = 101) were primarily female (64.4%), white (81.2%), and participated in contact sport (83.2%). Parents averaged 15.9 ± 1.4 on concussion knowledge, with only 34.7% (n = 35) of parents scoring > 17/20. Statements that received the lowest average agreement (3.29/4) regarding reporting intent were related to emotional symptoms. Some parents (n = 42, 41.6%) reported low confidence in recognizing symptoms of a concussion in their child. Parent demographics did not have clinically significant associations with survey responses, with 6/7 demographic variables resulting in no statistical significance (p > .05). Conclusions: Although one-third of parents attained high knowledge scores, several reported low confidence in recognizing concussion symptoms in their children. Parents scored lower in agreement with removing their child from play when concussion symptoms were subjective. Youth sports organizations providing concussion education to parents should consider these results when revising their materials.
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Corwin DJ, Metzger KB, McDonald CC, Pfeiffer MR, Arbogast KB, Master CL. The Variability of Recovery From Pediatric Concussion Using Multimodal Clinical Definitions. Sports Health 2024; 16:79-88. [PMID: 36896665 PMCID: PMC10732108 DOI: 10.1177/19417381231152448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND While concussions are common pediatric injuries, a lack of agreement on a standard definition of recovery creates multiple challenges for clinicians and researchers alike. HYPOTHESIS The percentage of concussed youth deemed recovered as part of a prospective cohort study will differ depending on the recovery definition. STUDY DESIGN Descriptive epidemiologic study of a prospectively enrolled observational cohort. LEVEL OF EVIDENCE Level 3. METHODS Participants aged 11 to 18 years were enrolled from the concussion program of a tertiary care academic center. Data were collected from initial and follow-up clinical visits ≤12 weeks from injury. A total of 10 recovery definitions were assessed: (1) cleared to full return to sports; (2) return to full school; (3) self-reported return to normal; (4) self-reported full return to school; (5) self-reported full return to exercise; (6) symptom return to preinjury state; (7) complete symptom resolution; (8) symptoms below standardized threshold; (9) no abnormal visio-vestibular examination (VVE) elements; and (10) ≤1 abnormal VVE assessments. RESULTS In total, 174 participants were enrolled. By week 4, 63.8% met at least 1 recovery definition versus 78.2% by week 8 versus 88.5% by week 12. For individual measures of recovery at week 4, percent recovered ranged from 5% by self-reported full return to exercise to 45% for ≤1 VVE abnormality (similar trends at 8 and 12 weeks). CONCLUSION There is wide variability in the proportion of youth considered recovered at various points following concussion depending on the definition of recovery, with higher proportions using physiologic examination-based measures and lower proportions using patient-reported measures. CLINICAL RELEVANCE These results further emphasize the need for a multimodal assessment of recovery by clinicians as a single and standardized definition of recovery that captures the broad impact of concussion on a given patient continues to be elusive.
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Affiliation(s)
- Daniel J. Corwin
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristina B. Metzger
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melissa R. Pfeiffer
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina L. Master
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Sports Medicine and Performance Center, and The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Bastos Gottgtroy R, Hume PA, Theadom A. Describing the patient journey through healthcare pathways following mild traumatic brain injury in New Zealand using novel Graph analysis. Brain Inj 2023; 37:1294-1304. [PMID: 37403290 DOI: 10.1080/02699052.2023.2230878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
AIM To identify treatment provider sequences and healthcare pathway characteristics and outcomes for people with mild traumatic brain injury (mTBI) in New Zealand. METHODS Total mTBI costs and key pathway characteristics were analysed using national healthcare data (patient's injury and services provided). Graph analysis produced sequences of treatment provider types for claims with more than one appointment and healthcare outcomes (costs and time to exit pathway) were compared. Key pathway characteristics' effect on healthcare outcomes were evaluated. RESULTS In two years, 55,494 accepted mTBI claims cost ACC USD$93,647,261 over four years. For claims with more than one appointment (36%), healthcare pathways had a median 49 days (IQR, 12-185). The 89 treatment provider types resulted in 3,396 different provider sequences of which 25% were General Practitioners only (GP), 13% Emergency Department to GP (ED-GP) and 5% GP to Concussion Service (GP-CS). Pathways with shorter time to exit and lower costs had correct mTBI diagnosis at initial appointment. Income maintenance comprised 52% of costs but only occurred for 20% claims. CONCLUSIONS Improving healthcare pathways for people with mTBI by investing in training of providers to enable correct mTBI diagnosis could yield longer term cost savings. Interventions to reduce income maintenance costs are recommended.
