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Geraghty DAP, Anderson V, Bray K, Hearps SJC, Fabiano F, Babl FE, Davis GA, Parkin GM, Rausa VC, Anderson N, Ignjatovic V, Seal M, Takagi M. Longitudinal neurocognitive trajectories and risk factors in the first three months following pediatric concussion. Brain Inj 2024:1-9. [PMID: 38704842 DOI: 10.1080/02699052.2024.2347553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To identify differential trajectories of neurocognitive outcomes following pediatric concussion and investigate predictors associated with patterns of recovery up to 3 months. METHODS 74 participants aged 8-17 years completed attention/working memory, processing speed, and executive function measures at 2 weeks, 1 month, and 3 months post-injury. We used principal component analysis to generate a composite of information processing. Group-based trajectory modeling identified latent trajectories. Multinominal logistic regression was used to examine associations between risk factors and trajectory groups. RESULTS We identified three trajectories of neurocognitive outcomes. The medium (54.6%) and high improving groups (35.8%) showed ongoing increase in information processing, while the low persistent group showed limited change 3 months post-injury. This group recorded below average scores on Digit Span Forward and Backward at 3 months. History of pre-injury headache was significantly associated with the persistent low scoring group, relative to the medium improving (p = 0.03) but not the high improving group (p = 0.09). CONCLUSIONS This study indicates variability in neurocognitive outcomes according to three differential trajectories, with groups partially distinguished by preexisting child factors (history of frequent headaches). Modelling that accounts for heterogeneity in individual outcomes is essential to identify clinically meaningful indices that are indicative of children requiring intervention.
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Affiliation(s)
- Daniel A P Geraghty
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
- Psychological Service, The Royal Children's Hospital, Melbourne, Australia
| | - Katherine Bray
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Stephen J C Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Rehabilitation Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - Fabian Fabiano
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
- Department of Critical Care, Melbourne University, Melbourne, Australia
| | - Gavin A Davis
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Australia
| | - Georgia M Parkin
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne, Australia
| | - Vanessa C Rausa
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Nick Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Vera Ignjatovic
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
| | - Marc Seal
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia
| | - Michael Takagi
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- School of Psychological Sciences, Monash University, Melbourne, Australia
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Valdivia-Tangarife ER, Morlett-Paredes A, Rizo-Curiel G, Jiménez-Maldonado ME, Ruiz-Sandoval JL, Barba AR, López-Enríquez A, Avilés-Martínez KI, Villaseñor-Cabrera T. Incidence, and factors associated with moderate/severe pediatric traumatic brain injury in children aged 5-15 years in western, Mexico. Eur J Paediatr Neurol 2024; 49:6-12. [PMID: 38278011 DOI: 10.1016/j.ejpn.2024.01.001] [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: 11/07/2022] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE The study objectives were to estimate the standardized incidence and evaluate factors associated with moderate/severe pediatric traumatic brain injury (p-TBI) in children aged 5-15 years in Western, Mexico. METHODS The study was cross-sectional in design. We estimated the standardized incidence of moderate/severe p-TBI using the direct methods of the World Health Organization (WHO) standard populations. We utilized the Glasgow Coma Scale (GCS) to identify moderate/severe p-TBI patients (GCS ≤ 13). Logistic regression analysis was applied to evaluate variables associated with moderate/severe p-TBI. RESULTS The standardized incidence of patients diagnosed with moderate/severe p-TBI was 31.0/100,000 person-years (95 % CI 28.7-33.4). According to age, the moderate/severe TBI group was included. A total of 254 (38.5 %) patients were aged 5-9 years, 343 (52.0 %) were aged 10-14 years, and 62 (9.5 %) were aged 15 years. Factors associated with moderate/severe TBI in the crude analysis were male sex (OR 5.50, 95 % CI 4.16-7.39, p < 0.001), primary school (OR 2.15, 95 % CI 1.62-2.84, p < 0.001), and falls (OR 1.34, 95 % CI 1.02-1.77, p = 0.035). Factors associated with moderate/severe p-TBI in the adjusted analysis were male sex (OR 6.12, 95 % CI 4.53-8.29, p < 0.001), primary school (OR 3.25, 95 % CI 2.31-4.55, p < 0.001), and falls (OR 1.78, 95 % CI 1.28-2.47, p < 0.001). CONCLUSION The incidence of moderate/severe p-TBI in children aged 5-15 years in western Mexico in this study was higher than that in other studies. One of the biggest factors associated with moderate/severe p-TBI was male sex, specifically those with lower education levels and those who were prone to falls.
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Affiliation(s)
| | | | - Genoveva Rizo-Curiel
- Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico
| | - Miriam E Jiménez-Maldonado
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; Departamento de Neurociencias, Universidad de California San Diego, La Jolla, CA, USA; Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico
| | | | | | | | | | - Teresita Villaseñor-Cabrera
- Departamento de Neurociencias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; Departamento de Neurociencias, Universidad de California San Diego, La Jolla, CA, USA; Departamento de Salud Pública, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Mexico; O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, Mexico.
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3
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Alsuwais S, Alqurashi N, Body R, Carley S. Interobserver reliability and diagnostic accuracy of prehospital triage for identifying traumatic brain injury in paediatric patients: a systematic review. Childs Nerv Syst 2024; 40:813-821. [PMID: 37851125 PMCID: PMC10891189 DOI: 10.1007/s00381-023-06144-3] [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] [Received: 02/27/2023] [Accepted: 08/31/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE The consistency and accuracy of paediatric TBI triage tools can be affected by different factors, such as patients' characteristics and the level of knowledge and skill of the caregiver. This systematic review included all the available data on the level of agreement between paramedics and ED physicians about the reliability of tools to identify paediatric TBI and the diagnostic accuracy of several such tools in prehospital settings when used by paramedics. METHODS MEDLINE (OVID), EMBASE (OVID), Cochrane Library (OVID), and CINAHL Plus (EBSCO) databases were searched from inception to 27 October 2022. Quality, bias, and applicability were assessed using COSMIN for interobserver reliability studies and QUADAS-2 tool for diagnostic accuracy studies. Narrative synthesis was employed because data were unsuitable for meta-analysis. RESULTS Initial searches identified 660 papers in total. Five met the inclusion criteria. Two studies showed moderate agreement between paramedics and ED physicians for GCS assessment. The PTS overtriage rate was 10% and the undertriage rate was 62%, while the triage tape had an overtriage rate of 18% and an undertriage rate of 68%. Pre-hospital GCS had 86.67% sensitivity and 71.43% specificity [95% CI]: 0.74-0.96 for neurosurgically significant TBI. CONCLUSION Low level of GCS agreement and poor diagnostic accuracy may cause further harm to the patient; thus, further studies are recommended to improve the prehospital management of children with head injuries.
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Affiliation(s)
- Sara Alsuwais
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK.
- Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Naif Alqurashi
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Richard Body
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon Carley
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
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Robertson-Benta CR, Pabbathi Reddy S, Stephenson DD, Sicard V, Hergert DC, Dodd AB, Campbell RA, Phillips JP, Meier TB, Quinn DK, Mayer AR. Cognition and post-concussive symptom status after pediatric mild traumatic brain injury. Child Neuropsychol 2024; 30:203-220. [PMID: 36825526 PMCID: PMC10447629 DOI: 10.1080/09297049.2023.2181946] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
Cognitive impairment and post-concussive symptoms (PCS) represent hallmark sequelae of pediatric mild traumatic brain injury (pmTBI). Few studies have directly compared cognition as a function of PCS status longitudinally. Cognitive outcomes were therefore compared for asymptomatic pmTBI, symptomatic pmTBI, and healthy controls (HC) during sub-acute (SA; 1-11 days) and early chronic (EC; approximately 4 months) post-injury phases. We predicted worse cognitive performance for both pmTBI groups relative to HC at the SA visit. At the EC visit, we predicted continued impairment from the symptomatic group, but no difference between asymptomatic pmTBI and HCs. A battery of clinical (semi-structured interviews and self-report questionnaires) and neuropsychological measures were administered to 203 pmTBI and 139 HC participants, with greater than 80% retention at the EC visit. A standardized change method classified pmTBI into binary categories of asymptomatic or symptomatic based on PCS scores. Symptomatic pmTBI performed significantly worse than HCs on processing speed, attention, and verbal memory at SA visit, whereas lower performance was only present for verbal memory for asymptomatic pmTBI. Lower performance in verbal memory persisted for both pmTBI groups at the EC visit. Surprisingly, a minority (16%) of pmTBI switched from asymptomatic to symptomatic status at the EC visit. Current findings suggest that PCS and cognition are more closely coupled during the first week of injury but become decoupled several months post-injury. Evidence of lower performance in verbal memory for both asymptomatic and symptomatic pmTBI suggests that cognitive recovery may be a process separate from the resolution of subjective symptomology.
