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D'Lauro C, Register-Mihalik JK, Meier TB, Kerr ZY, Knight K, Broglio SP, Leeds D, Lynall RC, Kroshus E, McCrea MA, McAllister TW, Schmidt JD, Master C, McGinty G, Jackson JC, Cameron KL, Buckley T, Kaminski T, Mihalik JP. Optimizing Concussion Care Seeking: Connecting Care-Seeking Behaviors and Neurophysiological States Through Blood Biomarkers. Am J Sports Med 2024; 52:801-810. [PMID: 38340366 DOI: 10.1177/03635465231221782] [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] [Indexed: 02/12/2024]
Abstract
BACKGROUND Timely and appropriate medical care after concussion presents a difficult public health problem. Concussion identification and treatment rely heavily on self-report, but more than half of concussions go unreported or are reported after a delay. If incomplete self-report increases exposure to harm, blood biomarkers may objectively indicate this neurobiological dysfunction. PURPOSE/HYPOTHESIS The purpose of this study was to compare postconcussion biomarker levels between individuals with different previous concussion diagnosis statuses and care-seeking statuses. It was hypothesized that individuals with undiagnosed concussions and poorer care seeking would show altered biomarker profiles. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Blood samples were collected from 287 military academy cadets and collegiate athletes diagnosed with concussion in the Advanced Research Core of the Concussion Assessment, Research and Education Consortium. The authors extracted each participant's self-reported previous concussion diagnosis status (no history, all diagnosed, ≥1 undiagnosed) and whether they had delayed or immediate symptom onset, symptom reporting, and removal from activity after the incident concussion. The authors compared the following blood biomarkers associated with neural injury between previous concussion diagnosis status groups and care-seeking groups: glial fibrillary acidic protein, ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light chain (NF-L), and tau protein, captured at baseline, 24 to 48 hours, asymptomatic, and 7 days after unrestricted return to activity using tests of parallel profiles. RESULTS The undiagnosed previous concussion group (n = 21) had higher levels of NF-L at 24- to 48-hour and asymptomatic time points relative to all diagnosed (n = 72) or no previous concussion (n = 194) groups. For those with delayed removal from activity (n = 127), UCH-L1 was lower at 7 days after return to activity than that for athletes immediately removed from activity (n = 131). No other biomarker differences were observed. CONCLUSION Individuals with previous undiagnosed concussions or delayed removal from activity showed some different biomarker levels after concussion and after clinical recovery, despite a lack of baseline differences. This may indicate that poorer care seeking can create neurobiological differences in the concussed brain.
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Affiliation(s)
- Christopher D'Lauro
- Department of Behavioral Sciences and Leadership, United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Johna K Register-Mihalik
- Matthew Gfeller Center & STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Zachary Yukio Kerr
- Matthew Gfeller Center & STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Kristen Knight
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Steven P Broglio
- University of Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Daniel Leeds
- Computer and Information Sciences, Fordham University, New York, New York, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Emily Kroshus
- University of Washington, Department of Pediatrics & Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, Seattle, Washington, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, Georgia, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Christina Master
- Division of Orthopedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Gerald McGinty
- United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Jonathan C Jackson
- United States Air Force Academy, Colorado Springs, Colorado, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy, West Point, New York, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Thomas Buckley
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Thomas Kaminski
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, Delaware, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
| | - Jason P Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Investigation performed at University of Georgia, Athens, Georgia, USA
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Mitra B, Major BP, Reyes J, Surendran N, Bain J, Giesler LP, O'Brien WT, Sorich E, Willmott C, Shultz SR, O'Brien TJ, Rosenfeld JV, McDonald SJ. MicroRNA biomarkers for diagnosis of mild traumatic brain injury and prediction of persistent symptoms: A prospective cohort study. J Clin Neurosci 2023; 115:38-42. [PMID: 37480731 DOI: 10.1016/j.jocn.2023.07.011] [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: 03/10/2023] [Revised: 06/23/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023]