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Affiliation(s)
- Renata Bastos Gottgtroy
- Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
- Traumatic Brain Injury Network, Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
| | - Patria A Hume
- Sport Performance Research Institute New Zealand (SPRINZ), Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
- Traumatic Brain Injury Network, Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Traumatic Brain Injury Network, Faculty of Health and Environment Science, Auckland University of Technology, Auckland, New Zealand
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Corwin DJ, Orchinik J, D'Alonzo B, Agarwal AK, Pettijohn KW, Master CL, Wiebe DJ. A Randomized Trial of Incentivization to Maximize Retention for Real-Time Symptom and Activity Monitoring Using Ecological Momentary Assessment in Pediatric Concussion. Pediatr Emerg Care 2023; 39:488-494. [PMID: 36730797 DOI: 10.1097/pec.0000000000002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aims of this study were to determine the incentivization strategy that maximizes patient adherence to report symptoms and activity via ecological momentary assessment (EMA) after pediatric concussion, and assess the feasibility of tracking concussed youth using EMA from the emergency department (ED) setting. METHODS This study was a randomized controlled trial of participants ages 13 to 18 years with concussion presenting to an urban, academic pediatric ED within 5 days of injury. Participants were randomized to 1 of 4 incentive arms: 2 dynamic (loss-based and streak) and 2 control flat-rate (monetary and electronic device). Participants reported symptoms 3 times per day and cognitive activity once each evening for 3 weeks. Physical activity (step count) and sleep were monitored using a Fitbit (kept by participants in the device flat-rate arm). The primary outcome was proportion of prompts to which participants responded. Secondary outcomes included differential response rates by demographics, and comparison of outcome determination between EMA and subsequent clinical visits. RESULTS Thirty participants were enrolled, with a median age of 15.5 years and 60% female. Median cumulative proportion of prompts responded to was 68.3% (interquartile range, 47.6%-82.5%) in the dynamic arms versus 54.0% (interquartile range. 20.6%-68.3%) in the flat-rate arms, P = 0.065. There were nonsignificant differences in median response by sex (65.9% for female vs 40.0% for male, P = 0.072), race/ethnicity (61.9% for non-Hispanic White vs 43.7% for non-Hispanic Black participants, P = 0.097), and insurance (61.9% for private insurance vs 47.6% for public insurance, P = 0.305). Recovery at 3 weeks was discernible for all but 2 participants (93.3%) using EMA data, compared with only 9 participants (30.0%) ( P < 0.001) from clinical visits. CONCLUSIONS Dynamic incentivization showed higher rates of response to tridaily symptom prompts compared with flat-rate incentivization. These data show tracking concussed youth using EMA from the ED is feasible using a dynamic incentivization strategy, with improved ability to discern outcomes compared with prospective monitoring using follow-up clinical visits.
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Affiliation(s)
| | | | | | | | - Kevin W Pettijohn
- From the Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
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Hu JC, Cummings JR, Ji X, Wilk AS. Evaluating Medicaid Managed Care Network Adequacy Standards And Associations With Specialty Care Access For Children. Health Aff (Millwood) 2023; 42:759-769. [PMID: 37276470 PMCID: PMC10706697 DOI: 10.1377/hlthaff.2022.01439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Medicaid managed care plans cover more than 80 percent of Medicaid-enrolled children, including many children with special health care needs (CSHCN). Federal rules require states to set network adequacy standards to improve specialty care access for Medicaid managed care enrollees. Using a quasi-experimental design and 2016-19 National Survey of Children's Health data, we examined the association between quantitative network adequacy standards and access to specialty care among 8,614 Medicaid-enrolled children, including 3,157 with special health care needs, in eighteen states. Outcomes included whether the child had any visit to non-mental health specialists, any visit to mental health professionals, or any unmet health care needs and whether the caregiver ever felt frustrated in getting services for the child in the past year. We observed no association between the adoption of any quantitative network adequacy standard and the above outcomes among Medicaid-enrolled children. Among CSHCN, however, adopting any quantitative standard was positively associated with caregivers feeling frustrated in getting services for the child, especially among CSHCN who visited non-mental health specialists. Without additional interventions, adopting new network adequacy standards may have unintended consequences for CSHCN.
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Affiliation(s)
- Ju-Chen Hu
- Ju-Chen Hu , Emory University, Atlanta, Georgia
| | | | - Xu Ji
- Xu Ji, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
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Hicks SD, Onks C, Kim RY, Zhen KJ, Loeffert J, Loeffert AC, Olympia RP, Fedorchak G, DeVita S, Gagnon Z, McLoughlin C, Madeira MM, Zuckerman SL, Lee T, Heller M, Monteith C, Campbell TR, Neville C, Fengler E, Dretsch MN. Refinement of saliva microRNA biomarkers for sports-related concussion. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:369-378. [PMID: 34461327 DOI: 10.1016/j.jshs.2021.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/29/2021] [Accepted: 07/13/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Recognizing sport-related concussion (SRC) is challenging and relies heavily on subjective symptom reports. An objective, biological marker could improve recognition and understanding of SRC. There is emerging evidence that salivary micro-ribonucleic acids (miRNAs) may serve as biomarkers of concussion; however, it remains unclear whether concussion-related miRNAs are impacted by exercise. We sought to determine whether 40 miRNAs previously implicated in concussion pathophysiology were affected by participation in a variety of contact and non-contact sports. Our goal was to refine a miRNA-based tool capable of identifying athletes with SRC without the confounding effects of exercise. METHODS This case-control study harmonized data from concussed and non-concussed athletes recruited across 10 sites. Levels of salivary miRNAs within 455 samples from 314 individuals were measured with RNA sequencing. Within-subjects testing was used to identify and exclude miRNAs that changed with either (a) a single episode of exercise (166 samples from 83 individuals) or (b) season-long participation in contact sports (212 samples from 106 individuals). The miRNAs that were not impacted by exercise were interrogated for SRC diagnostic utility using logistic regression (172 samples from 75 concussed and 97 non-concussed individuals). RESULTS Two miRNAs (miR-532-5p and miR-182-5p) decreased (adjusted p < 0.05) after a single episode of exercise, and 1 miRNA (miR-4510) increased only after contact sports participation. Twenty-three miRNAs changed at the end of a contact sports season. Two of these miRNAs (miR-26b-3p and miR-29c-3p) were associated (R > 0.50; adjusted p < 0.05) with the number of head impacts sustained in a single football practice. Among the 15 miRNAs not confounded by exercise or season-long contact sports participation, 11 demonstrated a significant difference (adjusted p < 0.05) between concussed and non-concussed participants, and 6 displayed moderate ability (area under curve > 0.70) to identify concussion. A single ratio (miR-27a-5p/miR-30a-3p) displayed the highest accuracy (AUC = 0.810, sensitivity = 82.4%, specificity = 73.3%) for differentiating concussed and non-concussed participants. Accuracy did not differ between participants with SRC and non-SRC (z = 0.5, p = 0.60). CONCLUSION Salivary miRNA levels may accurately identify SRC when not confounded by exercise. Refinement of this approach in a large cohort of athletes could eventually lead to a non-invasive, sideline adjunct for SRC assessment.