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Affiliation(s)
- Cidney R Robertson-Benta
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Sharvani Pabbathi Reddy
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - David D Stephenson
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Veronik Sicard
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Danielle C Hergert
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Andrew B Dodd
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
| | - Richard A Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - John P Phillips
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Departments of Psychology and Neurology, University of New Mexico, Albuquerque, NM, USA
| | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Andrew R Mayer
- The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, NM, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
- Departments of Psychology and Neurology, University of New Mexico, Albuquerque, NM, USA
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5
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Sinopidis X, Kallianezos P, Petropoulos C, Gkentzi D, Kostopoulou E, Fouzas S, Dassios T, Vervenioti A, Karatza A, Roupakias S, Panagidis A, Blevrakis E, Jelastopulu E. Post-Traumatic Stress as a Psychological Effect of Mild Head Injuries in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1115. [PMID: 37508613 PMCID: PMC10378063 DOI: 10.3390/children10071115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Head trauma is one of the most common pediatric emergencies. While the psychological effects of severe head injuries are well studied, the psychological consequences of mild head injuries often go overlooked. Head injuries with a Glasgow Coma Scale score of 13-15, with symptoms such as headache, vomiting, brief loss of consciousness, transient amnesia, and absence of focal neurological signs, are defined as mild. The aim of this study is to evaluate the stress of children with mild head injuries and their parents' relevant perception during the early post-traumatic period. METHODS This is a prospective cross-sectional study on a cohort of children with mild head injuries and their parents. Two questionnaires were implemented, the Child Trauma Screening Questionnaire (CTSQ) which was compiled by the children, and the Children's Revised Impact of Event Scale (CRIES-13), compiled by their parents. Both questionnaires are widely used and reliable. The first presents an excellent predictive ability in children with a risk of post-traumatic stress disorder, while the second is a weighted self-completed detecting instrument for the measurement of post-traumatic stress in children and adolescents, with a detailed evaluation of their reactions to the traumatic incident. The participants responded one week and one month after the traumatic event. RESULTS A total of 175 children aged 6-14 years and 174 parents participated in the study. Stress was diagnosed in 33.7% of children after one week, and in 9.9% after one month. Parental responses suggesting stress presence in their children were 19.0% and 3.9%, respectively. These outcomes showed that mild head injuries are not so innocent. They are often underestimated by their parents and may generate a psychological burden to the children during the early post-traumatic period. CONCLUSIONS Mild head injuries may affect the emotional welfare of children. Healthcare providers should understand the importance of the psychological effect of this overlooked type of injury. They should be trained in the psychological effect of trauma and be aware of this probability, promptly notify the parents accordingly, and provide psychological assistance beyond medical treatment. Follow-up and support are needed to avoid the possibility of future post-traumatic stress disorder. More extensive research is needed as the outcomes of this study regarded a limited population in numbers, age, and survey period. Furthermore, many children with mild head injuries do not ever visit the emergency department and stay at home unrecorded. Community-based research on the topic should therefore be considered.
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Affiliation(s)
- Xenophon Sinopidis
- Department of Pediatric Surgery, School of Medicine, University of Patras, 26504 Patras, Greece
| | | | | | - Despoina Gkentzi
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Eirini Kostopoulou
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Sotirios Fouzas
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Theodore Dassios
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Aggeliki Vervenioti
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Ageliki Karatza
- Department of Pediatrics, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Stylianos Roupakias
- Department of Pediatric Surgery, School of Medicine, University of Patras, 26504 Patras, Greece
| | - Antonios Panagidis
- Department of Pediatric Surgery, Pediatric Hospital of Patras, 26331 Patras, Greece
| | - Evangelos Blevrakis
- Department of Pediatric Surgery, School of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Eleni Jelastopulu
- Department of Public Health, School of Medicine, University of Patras, 26504 Patras, Greece
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6
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Dichiaro M, Baker D, Tlustos SJ. Return to Learn After Traumatic Brain Injury. Pediatr Clin North Am 2023; 70:445-460. [PMID: 37121636 DOI: 10.1016/j.pcl.2023.01.004] [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: 05/02/2023]
Abstract
A successful return of youth back to school after traumatic brain injury (TBI) is an important aspect of post-injury management. Regardless of the severity of the injury, returning to school is an important aspect of improving recovery and outcomes. Often temporary informal school adjustments suffice in supporting children returning to school after concussion. For those with more a significant TBI, often formal school supports and interventions are important. Given the resiliency and recovery often seen after pediatric brain injury, close monitoring, serial evaluations, and fluid supports are important in accurately identifying what specific sequelae require support in the school setting.
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Affiliation(s)
- Michael Dichiaro
- Department of Rehabilitation, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 13th Avenue B 285, Aurora, CO, USA.
| | - David Baker
- Department of Rehabilitation, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 13th Avenue B 285, Aurora, CO, USA
| | - Sarah J Tlustos
- Department of Rehabilitation, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 13th Avenue B 285, Aurora, CO, USA
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Yue JK, Krishnan N, Andrews JP, Semonche AM, Deng H, Aabedi AA, Wang AS, Caldwell DJ, Park C, Hirschhorn M, Ghoussaini KT, Oh T, Sun PP. Update on Pediatric Mild Traumatic Brain Injury in Rural and Underserved Regions: A Global Perspective. J Clin Med 2023; 12:jcm12093309. [PMID: 37176749 PMCID: PMC10179657 DOI: 10.3390/jcm12093309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/29/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Mild traumatic brain injury (MTBI) causes morbidity and disability worldwide. Pediatric patients are uniquely vulnerable due to developmental and psychosocial factors. Reduced healthcare access in rural/underserved communities impair management and outcome. A knowledge update relevant to current gaps in care is critically needed to develop targeted solutions. METHODS The National Library of Medicine PubMed database was queried using comprehensive search terms (("mild traumatic brain injury" or "concussion") and ("rural" or "low-income" or "underserved") and ("pediatric" or "child/children")) in the title, abstract, and Medical Subject Headings through December 2022. Fifteen articles on rural/underserved pediatric MTBI/concussion not covered in prior reviews were examined and organized into four topical categories: epidemiology, care practices, socioeconomic factors, and telehealth. RESULTS Incidences are higher for Individuals in rural regions, minorities, and those aged 0-4 years compared to their counterparts, and are increasing over time. Rural healthcare utilization rates generally exceed urban rates, and favor emergency departments (vs. primary care) for initial injury assessment. Management guidelines require customization to resource-constrained settings for implementation and adoption. Decreased community recognition of the seriousness of injury is a consensus challenge to care provision by clinicians. Low parental education and income were correlated with decreased MTBI knowledge and worse outcome. Telehealth protocols for triage/consultation and rehabilitation were feasible in improving care delivery to rural and remote settings. CONCLUSIONS Pediatric MTBI/concussion patients in rural/underserved regions experience increased risks of injury, geographic and financial healthcare barriers, and poorer outcomes. Globally, under-reporting of injury has hindered epidemiological understanding. Ongoing MTBI education should be implemented for rural caregivers, schools, and low-income populations to improve community awareness. Telehealth can improve care delivery across acuity settings, and warrants judicious inclusion in triage and treatment protocols.