Abstract
The diagnosis of mild traumatic brain injury (mTBI) and early identification of patients who have persistent symptoms remains challenging. Symptoms are variably reported, and tests for cognitive impairment require specific expertise. The aim of this study was to assess the ability of plasma micro-ribonucleic acid (miRNA) biomarkers to distinguish between patients with mTBI and healthy controls. A secondary aim was to assess whether miRNA biomarker levels on the day of injury could predict persistent symptoms on day 7. Injured patients presented to an adult, tertiary referral hospital emergency department and were diagnosed with isolated mTBI (n = 75). Venous blood samples were collected within 6 h of injury. Symptom severity was assessed using the Rivermead Post-Concussion Symptom Questionnaire (RPQ) on the day of injury and at 7 days post-injury. The comparator group (n = 44) were healthy controls without any injury, who had bloods sampled and symptom severity assessed at the same time-point. Patients after mTBI reported higher symptom severity and had worse cognitive performance than the control group. Plasma miR423-3p levels were significantly higher among mTBI patients acutely post-injury compared to healthy controls and provided moderate discriminative ability (AUROC 0.67; 95 %CI: 0.57-0.77). None of the assessed miRNA biomarkers predicted persistent symptoms at 7 days. Plasma miR423-3p levels measured within 6 h of injury can discriminate for mTBI compared to healthy controls, with potential utility for screening after head injury or as an adjunct to the diagnosis of mTBI. Acute plasma miRNA levels did not predict patients who reported persistent symptoms at 7 days.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Brendan P Major
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jonathan Reyes
- Monash-Epworth Rehabilitation Research Centre (MERRC), Epworth Hospital, Melbourne, VIC, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Australian Football League, Melbourne, VIC, Australia
| | - Nanda Surendran
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Jesse Bain
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Lauren P Giesler
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - William T O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | | | - Catherine Willmott
- Monash-Epworth Rehabilitation Research Centre (MERRC), Epworth Hospital, Melbourne, VIC, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Australian Football League, Melbourne, VIC, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia; Health Sciences, Vancouver Island University, Nanaimo, BC, Canada
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jeffrey V Rosenfeld
- Department of Neurosurgery, The Alfred Hospital, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
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Barnwell PV, Ingate MR, Sagar A, Contrada RJ. College students' perceptions of concussion: Illness beliefs and masculinity norms predict stigma and willingness to seek treatment. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-16. [PMID: 37487191 DOI: 10.1080/07448481.2023.2222845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 04/19/2023] [Accepted: 05/19/2023] [Indexed: 07/26/2023]
Abstract
College students' beliefs and attitudes concerning concussion, and masculinity norms, were examined in relation to stigma and willingness to seek treatment for possible concussion. Beliefs were measured using a revised Illness Perception Questionnaire (IPQ). Participants: Participants were 631 undergraduates at a Northeastern university, most of whom were nonathletes with no concussion. Methods: Data were collected online. Regression analysis were performed to identify predictors of stigma and treatment willingness. Results: Beliefs that concussion symptoms reflect malingering, are controllable, and have psychological causes were related to more stigmatizing attitudes, as was endorsement of masculinity norms regarding winning and risk-taking. Believing that concussion symptoms are long-lasting and endorsing competitiveness, pain discounting, and self-reliance predicted willingness to seek treatment. Preliminary structural models showed adequate fit. Conclusions: In addition to beliefs assessed by the IPQ, traditional conceptions of masculinity warrant greater attention in the study of concussion-related stigma and willingness to seek treatment.
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Affiliation(s)
- Patrick V Barnwell
- Psychology Department, Rutgers University, New Brunswick, New Jersy, USA
| | - Margaret R Ingate
- Psychology Department, Rutgers University, New Brunswick, New Jersy, USA
| | - Anushka Sagar
- Psychology Department, Rutgers University, New Brunswick, New Jersy, USA
| | - Richard J Contrada
- Psychology Department, Rutgers University, New Brunswick, New Jersy, USA
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