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Affiliation(s)
- Steven D Hicks
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA.
| | - Cayce Onks
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; Department of Family Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Raymond Y Kim
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Kevin J Zhen
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Jayson Loeffert
- Department of Orthopaedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; Department of Family Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Andrea C Loeffert
- Department of Pediatrics, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Robert P Olympia
- Department of Emergency Medicine, College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA
| | - Gregory Fedorchak
- Department of Research and Development, Quadrant Biosciences Inc., Syracuse, NY 13210, USA
| | - Samantha DeVita
- Department of Research and Development, Quadrant Biosciences Inc., Syracuse, NY 13210, USA
| | - Zofia Gagnon
- Department of Biology, Marist College, Poughkeepsie, NY 12601, USA
| | | | - Miguel M Madeira
- Department of Biology, Marist College, Poughkeepsie, NY 12601, USA
| | - Scott L Zuckerman
- Sports Concussion Center, College of Medicine, Vanderbilt University, Nashville, TN 37212, USA
| | - Timothy Lee
- Sports Concussion Center, College of Medicine, Vanderbilt University, Nashville, TN 37212, USA
| | - Matthew Heller
- Department of Family Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, NY 11568, USA
| | - Chuck Monteith
- Department of Athletic Training, Colgate University, Hamilton, NY 13346, USA
| | - Thomas R Campbell
- Department of Rehabilitation Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Christopher Neville
- Department of Physical Therapy Education, Orthopedics, and Neuroscience, College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Elise Fengler
- Department of Exercise Science, Syracuse University, Syracuse, NY 13210, USA
| | - Michael N Dretsch
- Department of Medical Research-West, Walter Reed Army Institute of Research, US Army Joint Base Lewis-McChord, Hillhurst, WA 98433, USA
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12
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van Ierssel J, O'Neil J, King J, Zemek R, Sveistrup H. Clinician Perspectives on Providing Concussion Assessment and Management via Telehealth: A Mixed-Methods Study. J Head Trauma Rehabil 2023; 38:E233-E243. [PMID: 36731011 DOI: 10.1097/htr.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine clinician perspectives regarding the use of telehealth for concussion assessment and management. SETTING A Pan-Canadian survey. PARTICIPANTS Twenty-five purposively sampled multidisciplinary clinician-researchers with concussion expertise (female, n = 21; physician, n = 11; and other health professional, n = 14). DESIGN Sequential mixed-method design: (1) electronic survey and (2) semistructured interviews with focus groups via videoconference. Qualitative descriptive design. MAIN OUTCOME MEASURES Survey : A 59-item questionnaire regarding the suitability of telehealth to perform recommended best practice components of concussion assessment and management. Focus groups : 10 open-ended questions explored survey results in more detail. RESULTS Clinicians strongly agreed that telehealth could be utilized to obtain a clinical history (96%), assess mental status (88%), and convey a diagnosis (83%) on initial assessment; to take a focused clinical history (80%); to monitor functional status (80%) on follow-up; and to manage symptoms using education on rest (92%), planning and pacing (92%), and sleep recommendations (91%); and to refer to a specialist (80%). Conversely, many clinicians believed telehealth was unsuitable to perform a complete neurologic examination (48%), cervical spine (38%) or vestibular assessment (61%), or to provide vestibular therapy (21%) or vision therapy (13%). Key benefits included convenience, provision of care, and patient-centered approach. General and concussion-specific challenges included technology, quality of care, patient and clinician characteristics, and logistics. Strategies to overcome identified challenges are presented. CONCLUSIONS From the perspective of experienced clinicians, telehealth is suited to manage symptomatic concussion patients presenting without red flags or following an initial in-person assessment, but may have limitations in ruling out serious pathology or providing return-to-sport clearance without an in-person physical examination.