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Affiliation(s)
- John K Yue
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Nishanth Krishnan
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - John P Andrews
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Alexa M Semonche
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Alexander A Aabedi
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Albert S Wang
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - David J Caldwell
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Christine Park
- Department of Neurosurgery, Duke University, Durham, NC 27708, USA
| | - Melessa Hirschhorn
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Kristen T Ghoussaini
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Taemin Oh
- Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132, USA
| | - Peter P Sun
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of California San Francisco, San Francisco, CA 94143, USA
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Saarinen M, Isaksson N, Himanen L, Erkinjuntti N, Vahlberg T, Koskinen S, Tenovuo O, Lähdesmäki T. Cognitive functions and symptoms predicting later use of psychiatric services following mild traumatic brain injury in school-age. Brain Inj 2023; 37:388-396. [PMID: 36355473 DOI: 10.1080/02699052.2022.2145365] [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]
Abstract
OBJECTIVE To investigate whether neuropsychological test performance or presence of some specific injury symptoms at 1-3 months following pediatric mild traumatic brain injury (mTBI) can help to identify the children at risk for developing post-traumatic psychiatric symptoms. METHODS Data from 120 children and adolescents aged 7-15 years, treated at Turku University Hospital between 2010 and 2016 due to mTBI, and who had undergone neuropsychological evaluation at 1-3 months following injury, were enrolled from the hospital records. Neuropsychological test performancesand injury symptom reports were retrospectively retrieved from the patient files. RESULTS Slow information processing speed (p = 0.044), emotion regulation deficit (p = 0.014), impulsivity (p = 0.013), verbal processing difficulties (p = 0.042) and headache (p = 0.026) were independent predictors for having later contact in psychiatric care. CONCLUSIONS Neuropsychological examination containing measure of information processing speed, injury symptom interview, and parental questionnaires on behavioural issues of the child at 1-3 months following mTBI seems to be useful in detecting children with risk for post traumatic psychiatric symptoms. Targeted support and guidance for this group of children and adolescents and their families are recommended to prevent the development of an unfavorable psychosocial outcome.
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Affiliation(s)
- Mari Saarinen
- Department of Pediatric Neurology, Turku University Hospital and University of Turku, Finland
| | - Nea Isaksson
- Department of Pediatric Neurology, Turku University Hospital and University of Turku, Finland
| | - Leena Himanen
- Department of Clinical Medicine, Turku University Hospital and University of Turku, Finland
| | - Nina Erkinjuntti
- Department of Pediatric Neurology, Turku University Hospital and University of Turku, Finland
| | - Tero Vahlberg
- Department of Biostatistics, Turku University Hospital and University of Turku, Finland
| | - Sanna Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Olli Tenovuo
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Finland
| | - Tuire Lähdesmäki
- Department of Pediatric Neurology, Turku University Hospital and University of Turku, Finland
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9
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Cutler L, Greenacre M, Abeare CA, Sirianni CD, Roth R, Erdodi LA. Multivariate models provide an effective psychometric solution to the variability in classification accuracy of D-KEFS Stroop performance validity cutoffs. Clin Neuropsychol 2023; 37:617-649. [PMID: 35946813 DOI: 10.1080/13854046.2022.2073914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectiveThe study was designed to expand on the results of previous investigations on the D-KEFS Stroop as a performance validity test (PVT), which produced diverging conclusions. Method The classification accuracy of previously proposed validity cutoffs on the D-KEFS Stroop was computed against four different criterion PVTs in two independent samples: patients with uncomplicated mild TBI (n = 68) and disability benefit applicants (n = 49). Results Age-corrected scaled scores (ACSSs) ≤6 on individual subtests often fell short of specificity standards. Making the cutoffs more conservative improved specificity, but at a significant cost to sensitivity. In contrast, multivariate models (≥3 failures at ACSS ≤6 or ≥2 failures at ACSS ≤5 on the four subtests) produced good combinations of sensitivity (.39-.79) and specificity (.85-1.00), correctly classifying 74.6-90.6% of the sample. A novel validity scale, the D-KEFS Stroop Index correctly classified between 78.7% and 93.3% of the sample. Conclusions A multivariate approach to performance validity assessment provides a methodological safeguard against sample- and instrument-specific fluctuations in classification accuracy, strikes a reasonable balance between sensitivity and specificity, and mitigates the invalid before impaired paradox.
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Affiliation(s)
- Laura Cutler
- Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, Ontario, Canada
| | - Matthew Greenacre
- Schulich School of Medicine, Western University, London, Ontario, Canada
| | - Christopher A Abeare
- Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, Ontario, Canada
| | | | - Robert Roth
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Laszlo A Erdodi
- Department of Psychology, Neuropsychology Track, University of Windsor, Windsor, Ontario, Canada
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10
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Mohammed FN, Master CL, Arbogast KB, McDonald CC, Sharma S, Kang B, Corwin DJ. Disparities in Adherence to Concussion Clinical Care Recommendations in a Pediatric Population. J Head Trauma Rehabil 2023; 38:147-155. [PMID: 36731016 PMCID: PMC9998329 DOI: 10.1097/htr.0000000000000823] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize the relationship of sociodemographic factors to adherence to provider recommendations for pediatric concussion. SETTING Primary care (PC) practices within the Children's Hospital of Philadelphia network. PARTICIPANTS Patients aged 5 to 18 years old who presented to any PC site for concussion from September 26, 2019, to December 31, 2019. DESIGN Retrospective medical record review. MAIN MEASURES The primary outcome was adherence to follow-up recommendations as defined by (1) continued follow-up until provider clearance to return to full activity; (2) no more than 2 no-show visits; and (3) for those referred to specialty care (SC), attending at least 1 visit. We compared adherence by race/ethnicity, insurance, age, sex, injury mechanism, and repeat head injury using bivariate and multivariate analyses. A secondary outcome of referral to SC was compared by sociodemographic factors. RESULTS A total of 755 patients were included. Overall, 80.5% of the patients met adherence criteria. Following adjustment, non-Hispanic Black patients and publicly insured/self-pay patients were less likely to adhere to recommendations than non-Hispanic White patients (adjusted odds ratio [AOR] = 0.60; 95% CI, 0.37-1.00) and privately insured patients (AOR = 0.48; 95% CI, 0.30-0.75), respectively. When assessing differences in referral to SC, non-Hispanic Black patients and publicly insured/self-pay patients were more likely to receive a referral than their non-Hispanic White peers (OR = 1.56; 95% CI, 1.00-2.45) and privately insured patients (OR = 1.56; 95% CI, 1.05-2.32), respectively. CONCLUSION This study highlights disparities in adherence to concussion care recommendations, with non-Hispanic Black and publicly insured/self-pay patients less likely to adhere to follow-up recommendations than non-Hispanic White and privately insured patients, respectively. These disparities may impact recovery trajectories. Future studies should aim to identify specific individual- and system-level barriers preventing adherence to care in order to ultimately inform targeted interventions to achieve equity in care delivery and outcomes.
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Affiliation(s)
- Fairuz N Mohammed
- Center for Injury Research and Prevention (Mrs Mohammed, Drs Master, Arbogast, McDonald, and Corwin, and Mss Sharma and Kang), Sports Medicine and Performance Center (Dr Master), and Division of Emergency Medicine (Drs Arbogast and Corwin), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Perelman School of Medicine (Drs Master, Arbogast, McDonald, and Corwin) and School of Nursing (Dr McDonald), University of Pennsylvania, Philadelphia
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Daugherty J, Sarmiento K, Breiding M. Comparison of self-reported lifetime concussions and mild traumatic brain injuries among adults. Brain Inj 2023; 37:1-8. [PMID: 36760062 PMCID: PMC10409868 DOI: 10.1080/02699052.2023.2175909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/12/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION The reliability of self-reported brain injury data relies on how well people interpret the questions. OBJECTIVE This study examines how different yet commonly used questions may impact traumatic brain injury (TBI) estimates. METHODS Self-report data were collected from 4,053 respondents in the summer wave of Porter Novelli's 2020 ConsumerStyles survey. Respondents were randomized to be asked about lifetime experience of either concussion or mild TBI (mTBI) and then asked follow-up questions. RESULTS Approximately 25.5% of respondents reported sustaining a concussion in their lifetime while 17.2% reported an mTBI. The circumstances of the injuries, such as location and mechanism of injury, were similar. A greater percentage of individuals who were asked about concussions (91.1%) reported receiving a diagnosis for their most serious injury compared to those who were asked about diagnosis of an mTBI (69.9%). DISCUSSION A greater percentage of respondents reported a lifetime history of concussion than mTBI. More respondents with a lifetime history of concussion reported receiving a diagnosis. These results suggest that the terminology used can impact reporting. These findings suggest that there is a meaningful difference in the understanding of the terms 'concussion' and 'mild TBI,' with people perceiving mTBI as a more serious injury.