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Affiliation(s)
- Jacqueline van Ierssel
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada (Drs van Ierssel and Zemek); School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada (Drs O'Neil, King, and Sveistrup); Bruyère Research Institute, Ottawa, Canada (Drs O'Neil and Sveistrup); and Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada (Dr Zemek)
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13
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Ramsay S, Dahinten VS, Ranger M, Babul S. Follow-up visits after a concussion in the pediatric population: An integrative review. NeuroRehabilitation 2023; 52:315-328. [PMID: 37005895 PMCID: PMC10200233 DOI: 10.3233/nre-220216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Concussions are a significant health issue for children and youth. After a concussion diagnosis, follow-up visits with a health care provider are important for reassessment, continued management, and further education. OBJECTIVE This review aimed to synthesize and analyse the current state of the literature on follow-up visits of children with a concussive injury and examine the factors associated with follow-up visits. METHODS An integrative review was conducted based on Whittemore and Knafl's framework. Databases searched included PubMed, MEDLINE, CINAHL, PsycINFO, and Google Scholar. RESULTS Twenty-four articles were reviewed. We identified follow-up visit rates, timing to a first follow-up visit, and factors associated with follow-up visits as common themes. Follow-up visit rates ranged widely, from 13.2 to 99.5%, but time to the first follow-up visit was only reported in eight studies. Three types of factors were associated with attending a follow-up visit: injury-related factors, individual factors, and health service factors. CONCLUSION Concussed children and youth have varying rates of follow-up care after an initial concussion diagnosis, with little known about the timing of this visit. Diverse factors are associated with the first follow-up visit. Further research on follow-up visits after a concussion in this population is warranted.
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Affiliation(s)
- Scott Ramsay
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - V Susan Dahinten
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Manon Ranger
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Shelina Babul
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- BC Injury and Research Prevention Unit, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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14
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Roby PR, Metzger KB, McDonald CC, Corwin DJ, Huber CM, Patton DA, Margulies SS, Grady MF, Master CL, Arbogast KB. Pre- and post-season visio-vestibular function in healthy adolescent athletes. PHYSICIAN SPORTSMED 2022; 50:522-530. [PMID: 34521303 PMCID: PMC8934744 DOI: 10.1080/00913847.2021.1980744] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate pre - to post-season differences in individual subtests of the Visio-Vestibular Examination (VVE) in healthy middle and high school athletes. METHODS This prospective cohort study recruited participants from a private suburban United States secondary school. Participants completed a demographic questionnaire prior to the start of their season. A proxy for head impact exposure was estimated by incorporating previously published head impact frequencies by team and sport. The VVE was completed pre - and post-season and consisted of 9 subtests: smooth pursuit, horizontal/vertical saccades and gaze stability, binocular convergence, left/right monocular accommodation, and complex tandem gait. Generalized estimating equations were employed to assess the relative risk of an abnormal VVE outcome based on testing session (pre - vs. post-season). RESULTS Participants included middle and high school athletes (n = 115; female = 59 (51.3%); median age at first assessment = 14.9 years, [IQR = 13.6, 16.0]) during 2017/18 - 2019/20 school years. During pre-season testing, accommodation (10.0%) and complex tandem gait (9.2%) had the largest proportion of abnormal outcomes, while smooth pursuits (10.6%) and convergence (9.5%) had the largest proportion of abnormal outcomes post-season. When assessing the effect of testing session on the relative risk of any abnormal VVE subtest, there were no significant findings (P ≥ 0.25). Additionally, there were no significant effects of testing session when adjusting for estimated head impact exposure for any VVE subtest (P ≥ 0.25). CONCLUSIONS Visio-vestibular function as measured by the VVE does not change from pre - to post-season in otherwise healthy adolescent athletes. Our findings suggest that the VVE may be stable and robust to typical neurodevelopment occurring in this dynamic age group and help inform post-injury interpretation of visio-vestibular impairments.
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Affiliation(s)
- Patricia R Roby
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Catherine C McDonald
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Corwin
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Colin M Huber
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Declan A Patton
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan S Margulies
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Matthew F Grady
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine Performance Center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christina L Master
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Sports Medicine Performance Center, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, the Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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15
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Sheldrake E, Lam B, Al-Hakeem H, Wheeler AL, Goldstein BI, Dunkley BT, Ameis S, Reed N, Scratch SE. A Scoping Review of Magnetic Resonance Modalities Used in Detection of Persistent Postconcussion Symptoms in Pediatric Populations. J Child Neurol 2022; 38:85-102. [PMID: 36380680 DOI: 10.1177/08830738221120741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Up to 30% of youth with concussion experience PPCSs (PPCS) lasting 4 weeks or longer, and can significantly impact quality of life. Magnetic resonance imaging (MRI) has the potential to increase understanding of causal mechanisms underlying PPCS. However, there are no clear modalities to assist in detecting PPCS. This scoping review aims to synthesize findings on utilization of MRI among children and youth with PPCS, and summarize progress and limitations. Thirty-six studies were included from 4907 identified papers. Many studies used multiple modalities, including (1) structural (n = 27) such as T1-weighted imaging, diffusion weighted imaging, and susceptibility weighted imaging; and (2) functional (n = 23) such as functional MRI and perfusion-weighted imaging. Findings were heterogeneous among modalities and regions of interest, which warrants future reviews that report on the patterns and potential advancements in the field. Consideration of modalities that target PPCS prediction and sensitive modalities that can supplement a biopsychosocial approach to PPCS would benefit future research.
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Affiliation(s)
- Elena Sheldrake
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Lam
- Bloorview Research Institute, Toronto, Ontario, Canada
| | | | - Anne L Wheeler
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin T Dunkley
- Neuroscience and Mental Health Program, 7979Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Ameis
- 7978Centre for Addiction and Mental Health, Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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16
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Arbogast KB, Ghosh RP, Corwin DJ, McDonald CC, Mohammed FN, Margulies SS, Barnett I, Master CL. Trajectories of Visual and Vestibular Markers of Youth Concussion. J Neurotrauma 2022; 39:1382-1390. [PMID: 35785959 PMCID: PMC9529314 DOI: 10.1089/neu.2022.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Visual and vestibular deficits, as measured by a visio-vestibular examination (VVE), are markers of concussion in youth. Little is known about VVE evolution post-injury, nor influence of age or sex on trajectory. The objective was to describe the time trend of abnormal VVE elements after concussion. Two cohorts, 11-18 years, were enrolled: healthy adolescents (n = 171) from a high school with VVE assessment before or immediately after their sport seasons and concussed participants (n = 255) from a specialty care concussion program, with initial assessment ≤28 days from injury and VVE repeated throughout recovery during clinical visits. The primary outcome, compared between groups, is the time course of recovery of the VVE examination, defined as the probability of an abnormal VVE (≥2/9 abnormal elements) and modeled as a cubic polynomial of days after injury. We explored whether probability trajectories differed by: age (<14 years vs. 14+ years), sex, concussion history (0 versus 1+), and days from injury to last assessment (≤28 days vs. 29+ days). Overall, abnormal VVE probability peaked at 0.57 at day 8 post-injury, compared with an underlying prevalence of 0.083 for uninjured adolescents. Abnormal VVE probability peaked higher for those 14+ years, female, with a concussion history and whose recovery course was longer than 28 days post-injury, compared with their appropriate strata subgroups. Females and those <14 years demonstrated slower resolution of VVE abnormalities. VVE deficits are common in adolescents after concussion, and the trajectory of resolution varies by age, sex, and concussion history. These data provide insight to clinicians managing concussions on the timing of deficit resolution after injury.
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Affiliation(s)
- Kristy B. Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Riddhi P. Ghosh
- Department of Mathematics and Statistics, Bowling Green State University, Bowling Green, Ohio, USA
| | - Daniel J. Corwin
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fairuz N. Mohammed
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Susan S. Margulies
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Ian Barnett
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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17
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Alnawmasi MM, Mani R, Khuu SK. Changes in the components of visual attention following traumatic brain injury: A systematic review and meta-analysis. PLoS One 2022; 17:e0268951. [PMID: 35679230 PMCID: PMC9182329 DOI: 10.1371/journal.pone.0268951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We conducted a systematic review and meta-analysis to understand the impact of traumatic brain injury (TBI) on visual attention and whether different components and processes of visual attention (such as selective, sustained, divided, and covert orientation of visual attention) are affected following brain injury. Methods A literature search between January 1980 to May 2021 was conducted using Medline, Scopus, PubMed, and Google Scholar databases was undertaken for studies that assessed visual attention using different tasks that target specific or multiple components of visual attention. Three hundred twenty-nine potentially relevant articles were identified, and 20 studies met our inclusion criteria. Results A total of 123 effect sizes (ES) were estimated from 20 studies that included 519 patients with TBI and 530 normal participants. The overall combined ES was statistically significant and large (ES = 0.92), but with high heterogeneity (Q = 614.83, p < 0.0001, I2 = 80.32%). Subgroup analysis showed that the impact of TBI severity, with the ES for moderate-severe TBI significantly higher than mild TBI (t (112) = 3.11, p = 0.002). Additionally, the component of visual attention was differentially affected by TBI (F (2, 120) = 10.25, p<0.0001); the ES for selective attention (ES = 1.13) and covert orientation of visual attention (ES = 1.14) were large, whilst for sustained attention, the ES was medium at 0.43. A subgroup analysis comparing outcome measures showed that reaction time (ES = 1.12) was significantly more affected compared to performance accuracy (ES = 0.43), F (1, 96) = 25.98, p<0.0001). Conclusion Large and significant deficits in visual attention was found following TBI which can last for years after the initial injury. However, different components of visual attention were not affected to the same extent, with selective visual attention and orientation of visual attention most affected following TBI.
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Affiliation(s)
- Mohammed M. Alnawmasi
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
- Department of Optometry, College of Applied Medical Science, Qassim University, Buraydah, Saudi Arabia
- * E-mail:
| | - Revathy Mani
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Sieu K. Khuu
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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18
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Kaae C, Cadigan K, Lai K, Theis J. Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review. NeuroRehabilitation 2022; 50:279-296. [DOI: 10.3233/nre-228012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Individuals who have suffered a concussion/mild traumatic brain injury (mTBI) frequently report symptoms associated with vestibular and/or oculomotor dysfunction (VOD) like dizziness, nausea, fatigue, brain fog, headache, gait and neurocognitive impairments which are associated with the development of chronic symptoms. The Vestibular/Ocular Motor Screening (VOMS) tool has been established as a reliable and clinically relevant complement to use alongside a battery of post-concussion tests to improve screening and referral for further evaluation and treatment of VOD. OBJECTIVES: This paper will review the pathoanatomy and symptomatology of common vestibular and oculomotor disorders after concussion, as well as the utility of the VOMS to assist in diagnosis, referral, and management. METHODS: Primary articles were identified using a search via PubMed, Google Scholar, OneSearch, and CINAHL. Search key terms were combinations of “mild traumatic brain injury” or “concussion” or “pursuit” or “accommodation” or “vergence” or “convergence insufficiency” or “saccades” or “vestibulo-ocular reflex” or “vestibular ocular motor screen” or “vestibular rehabilitation”, or “vision rehabilitation” including adult and pediatric populations that were published in print or electronically from 1989 to 2021 in English. Classic papers on anatomy of eye movements, vestibular system and pathological changes in mTBI were also included, regardless of publication date. RESULTS: Objective impairments are commonly found during testing of smooth pursuit, saccades, vergence, accommodation, vestibular ocular reflex, and visual motion sensitivity after mTBI. These deficits can be actively treated with vestibular physical therapy and oculomotor/neuro-optometric vision therapy. VOMS is an efficient and reliable tool that can be used by all healthcare and rehabilitation providers to aid in diagnosis of post-concussion VOD, to help facilitate the decision to refer for further evaluation and treatment to expedite symptomatic post-concussion recovery. CONCLUSIONS: VOD is common after concussion in acute, post-acute, and chronic phases. Once areas of impairments are identified through proper assessment, clinicians can maximize recovery by referring to vestibular physical therapy and/or neuro-optometry to design a targeted treatment program to address individual deficits.