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Affiliation(s)
- Jill Daugherty
- Division of Injury Prevention, Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Atlanta, Georgia, United States of America
| | - Kelly Sarmiento
- Division of Injury Prevention, Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Atlanta, Georgia, United States of America
| | - Matthew Breiding
- Division of Injury Prevention, Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Atlanta, Georgia, United States of America
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12
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Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury. CHILDREN 2022; 9:children9091321. [PMID: 36138630 PMCID: PMC9497748 DOI: 10.3390/children9091321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population’s academic functioning. Consistently, poorer academic achievement and elevated need for educational supports have been well-documented among youth with a history of acquired brain injury. The current paper reviews the literature on neuropsychological, psychiatric, and academic outcomes of pediatric acquired brain injury. A discussion of special education law as it applies to this patient population, ongoing limitations within the field, and a proposal of solutions are also included.
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13
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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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Abstract
PURPOSE OF REVIEW Mild traumatic brain injury (mTBI) is a significant public health concern for children. This review summarizes recent literature on early symptoms and neuropsychiatric and neuropsychological outcomes following pediatric mTBI and highlights factors that predict prolonged recovery. Evidence-based recommendations for assessment and treatment are also discussed. RECENT FINDINGS Whereas most children recover within 1 month after mTBI, 10-30% of children experience lingering neuropsychiatric or neuropsychological symptoms 3 months or more after injury. For the subset who experience prolonged recovery, new or worsening emotional and behavioral symptoms are the most frequent concerns. Recent research has suggested that specific factors, including preinjury mental health concerns, female sex, and family characteristics, are associated with increased risk of experiencing prolonged recovery. Early management includes reassurance, brief rest (1-3 days), and gradual return to typical activities. When symptoms linger for more than 4 weeks, evaluation in a specialty clinic is recommended and multimodal therapies are considered. Active recovery models, which include gradual return to aerobic exercise and cognitive behavioral approaches, are promising for the management of prolonged symptoms. SUMMARY A minority of children with mTBI experience prolonged neuropsychiatric or neuropsychological concerns. While our understanding of pediatric mTBI is growing, and recommendations for assessment and management have been developed, many gaps remain.
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15
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Kamba G, Plourde V. Psychoeducational Interventions and Postconcussive Recovery in Children and Adolescents: A Rapid Systematic Review. Arch Clin Neuropsychol 2022; 37:568-582. [PMID: 35262665 DOI: 10.1093/arclin/acac011] [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] [Accepted: 01/27/2022] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVE The purpose of this rapid systematic review was to identify and synthesize results of empirical studies that have examined psychoeducational interventions provided to children and adolescents aged 5-19 recovering from a concussion and their families. METHODS This study followed the PRISMA guidelines adjusted for a rapid systematic review. We searched three databases (EMBASE, PsycInfo and MEDLINE) with key terms for concussion (or mild traumatic brain injury - mTBI), the intervention (psychoeducation, instructions, and reassurance) and the target population (children and adolescents aged 5 to 19). Our search strategy generated 2225 unique records and seven were included. We performed a quality appraisal on the included studies using the Mixed Methods Appraisal Tool (MMAT). RESULTS Results indicated that psychoeducational interventions had satisfactory feasibility results. Caregivers generally found the intervention to be useful to determine return to play (n=2) and understand consequences following a concussion (n=1). However, results from studies on post-concussive symptom improvement (n=4) and post-intervention concussion knowledge (n=2) showed variability and mixed findings. Methodological quality was low for most studies. CONCLUSIONS This present review shows that there are very few published studies on psychoeducational interventions offered to children, adolescents, and families for the post-concussion management. Current evidence suggests that those interventions are useful in guiding caregivers during their child's recovery. However, the impact of psychoeducational interventions on post-concussive recovery seems to be less clear.
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Affiliation(s)
- Gloria Kamba
- School of Psychology, Université de Moncton, Moncton, New-Brunswick, Canada
| | - Vickie Plourde
- Centre de formation médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada; Faculté Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
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16
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Crasta JE, Tucker RN, Robinson J, Chen HW, Crocetti D, Suskauer SJ. Altered white matter diffusivity and subtle motor function in a pilot cohort of adolescents with sports-related concussion. Brain Inj 2022; 36:393-400. [PMID: 35157539 PMCID: PMC9133076 DOI: 10.1080/02699052.2022.2034181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and objective: Adolescents with sports-related concussion (SRC) demonstrate acute and persistent deficits in subtle motor function. However, there is limited research examining related neurological underpinnings. This pilot study examined changes in motor-associated white matter pathways using diffusion tensor imaging (DTI) and their relationship with subtle motor function. Methods: Twelve adolescents with SRC (12–17 years) within two-weeks post-injury and 13 never-injured neurotypical peers completed DTI scanning. A subset of 6 adolescents with SRC returned for a follow-up visit post-medical clearance from concussion. Subtle motor function was evaluated using the Physical and Neurological Examination of Subtle Signs (PANESS). Results: Adolescents with SRC showed higher mean diffusivity (MD) of the superior corona radiata and greater subtle motor deficits compared to controls. Across all participants, greater subtle motor deficits were associated with higher (more atypical) MD of the superior corona radiata. Preliminary longitudinal analysis indicated reduction in fractional anisotropy of the corpus callosum but no change in the MD of the superior corona radiata from the initial visit to the follow-up visit post-medical clearance. Conclusions: These findings support preliminary evidence for a brain–behavior relationship between superior corona radiata microstructure and subtle motor deficits in adolescents with SRC that merits further investigation.
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Affiliation(s)
- Jewel E Crasta
- Occupational Therapy Division, The Ohio State University, Columbus, Ohio, USA
| | | | | | | | | | - Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland, USA.,Department of Physical Medicine and Rehabilitation and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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17
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Smith A, Thomas J, Friedhoff C, Chin E. The Utility of the Test of Memory Malingering Trial 1 in Differentiating Neurocognitive, Emotional, and Behavioral Functioning in a Pediatric Concussion Population. Arch Clin Neuropsychol 2021; 37:322-337. [PMID: 34386811 DOI: 10.1093/arclin/acab065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/08/2021] [Accepted: 07/21/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In concussion populations, suboptimal task engagement detected by performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive symptoms (PCS). This study examined if Pass/Fail status on the Test of Memory Malingering-TOMM Trial 1-differentiated the neurocognitive, emotional, and behavioral profile of pediatric patients with concussion. METHOD This study utilized archival data from 93 patients (mean age = 14.56 and SD = 2.01) with a history of concussion who were assessed at ~5-6 weeks post-injury (mean days = 40.27 and SD = 35.41). Individuals were divided into "Pass" and "Fail" groups based on TOMM Trial 1 performance. The testing battery included ACT, CPT-II and III, HVLT-R, WJ-III and IV ACH, ImPACT, BASC-2, and BRIEF. RESULTS The overall pass rate on Trial 1 was 70% (mean = 46.04 and SD = 4.55). Findings suggested that a passing score on Trial 1 may be associated with adequate performance across the remaining two trials of the TOMM. The Fail group scored significantly lower across attention, memory, and processing speed measures when compared with the Pass group. On rating scales, significantly more concerns were endorsed with the Fail group for attention and executive functioning relative to the Pass group. Parents generally endorsed significantly more concerns for executive functioning when compared with their children's self-reported symptoms. There was a trend for the Fail group to report more PCS; however, they did not significantly differ from the Pass group for depression, anxiety, or somatization. CONCLUSIONS This study highlights the importance of utilizing PVTs when evaluating concussion recovery.