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Affiliation(s)
- Cristen Kaae
- Kaiser Permanente Medical Center, Vallejo, CA, USA
| | | | - Katherine Lai
- Kaiser Permanente Medical Center, Oakland, CA, USA
- Herbert Wertheim School of Optometry & Vision Science at the University of California, Berkeley, CA, USA
| | - Jacqueline Theis
- Herbert Wertheim School of Optometry & Vision Science at the University of California, Berkeley, CA, USA
- Virginia Neuro-Optometry at Concussion Care Centre of Virginia, Richmond VA, USA
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19
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Persistent post-concussive syndrome in children after mild traumatic brain injury is prevalent and vastly underdiagnosed. Sci Rep 2022; 12:4364. [PMID: 35288616 PMCID: PMC8921281 DOI: 10.1038/s41598-022-08302-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Data on epidemiology and prognosticators of persistent post-concussion syndrome (PPCS) after mild traumatic brain injury (mTBI) in the pediatric population is scarce. The aim of this study was to evaluate the prevalence of PPCS in children after mTBI and to identify clinical variables in children who are at high risk for developing PPCS. A multicenter, retrospective matched cohort in which PPCS symptoms were evaluated in children 8–15-year-old, 6–60 months after being admitted to the emergency department because of mTBI. The control group included children admitted to the emergency department because of uncomplicated distal radius fractures. The children's guardians were interviewed for the presence of PPCS symptoms using the "Rivermead Post-Concussion Questionnaire". A multivariable logistic regression model was used to identify predictors of PPCS. Two-hundred and five children were included in the mTBI group and 205 in the control. The median time from the injury was 33.5 months in the mTBI group and 33.8 in the control. The prevalence of PPCS in the mTBI group was 25.3% and PPCS like symptoms in the control was 2.4%, p < 0.001. Within the 6–60 months period, the PPCS prevalence was not influenced by the time that elapsed from the injury. In the mTBI group, motor vehicle accidents and adolescence were found to be risk factors for PPCS. PPCS is underdiagnosed in the pediatric population and 25% of children admitted to the ED due to mTBI may suffer from PPCS. Screening guidelines should be implemented to identify and properly treat these children.
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20
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Corwin DJ, Root JM, Zonfrillo MR, Thomas DG. Concussion Referral and Practice Patterns by Pediatric Emergency Medicine Providers. Pediatr Emerg Care 2022; 38:e1133-e1138. [PMID: 34432741 DOI: 10.1097/pec.0000000000002523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Concussion is a commonly encountered diagnosis for pediatric emergency medicine (PEM) providers, yet little is known regarding referral patterns to specialists. Our goal was to assess PEM providers' referral patterns and current usage of standardized evaluation tools. METHODS This study was conducted as cross-sectional survey of PEM providers recruited from the American Academy of Pediatrics Section on Emergency Medicine Listserv. Surveys were distributed at 3 time points between December 1, 2020, and February 28, 2021, and included multiple choice, Likert scale, and free text questions. Descriptive statistics and bivariate analyses were used to describe the sample and compare responses between those with variable experience and confidence in concussion management. RESULTS In total, 162 of 491 Listserv members (33.0%) completed the survey. The factors most often reported to assist in referral decisions were history of severe (92.6%) or multiple (90.7%) prior concussions, prolonged symptom duration (89.5%), and severity of current symptoms (84.6%). Most providers reported having large experience (63.0%) and confidence (54.9%) in managing concussion. Standardized symptom scales (8.0%), vestibular (11.7%) and balance assessments (13.0%), and prognostic tools (6.8%) were infrequently used. Most (64.2%) providers felt specialty referral was important. More than 80% reported high likelihood to use an accurate risk stratification tool to facilitate referral. CONCLUSIONS Although most PEM providers reported significant experience and confidence in managing pediatric concussion, standardized assessment tools were infrequently used. Most were likely to use a risk stratification tool to assist in specialty referral. Future studies should assess the ability of targeted referral strategies to improve recovery for concussed youth.