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Affiliation(s)
- Alphonso Smith
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
| | - Julia Thomas
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
| | - Claire Friedhoff
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
| | - Esther Chin
- AMITA Health Neurosciences Institute - Center for Pediatric Brain, Hoffman Estates, IL, USA
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18
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Stein A, Iyer KK, Khetani AM, Barlow KM. Changes in working memory-related cortical responses following pediatric mild traumatic brain injury: A longitudinal fMRI study. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/20597002211006541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Persistent post-concussion symptoms (PPCS) lasting longer than 4 weeks affect 25% of children with mild traumatic brain injury (mTBI) or concussion. Working memory (WM) problems are a common complaint in children with PPCS. Despite normal function on traditional neuropsychological tests, these children exhibit aberrant cortical responses within the dorsolateral prefrontal cortex (dlPFC) and default mode network (DMN) regions – both of which are implicated in WM. Using a prospective, longitudinal cohort study design, we investigated changes in cortical fMRI responses within the dlPFC and DMN during an nback WM task at two timepoints: one and two months post-injury. Across these timepoints, the primary outcome was change in cortical activations (increase in BOLD) and deactivations (decrease in BOLD) of both dlPFC and DMN. Twenty-nine children (mean age 15.49 ± 2.15; 48.3% male) with fMRI scans at both timepoints were included, following data quality control. Student’s t-tests were used to examine cortical activations across time and task difficulty. ANCOVA F-tests examined cortical responses after removal of baseline across time, task difficulty and recovery. Volumes of interest (5 mm sphere) were placed in peak voxel regions of the DMN and dlPFC to compare cortical responses between recovered and unrecovered participants over time (one-way ANOVA). Between one and two months post-injury, we found significant increases in dlPFC activations and significant activations and deactivations in the DMN with increasing task difficulty, alongside improved task performance. Cortical responses of the DMN and bilateral dlPFC displayed increased intensity in recovered participants, together with improved attention and behavioural symptoms. Overall, our findings suggest evidence of neural compensation and ongoing cognitive recovery from pediatric TBI over time between one and two months post injury in children with PPCS. These results highlight the wider and persisting implications of mTBI in children, whose maturing brains are particularly vulnerable to TBI.
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Affiliation(s)
- Athena Stein
- Acquired Brain Injury in Children Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kartik K Iyer
- Acquired Brain Injury in Children Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Aneesh M Khetani
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Karen M Barlow
- Acquired Brain Injury in Children Research Program, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Queensland Pediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Australia
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Saarinen M, Erkinjuntti N, Koskinen S, Himanen L, Vahlberg T, Tenovuo O, Lähdesmäki T. Prolonged injury symptoms and later visits to psychiatric care after mild traumatic brain injury in school-age. Brain Inj 2021; 35:690-697. [PMID: 33678108 DOI: 10.1080/02699052.2021.1895316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate demographic and pre-injury factors in Finnish school-aged children admitted to pediatric neurology services after mild traumatic brain injury (mTBI). The relation of these factors to prolonged injury symptoms and later visits into psychiatric care was assessed. METHODS Demographic information, pre-injury learning status, and neuropsychological test results of 120 patients aged 7-16 years were retrospectively collected from the hospital medical records. Data were compared with self- or parent-reported injury symptoms at 1-3 months post-injury and later visits to psychiatric care. RESULTS According to medical records, 14.2% of the children with mTBI had a diagnosed neurobehavioral or psychiatric condition pre-injury. Additionally, 53.3% of the children had some neurobehavioral or psychiatric concerns or traits prior to the injury. Over half (56.7%) of the children studied were symptomatic at 1-3 months following the injury. Female gender and presence of prolonged symptoms were predictive for later visit into psychiatric care. CONCLUSIONS Pre-injury neurobehavioral or psychiatric problems may predict prolonged injury symptoms following pediatric mTBI. In this retrospective patient series, prolonged symptoms and female gender seem to predict the need for later psychiatric care. Monitoring the recovery of children with mTBI and pre-injury risk factors is important for timely interventions.
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Affiliation(s)
- M Saarinen
- Department of Pediatric Neurology, University of Turku, Turku, Finland
| | - N Erkinjuntti
- Department of Pediatric Neurology, University of Turku, Turku, Finland.,Department of Pediatric Neurology, Turku University Hospital, Turku, Finland
| | - S Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - L Himanen
- Department of Psychology, University of Turku, Turku, Finland
| | - T Vahlberg
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - O Tenovuo
- Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - T Lähdesmäki
- Department of Pediatric Neurology, University of Turku, Turku, Finland.,Department of Pediatric Neurology, Turku University Hospital, Turku, Finland
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20
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Wan AN, Nasr AS. Return to learn: An ethnographic study of adolescent young adults returning to school post-concussion. J Clin Nurs 2021; 30:793-802. [PMID: 33351994 DOI: 10.1111/jocn.15617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/07/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The Centers for Disease Control and Prevention estimates that 3.8 million concussions occur in the United States each year. Concussion symptoms can negatively impact the academic performance of adolescents after they return to school. The purpose of this study was to better understand the perceptions of parent-adolescent dyads as male and female adolescents returned to learn after sustaining a concussion. METHODS A qualitative ethnographic study of 10, English-speaking, parent-adolescent dyads was conducted, following the adolescents return to school after a recent concussion. Dyads were recruited from a Concussion Clinic in Menlo Park, California between October 2018 and October 2019. Adolescents were aged 14-16 years old. Each dyad participated in a semistructured interview. Interviews were subsequently transcribed and analysed using thematic analysis. This qualitative study design utilised COREQ (File S1). This study was approved by the Institutional Review Board and ethics committee. CONCLUSIONS Three categories were identified: adolescents feeling misunderstood by school staff about their injuries, adolescents feeling overwhelmed by their injuries, and academic accommodations lacking clarity and implementation. The overarching theme that emerged was clear: Parents and adolescents lacked consistent guidelines for the adolescents' return to learn after a concussion. RELEVANCE TO CLINICAL PRACTICE Post-concussion syndrome as a result of head injury is a complex condition that requires a multidisciplinary approach to treatment. This treatment should be individualised and appropriately adjusted to provide the adolescent with the most optimal environment for recovery. This study provides data to suggest that more guidance from the medical provider or treatment team is needed for teachers and school administrators in order to create an ideal return to learn environment for the adolescent who is recovering from a head injury.
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Affiliation(s)
- Anna N Wan
- Stanford Children's Hospital, Palo Alto, CA, USA
| | - Annette S Nasr
- Stanford Children's Hospital, Palo Alto, CA, USA.,Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.,Director Department of Nursing Research and Evidence-Based Practice, Stanford Children's Hospital, Palo Alto, CA, USA
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21
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Sharma A, Muresanu DF, Sahib S, Tian ZR, Castellani RJ, Nozari A, Lafuente JV, Buzoianu AD, Bryukhovetskiy I, Manzhulo I, Patnaik R, Wiklund L, Sharma HS. Concussive head injury exacerbates neuropathology of sleep deprivation: Superior neuroprotection by co-administration of TiO 2-nanowired cerebrolysin, alpha-melanocyte-stimulating hormone, and mesenchymal stem cells. PROGRESS IN BRAIN RESEARCH 2020; 258:1-77. [PMID: 33223033 DOI: 10.1016/bs.pbr.2020.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sleep deprivation (SD) is common in military personnel engaged in combat operations leading to brain dysfunction. Military personnel during acute or chronic SD often prone to traumatic brain injury (TBI) indicating the possibility of further exacerbating brain pathology. Several lines of evidence suggest that in both TBI and SD alpha-melanocyte-stimulating hormone (α-MSH) and brain-derived neurotrophic factor (BDNF) levels decreases in plasma and brain. Thus, a possibility exists that exogenous supplement of α-MSH and/or BDNF induces neuroprotection in SD compounded with TBI. In addition, mesenchymal stem cells (MSCs) are very portent in inducing neuroprotection in TBI. We examined the effects of concussive head injury (CHI) in SD on brain pathology. Furthermore, possible neuroprotective effects of α-MSH, MSCs and neurotrophic factors treatment were explored in a rat model of SD and CHI. Rats subjected to 48h SD with CHI exhibited higher leakage of BBB to Evans blue and radioiodine compared to identical SD or CHI alone. Brain pathology was also exacerbated in SD with CHI group as compared to SD or CHI alone together with a significant reduction in α-MSH and BDNF levels in plasma and brain and enhanced level of tumor necrosis factor-alpha (TNF-α). Exogenous administration of α-MSH (250μg/kg) together with MSCs (1×106) and cerebrolysin (a balanced composition of several neurotrophic factors and active peptide fragments) (5mL/kg) significantly induced neuroprotection in SD with CHI. Interestingly, TiO2 nanowired delivery of α-MSH (100μg), MSCs, and cerebrolysin (2.5mL/kg) induced enhanced neuroprotection with higher levels of α-MSH and BDNF and decreased the TNF-α in SD with CHI. These observations are the first to show that TiO2 nanowired administration of α-MSH, MSCs and cerebrolysin induces superior neuroprotection following SD in CHI, not reported earlier. The clinical significance of our findings in light of the current literature is discussed.