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Affiliation(s)
- Daniel J Corwin
- From the Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jeremy M Root
- Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC
| | - Mark R Zonfrillo
- Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI
| | - Danny G Thomas
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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21
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Peacock WF, Kuehl D, Bazarian J, Singer AJ, Cannon C, Rafique Z, d'Etienne JP, Welch R, Clark C, Diaz-Arrastia R. Defining Acute Traumatic Encephalopathy: Methods of the "HEAD Injury Serum Markers and Multi-Modalities for Assessing Response to Trauma" (HeadSMART II) Study. Front Neurol 2021; 12:733712. [PMID: 34956041 PMCID: PMC8693379 DOI: 10.3389/fneur.2021.733712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Despite an estimated 2.8 million annual ED visits, traumatic brain injury (TBI) is a syndromic diagnosis largely based on report of loss of consciousness, post-traumatic amnesia, and/or confusion, without readily available objective diagnostic tests at the time of presentation, nor an ability to identify a patient's prognosis at the time of injury. The recognition that “mild” forms of TBI and even sub-clinical impacts can result in persistent neuropsychiatric consequences, particularly when repetitive, highlights the need for objective assessments that can complement the clinical diagnosis and provide prognostic information about long-term outcomes. Biomarkers and neurocognitive testing can identify brain injured patients and those likely to have post-concussive symptoms, regardless of imaging testing results, thus providing a physiologic basis for a diagnosis of acute traumatic encephalopathy (ATE). The goal of the HeadSMART II (HEAD injury Serum markers and Multi-modalities for Assessing Response to Trauma) clinical study is to develop an in-vitro diagnostic test for ATE. The BRAINBox TBI Test will be developed in the current clinical study to serve as an aid in evaluation of patients with ATE by incorporating blood protein biomarkers, clinical assessments, and tools to measure, identify, and define associated pathologic evidence and neurocognitive impairments. This protocol proposes to collect data on TBI subjects by a multi-modality approach that includes serum biomarkers, clinical assessments, neurocognitive performance, and neuropsychological characteristics, to determine the accuracy of the BRAINBox TBI test as an aid to the diagnosis of ATE, defined herein, and to objectively determine a patient's risk of developing post-concussive symptoms.
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Affiliation(s)
| | - Damon Kuehl
- Carillion Clinic, Roanoke, VA, United States
| | - Jeff Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, NY, United States
| | - Adam J Singer
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Chad Cannon
- University of Kansas Medical Center, Kansas City, MO, United States
| | | | - James P d'Etienne
- Integrative Emergency Service/John Peter Smith Health System, Fort Worth, TX, United States
| | - Robert Welch
- Detroit Medical Center, Detroit, MI, United States
| | - Carol Clark
- William Beaumont Hospital, Royal Oak, MI, United States
| | - Ramon Diaz-Arrastia
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
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22
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Wallace J, Hou BQ, Hajdu K, Tang AR, Grusky AZ, Lee T, Zuckerman SL, Yengo-Kahn AM. Healthcare Navigation of Black and White Adolescents Following Sport-Related Concussion: A Path Towards Achieving Health Equity. J Athl Train 2021; 57:352-359. [PMID: 35439315 PMCID: PMC9020596 DOI: 10.4085/1062-6050-0330.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Care-seeking behaviors for sport-related concussion (SRC) are not consistent across demographic subgroups. These differences may not only stem from health inequities but can further perpetuate disparities in care for SRCs. OBJECTIVE To determine whether racial differences exist in the care pathway from injury to SRC clinic within adolescent athletes. DESIGN Retrospective cohort Setting: Regional SRC center Participants: Of 582 total athletes, 486 (83.5%) White and 96 (16.5%) Black adolescent athletes were diagnosed with SRC and evaluated within 3 months at the SRC clinic. MAIN OUTCOME MEASURES Race was the defined exposure, dichotomized as Black or White. The four primary outcomes included: 1)location of first health system contact, 2)time from injury to first health system contact 3) time to in-person SRC clinic visit, and 4) whether the athlete established care (>1 visit), was released immediately to an athletic trainer, or lost to follow-up. RESULTS Black and White athletes mostly presented directly to SRC clinic (61.5% vs 62.3%) at a median[interquartile range] of 3[1,5] vs 4[1,8] days respectively (p=0.821). Similar proportions of Black and White athletes also first presented to the ED (30.2% vs 27.2%) at a median of 0[0,1] vs 0[0,1] days (p=0.941). Black athletes more frequently had care transferred to their athletic trainer (39.6% vs 29.6%) and less frequently established care (56.3% vs 64.0%), however these differences were not statistically significant (p=0.138). Lost to follow-up was uncommon among Black and White athletes alike (4.2% vs 6.4%). CONCLUSIONS This study demonstrated that within an established SRC referral network and multidisciplinary clinic, there were no observed racial disparities in how athletes were initially managed and/or ultimately presented to SRC clinic despite racial differences in school type and insurance coverage. SRC center assimilation and affiliation with school systems may be helpful in improving access and providing equitable care across diverse patient demographics.