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Affiliation(s)
- Aruna Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
| | - Dafin F Muresanu
- Department of Clinical Neurosciences, University of Medicine & Pharmacy, Cluj-Napoca, Romania; "RoNeuro" Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Seaab Sahib
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Z Ryan Tian
- Department of Chemistry & Biochemistry, University of Arkansas, Fayetteville, AR, United States
| | - Rudy J Castellani
- Department of Pathology, University of Maryland, Baltimore, MD, United States
| | - Ala Nozari
- Anesthesiology & Intensive Care, Massachusetts General Hospital, Boston, MA, United States
| | - José Vicente Lafuente
- LaNCE, Department of Neuroscience, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Anca D Buzoianu
- Department of Clinical Pharmacology and Toxicology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Igor Bryukhovetskiy
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia; Laboratory of Pharmacology, National Scientific Center of Marine Biology, Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
| | - Igor Manzhulo
- Department of Fundamental Medicine, School of Biomedicine, Far Eastern Federal University, Vladivostok, Russia; Laboratory of Pharmacology, National Scientific Center of Marine Biology, Far East Branch of the Russian Academy of Sciences, Vladivostok, Russia
| | - Ranjana Patnaik
- Department of Biomaterials, School of Biomedical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi, India
| | - Lars Wiklund
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Hari Shanker Sharma
- International Experimental Central Nervous System Injury & Repair (IECNSIR), Department of Surgical Sciences, Anesthesiology & Intensive Care Medicine, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
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22
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Ryan NP, Anderson VA, Bigler ED, Dennis M, Taylor HG, Rubin KH, Vannatta K, Gerhardt CA, Stancin T, Beauchamp MH, Hearps S, Catroppa C, Yeates KO. Delineating the Nature and Correlates of Social Dysfunction after Childhood Traumatic Brain Injury Using Common Data Elements: Evidence from an International Multi-Cohort Study. J Neurotrauma 2020; 38:252-260. [PMID: 32883163 DOI: 10.1089/neu.2020.7057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Although childhood traumatic brain injury (TBI) has been linked to heightened risk of impaired social skills and behavior, current evidence is weakened by small studies of variable methodological quality. To address these weaknesses, this international multi-cohort study involved synthesis of data from two large observational cohort studies of complicated mild-severe child TBI in Australia and North America. Both studies adopted a unified approach to data collection and coding procedures, providing the opportunity to merge datasets from multiple, well-characterized cohorts for which gold standard measures of social outcomes were collected during the chronic recovery phase. The study involved 218 children, including 33 children with severe TBI, 83 children with complicated mild-moderate TBI, 59 children with orthopedic injury, and 43 age- and sex-matched typically developing control children. All injured children were recruited from academic children's hospitals and underwent direct cognitive assessments including measures of theory of mind (ToM) at least 1-year post- injury. Parents rated their child's social adjustment using standardized measures of social skills, communication and behavior. Results showed a brain-injury specific effect on ToM abilities, such that children with both complicated mild to moderate and severe TBI displayed significantly poorer ToM than children without TBI. In mediator models, poorer ToM predicted poorer parent-rated self-direction and social skills, as well as more frequent behavioral symptoms. The ToM mediated the effect of severe TBI on parent ratings of communication and social skills, as well as on overall behavior symptoms. The findings suggest that deficits in ToM are evident across the spectrum of TBI severity and represent one mechanism linking severe child TBI to long-term social adjustment difficulties. The findings underscore the value of large-scale data harmonization projects to increase the quality of evidence regarding the outcomes of TBI. Clinical and scientific implications are discussed.
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Affiliation(s)
- Nicholas P Ryan
- Brain and Mind Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Cognitive Neuroscience Unit, Deakin University, Geelong, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Vicki A Anderson
- Brain and Mind Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Psychology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Erin D Bigler
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - H Gerry Taylor
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
- Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Centre, Cleveland, Ohio, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kenneth H Rubin
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, Maryland, USA
| | - Kathryn Vannatta
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Cynthia A Gerhardt
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics and Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Terry Stancin
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Quebec, Canada
- Research Centre, Ste-Justine Hospital, Montreal, Quebec, Canada
| | - Stephen Hearps
- Brain and Mind Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Cathy Catroppa
- Brain and Mind Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Apple RW, Stran BM, Tross B. Psychologists' Role in Concussion Assessments for Children and Adolescents in Pediatric Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207549. [PMID: 33080778 PMCID: PMC7589585 DOI: 10.3390/ijerph17207549] [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: 08/19/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
An estimated 1.1 to 1.9 million children and adolescents in the United States are treated for a sports- or recreationally-related concussion each year. The importance of formalized assessment and measurement of concussion symptoms has been widely recognized as a component of best-practice treatment. The present paper reviews a sample of the most commonly used measures of concussion symptomology and explores psychologists' role in their application in a pediatric practice. In addition, other issues such as accessibility and the appropriateness of application with child and adolescent patients are discussed. Literature is reviewed from journals pertaining to pediatric and adolescent medicine, sports medicine, neuropsychology, and testing and measurement.
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Goreth MB, Palokas M. Association between premorbid neuropsychological conditions and pediatric mild traumatic brain injury/concussion recovery time and symptom severity: a systematic review. ACTA ACUST UNITED AC 2020; 17:1464-1493. [PMID: 31305386 DOI: 10.11124/jbisrir-2017-004008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this review was to identify associations between premorbid neuropsychological conditions and pediatric mild traumatic brain injury/concussion recovery time and symptom severity. INTRODUCTION There is a lack of evidence-based clinical guidelines for the care of children with a premorbid neuropsychological condition who have sustained a mild traumatic brain injury, also known as concussion. This necessitates inquiry for any associations that may exist, which may contribute to an enhanced understanding of injury recovery patterns. INCLUSION CRITERIA Participants included children ages six through 18 years with any diagnosed or self-reported premorbid neuropsychological condition(s) and mild traumatic brain injury/concussion. Participants with concomitant intracranial or extra-axial head injury found on diagnostic imaging were excluded. Outcomes for this review included recovery time or symptom(s) severity post-concussion. Studies considered for review were analytical observational studies, including retrospective, prospective, cross-sectional or longitudinal cohort studies or case-control studies, as well as descriptive observational study designs, including case series, individual case reports and descriptive cross-sectional studies. METHODS A comprehensive search was undertaken in January 2018 for both published and unpublished studies utilizing an a priori protocol. Major databases searched included CINAHL, Embase, PubMed, Psychology and Behavioral Sciences Collection and PsycINFO. Other sources searched for unpublished and gray literature included the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Google Scholar, ProQuest Dissertations and Theses Global: Sciences and Engineering Collection and MedNar. Additional searches of government websites and reports targeting healthcare or sports-related concussions included Australian Sports Commission, Canadian Institutes for Health Research, the National Health Service of the United Kingdom, the U.S. Department of Health and Human Services: Agency for Healthcare Research and Quality, and the U.S. Department of Health and Human Services: Centers for Disease Control and Prevention. Critical appraisal and data extraction were completed by two independent reviewers. Validation of methodologic quality was performed utilizing standardized tools from the Joanna Briggs Institute, and any disputes were resolved through discussion. Due to significant heterogeneity among studies, a meta-analysis could not be conducted. Therefore, extracted data are reported in a narrative synthesis. RESULTS A total of 12 studies (one analytical cross-sectional, two case-control and nine cohort) with 2,973 participants met inclusion criteria. Results of the findings among premorbid conditions varied. However, statistically significant associations with prolonged recovery or increased symptom severity were identified in children with pre-concussion histories of learning disabilities or poor academic achievement; anxiety, depression, mood disorders or other psychiatric illnesses; prior head injuries; somatization (in females); sleep disorders (in males); and the presence of multiple neuropsychological conditions. CONCLUSIONS Due to heterogeneity among studies and limitations of the review, findings suggest that clinicians providing post-concussive care may consider the presence of premorbid neuropsychological conditions, specifically learning disabilities or poor academic achievement; anxiety, depression, mood disorders or other psychiatric illnesses; prior head injuries; somatization; sleep disorders; or the presence of multiple neuropsychological conditions as potential contributors to prolonged recovery times or increased symptom severity in children and adolescents with mild traumatic brain injuries.
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Affiliation(s)
- Michelle Borzik Goreth
- School of Nursing, University of Mississippi Medical Center, Jackson, USA.,Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
| | - Michelle Palokas
- School of Nursing, University of Mississippi Medical Center, Jackson, USA.,Mississippi Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence
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Wallace J, Moran R, Bretzin A, Hileman B, Huang GS. Examination of Racial Disparities in Adolescents Seen in the Emergency Department for Head, Neck, or Brain Injury. J Emerg Med 2020; 59:783-794. [PMID: 32893067 DOI: 10.1016/j.jemermed.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/25/2020] [Accepted: 07/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Given the frequency, severity, and attention of traumatic brain injury in children, benchmarking disparities and injury characteristics for adolescent patients is pivotal in understanding and enhancing both clinical care and outcomes. OBJECTIVES The purpose of this study was to investigate racial disparities on mechanism of injury, clinical outcomes, and social-health factors among adolescents treated in the emergency department (ED) for a head, neck, or brain injury. METHODS This study is the result of a retrospective chart review of head-, neck-, and brain-injured adolescent patients (n = 2857) treated at three community hospital EDs and one stand-alone ED. Outcome measures included patient demographics (gender, race/ethnicity, age), Glasgow Coma Scale score, hospital length of stay, intensive care unit length of stay, mechanism of injury, primary diagnosis, secondary diagnosis of a concussion, ventilation days, discharge disposition, and primary insurance. RESULTS There were racial differences in primary diagnosis, mechanism of injury, and insurance status. Results indicated that a higher proportion of white patients were diagnosed with a concussion compared with black patients (p < 0.001). Moreover, a higher proportion of white patients were seen in the ED for head, neck, or brain injury as a result of a sports or motor vehicle incident, whereas a leading mechanism among black patients was assault (p = 0.01). More white patients had private insurance, whereas more black patients had Medicaid (p < 0.001). CONCLUSION The disparities in mechanisms for which black and white adolescent patients are seeking care at the ED for head, neck, or brain injury help to identify social-health risks of sustaining a head, neck, or brain injury. These racial disparities between black and white adolescents seen at the ED for head, neck, or brain injury suggest the need for further research to better understand the national representation of these disparities.
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Affiliation(s)
- Jessica Wallace
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama; Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Ryan Moran
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama
| | - Abigail Bretzin
- Department of Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Barbara Hileman
- Trauma and Neurosciences Research, Mercy Health, St. Elizabeth Youngstown Hospital, Youngstown, Ohio
| | - Gregory S Huang
- Department of Trauma, Mercy Health, St. Elizabeth Youngstown Hospital, Youngstown, Ohio
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Characteristics of Concussion in Elementary School-Aged Children: Implications for Clinical Management. J Pediatr 2020; 223:128-135. [PMID: 32507622 PMCID: PMC7419017 DOI: 10.1016/j.jpeds.2020.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/11/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To comprehensively characterize the clinical presentation and course of care for concussion among 5- to 11-year-old children, identifying preinjury and injury factors potentially influencing clinical outcomes. STUDY DESIGN A single-institution retrospective cohort study using electronic health record data from children ages 5- to 11 years with a concussion from July 1, 2014, through June 30, 2015. Electronic health record data were abstracted for a 20% random sample of 292 patients. RESULTS Three-fourths of patients (74.3%) presenting for concussion care had a standardized visiovestibular assessment performed. Almost all of those who eventually sought specialty care (92.9%) also had such an assessment, and only 42.9% patients initially seen in the emergency department or urgent care were examined in this manner. Of those assessed, 62.7% (n = 136) demonstrated deficits, with children ages 9-11 years more frequently exhibiting deficits than their younger counterparts (67.9% vs 53.2%; P = .03). Almost all patients (95.9%) reported at least 1 somatic symptom (eg, headache, dizziness), and one-half to two-thirds reported problems with sleep (54.1%) and visiovestibular symptoms (66.1%). Only 11.6% of children were referred for rehabilitation therapies and less than one-half of concussed patients (43.8%) were provided with a letter recommending school accommodations. CONCLUSIONS Somatic symptoms, sleep problems, and visiovestibular deficits are common in elementary school-aged children with concussion, but specific visiovestibular clinical assessments are often not performed, particularly in the emergency department setting. Recommendations for school accommodations are often not provided at the time of concussion diagnosis. Incorporating a standardized visiovestibular assessment into practice could facilitate early targeted school accommodations and thereby improve return to learning for elementary school-aged children with concussion.
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Fraunberger EA, DeJesus P, Zanier ER, Shutt TE, Esser MJ. Acute and Persistent Alterations of Cerebellar Inflammatory Networks and Glial Activation in a Rat Model of Pediatric Mild Traumatic Brain Injury. J Neurotrauma 2020; 37:1315-1330. [DOI: 10.1089/neu.2019.6714] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Erik A. Fraunberger
- Hotchkiss Brain Institute, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Pauline DeJesus
- Hotchkiss Brain Institute, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Elisa R. Zanier
- Laboratory of Acute Brain Injury and Therapeutic Strategies, Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Timothy E. Shutt
- Hotchkiss Brain Institute, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Medical Genetics, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Department of Biochemistry and Molecular Biology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Michael J. Esser
- Hotchkiss Brain Institute, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Postconcussive Symptoms Following Mild TBI and Extracranial Injury: What Are the Contributing Factors? J Int Neuropsychol Soc 2020; 26:451-463. [PMID: 31822313 DOI: 10.1017/s1355617719001279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Whether mild traumatic brain injury (mTBI) sustained by children results in persistent or recurrent symptoms, over and above those experienced by children who solely sustain mild extracranial injuries, remains debated. The current prospective longitudinal case-controlled study aimed to examine the relative influence of injury and noninjury factors on symptoms in preschool and primary school-aged children who sustained an mTBI or mild extracranial injury at least 8 month earlier. METHODS Participants were 64 parents of children (31 mTBI, 33 trauma controls) who sustained injury between ages 2 and 12, whose postconcussive symptoms across the first 3-month postinjury have been previously described. The current study assessed postconcussive symptoms at 8 or more months postinjury (M = 24.3, SD = 8.4) and examined a range of injury and noninjury predictive factors. RESULTS At or beyond 8-month postinjury, symptom numbers in the mTBI group were comparable with those of the group who sustained mild extracranial injury. Educational attainment of parents (below or above high-school attainment level) was the only predictor of symptoms at follow-up, with preexisting learning difficulties approaching significance as a predictor. CONCLUSIONS While our earlier study found that mTBI was associated with symptoms at 3-month postinjury, follow-up at more than 8 months showed mTBI no longer predicted symptom reporting. While mTBI contributes significantly to the presence of symptoms in the first few months postinjury, researchers and healthcare practitioners in this field need to consider the potential impact of noninjury factors on persistent or recurrent symptoms after mTBI.