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Affiliation(s)
- Jessica Wallace
- 1Department of Health Science, Athletic Training Program, University of Alabama, Tuscaloosa, AL
| | - Brian Q Hou
- 2Vanderbilt University School of Medicine, Nashville, TN.,3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine Hajdu
- 2Vanderbilt University School of Medicine, Nashville, TN.,3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Alan R Tang
- 2Vanderbilt University School of Medicine, Nashville, TN.,3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Alan Z Grusky
- 2Vanderbilt University School of Medicine, Nashville, TN.,3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Timothy Lee
- 3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- 3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN.,4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Aaron M Yengo-Kahn
- 3Vanderbilt Sport Concussion Center, Vanderbilt University Medical Center, Nashville, TN.,4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
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23
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Corwin DJ, Grady MF, Master CL, Joffe MD, Zonfrillo MR. Evaluation and Management of Pediatric Concussion in the Acute Setting. Pediatr Emerg Care 2021; 37:371-379. [PMID: 34180858 DOI: 10.1097/pec.0000000000002498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Concussion, a type of mild traumatic brain injury, is a common injury encountered by providers caring for pediatric patients in the emergency department (ED) setting. Our understanding of the pathophysiologic basis for symptom and recovery trajectories for pediatric concussion continues to rapidly evolve. As this understanding changes, so do recommendations for optimal management of concussed youth. As more and more children present to EDs across the country for concussion, it is imperative that providers caring for children in these settings remain up-to-date with diagnostic recommendations and management techniques. This article will review the definition, epidemiology, pathophysiology, diagnosis, and management of pediatric concussion in the ED setting.
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Affiliation(s)
- Daniel J Corwin
- From the Attending Physician, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Matthew F Grady
- Attending Physician, Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Christina L Master
- Attending Physician, Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Mark D Joffe
- From the Attending Physician, Division of Emergency Medicine, Children's Hospital of Philadelphia
| | - Mark R Zonfrillo
- Attending Physician, Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Hasbro Children's Hospital, Providence, RI
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24
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Zhan X, Li Y, Liu Y, Domel AG, Alizadeh HV, Raymond SJ, Ruan J, Barbat S, Tiernan S, Gevaert O, Zeineh MM, Grant GA, Camarillo DB. The relationship between brain injury criteria and brain strain across different types of head impacts can be different. J R Soc Interface 2021; 18:20210260. [PMID: 34062102 PMCID: PMC8169213 DOI: 10.1098/rsif.2021.0260] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/06/2021] [Indexed: 12/27/2022] Open
Abstract
Multiple brain injury criteria (BIC) are developed to quickly quantify brain injury risks after head impacts. These BIC originated from different head impact types (e.g. sports and car crashes) are widely used in risk evaluation. However, the accuracy of using the BIC on brain injury risk estimation across head impact types has not been evaluated. Physiologically, brain strain is often considered the key parameter of brain injury. To evaluate the BIC's risk estimation accuracy across five datasets comprising different head impact types, linear regression was used to model 95% maximum principal strain, 95% maximum principal strain at the corpus callosum and cumulative strain damage (15%) on 18 BIC. The results show significantly different relationships between BIC and brain strain across datasets, indicating the same BIC value may suggest different brain strain across head impact types. The accuracy of brain strain regression is generally decreasing if the BIC regression models are fitted on a dataset with a different type of head impact rather than on the dataset with the same type. Given this finding, this study raises concerns for applying BIC to estimate the brain injury risks for head impacts different from the head impacts on which the BIC was developed.
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Affiliation(s)
- Xianghao Zhan
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Yiheng Li
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, USA
| | - Yuzhe Liu
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - August G. Domel
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | | | - Samuel J. Raymond
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Jesse Ruan
- Ford Motor Company, 3001 Miller Road, Dearborn, MI 48120, USA
| | - Saeed Barbat
- Ford Motor Company, 3001 Miller Road, Dearborn, MI 48120, USA
| | | | - Olivier Gevaert
- Department of Biomedical Data Science, Stanford University, Stanford, CA 94305, USA
| | - Michael M. Zeineh
- Department of Radiology, Stanford University, Stanford, CA 94305, USA
| | - Gerald A. Grant
- Department of Neurosurgery, Stanford University, Stanford, CA 94305, USA
| | - David B. Camarillo
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
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25
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Moyron RB, Vallejos PA, Fuller RN, Dean N, Wall NR. Neuroimaging and advanced research techniques may lead to improved outcomes in military members suffering from traumatic brain injury. Trauma Surg Acute Care Open 2021; 6:e000608. [PMID: 33490604 PMCID: PMC7797256 DOI: 10.1136/tsaco-2020-000608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022] Open
Abstract
Recent military conflicts in Iraq and Afghanistan have resulted in the significant increase in blast-related traumatic brain injury (TBI), leading to increased Department of Defense interest in its potential long-term effects ranging from the mildest head injuries termed subconcussive trauma to the most debilitating termed chronic traumatic encephalopathy (CTE). Most patients with mild TBI will recover quickly while others report persistent symptoms called postconcussive syndrome. Repeated concussive and subconcussive head injuries result in neurodegenerative conditions that may hinder the injured for years. Fundamental questions about the nature of these injuries and recovery remain unanswered. Clinically, patients with CTE present with either affective changes or cognitive impairment. Genetically, there have been no clear risk factors identified. The discovery that microglia of the cerebral cortex discharged small extracellular vesicles in the injured and adjacent regions to a TBI may soon shed light on the immediate impact injury mechanisms. The combination of neuroimaging and advanced research techniques may, one day, fill critical knowledge gaps and lead to significant TBI research and treatment advancements.
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Affiliation(s)
- Ron B Moyron
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Paul A Vallejos
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Ryan N Fuller
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
| | - Natasha Dean
- Department of Biology, La Sierra University, Riverside, California, USA
| | - Nathan R Wall
- Department of Basic Sciences, Loma Linda University, Loma Linda, California, USA
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