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Sarmiento K, Gioia GA, Kirkwood MW, Wade SL, Yeates KO. A commentary for neuropsychologists on CDC's guideline on the diagnosis and management of mild traumatic brain injury among children. Clin Neuropsychol 2020; 34:259-277. [PMID: 31530221 PMCID: PMC7039321 DOI: 10.1080/13854046.2019.1660806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/28/2019] [Accepted: 08/18/2019] [Indexed: 12/27/2022]
Abstract
Objective: In 2018, the Centers for Disease Control Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. This commentary summarizes the key recommendations in the CDC Pediatric mTBI Guideline most relevant for neuropsychologists and discusses research gaps and topics that should receive attention in future iterations of the Guideline.Method: We described the methods used to develop the Guideline, which included a comprehensive Systematic Review. We also distilled and presented key practice strategies reflected in Guideline.Results: To optimize care of pediatric patients with mTBI, neuropsychologists should: use validated, age-appropriate symptom scales, assess evidence-based risk factors for prolonged recovery, provide patients with instructions on return to activity customized to their symptoms, and counsel patients to return gradually to nonsports activities after a short period of rest. Future iterations of the Guideline should encompass a review and guidance on care of patients with psychiatric and psychological difficulties, as well as the potential use of imaging to assess patients with persistent symptoms. Expanded research on mTBI among girls, children age 8 and under, and effective treatments for pediatric mTBI will be beneficial to inform care practices.Conclusions: Recommendations in the CDC Pediatric mTBI Guideline highlight multiple opportunities for neuropsychologists to take action to improve the care of young patients with mTBI and to advance research in the field. Multiple resources and tools are available to support implementation of these recommendations into clinical practice.
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Affiliation(s)
- Kelly Sarmiento
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerard A. Gioia
- Division of Pediatric Neuropsychology, Children’s National Health System, George Washington University School of Medicine, Washington, DC, USA
| | - Michael W. Kirkwood
- Department of Physical Medicine and Rehabilitation, Children’s Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Shari L. Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Keith O. Yeates
- Departments of Psychology and Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
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Ramos-Usuga D, Benito-Sánchez I, Pérez-Delgadillo P, Valdivia-Tangarife R, Villaseñor-Cabrera T, Olabarrieta-Landa L, Arango-Lasprilla J. Trajectories of neuropsychological functioning in Mexican children with traumatic brain injury over the first year after injury. NeuroRehabilitation 2019; 45:295-309. [DOI: 10.3233/nre-192834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D. Ramos-Usuga
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - I. Benito-Sánchez
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - P. Pérez-Delgadillo
- Rusk Rehabilitation at New York University Langone Health, New York, NY, USA
| | | | - T. Villaseñor-Cabrera
- Department of Psychology, University of Guadalajara, Guadalajara, Mexico
- Department of Neurosciences, University of Guadalajara, Guadalajara, Mexico
| | - L. Olabarrieta-Landa
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, Spain
| | - J.C. Arango-Lasprilla
- BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Leioa, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
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Lowry R, Haarbauer-Krupa JK, Breiding MJ, Thigpen S, Rasberry CN, Lee SM. Concussion and Academic Impairment Among U.S. High School Students. Am J Prev Med 2019; 57:733-740. [PMID: 31753255 PMCID: PMC10956705 DOI: 10.1016/j.amepre.2019.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Sports and physical activities are a frequent cause of traumatic brain injury, primarily concussions, among adolescents. These concussions may adversely affect students' ability to learn and impair academic achievement in educational settings. METHODS The 2017 Youth Risk Behavior Survey, conducted among a nationally representative sample of 14,765 U.S. high school students, was analyzed in 2018 to examine associations between self-reported sports- and physical activity-related concussions and symptoms of cognitive impairment (difficulty concentrating, remembering, or making decisions) and self-reported academic grades (mostly A's=4.0, mostly B's=3.0, mostly C's=2.0, mostly D's=1.0, mostly F's=0.0). Adjusted prevalence ratio and the difference in self-reported estimated grade point average were adjusted for sex, race/ethnicity, grade, and athlete status (participation on sports teams) and considered statistically significant if p<0.05. RESULTS Male students were more likely than female students (17.1% vs 13.0%), and athletes were more likely than nonathletes (21.4% vs 7.6%) to have a self-reported sports- and physical activity-related concussion in the 12 months preceding the survey. Students with a reported sports- and physical activity-related concussion were more likely than students without one to report symptoms of cognitive impairment regardless of whether they were male (adjusted prevalence ratio=1.49), female (adjusted prevalence ratio=1.37), athletes (adjusted prevalence ratio=1.45), or nonathletes (adjusted prevalence ratio=1.42). Self-reported grade point averagedecreased significantly from 3.14 among students who reported no concussions (referent), to 3.04 among students who reported a single concussion, and 2.81 among students who reported ≥2 concussions. CONCLUSIONS School-based programs are needed to monitor students' academic performance and provide educational support and resources to promote academic success following a concussion.
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Affiliation(s)
- Richard Lowry
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
| | - Juliet K Haarbauer-Krupa
- Traumatic Brain Injury Team, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
| | - Matthew J Breiding
- Traumatic Brain Injury Team, Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
| | - Sally Thigpen
- Division of Analysis, Research, and Practice Integration, National Center for Injury Prevention and Control, CDC, Atlanta, Georgia
| | - Catherine N Rasberry
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Sarah M Lee
- School Health Branch, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Multidisciplinary Concussion Management: A Model for Outpatient Concussion Management in the Acute and Post-Acute Settings. J Head Trauma Rehabil 2019; 34:375-384. [DOI: 10.1097/htr.0000000000000527] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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33
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Gladstone E, Narad ME, Hussain F, Quatman-Yates CC, Hugentobler J, Wade SL, Gubanich PJ, Kurowski BG. Neurocognitive and Quality of Life Improvements Associated With Aerobic Training for Individuals With Persistent Symptoms After Mild Traumatic Brain Injury: Secondary Outcome Analysis of a Pilot Randomized Clinical Trial. Front Neurol 2019; 10:1002. [PMID: 31620073 PMCID: PMC6759771 DOI: 10.3389/fneur.2019.01002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/02/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To report secondary neurocognitive and quality of life outcomes for a pilot randomized clinical trial (RCT) of aerobic training for management of prolonged symptoms after a mild traumatic brain injury (mTBI) in adolescents. Setting: Outpatient research setting. Participants: Thirty adolescents between the ages of 12 and 17 years who sustained a mTBI and had between 4 and 16 weeks of persistent post-concussive symptoms. Design: Secondary outcome analysis of a partially masked RCT of sub-symptom exacerbation aerobic training compared with a full-body stretching program highlighting cognitive and quality of life outcomes. Main Measures: The secondary outcomes assessed included neurocognitive changes in fluid and crystallized age-adjusted cognition using the National Institutes of Health (NIH) toolbox and self and parent-reported total quality of life using the Pediatric Quality of Life Inventory. Results: Twenty-two percent of eligible participants enrolled in the trial. General linear models did not reveal statistically significant differences between groups. Within group analyses using paired t-tests demonstrated improvement in age-adjusted fluid cognition [t (13) = 3.39, p = 0.005, Cohen's d = 0.61] and crystallized cognition [t (13) = 2.63, p = 0.02, Cohen's d = 0.70] within the aerobic training group but no significant improvement within the stretching group. Paired t-tests demonstrated significant improvement in both self-reported and parent-reported total quality of life measures in the aerobic training group [self-report t (13) = 3.51, p = 0.004, Cohen's d = 0.94; parent-report t (13) = 6.5, p < 0.0001, Cohen's d = 1.80] and the stretching group [self-report t (14) = 4.20, p = 0.0009, Cohen's d = 1.08; parent-report t (14) = 4.06, p = 0.0012, Cohen's d = 1.045]. Conclusion: Quality of life improved significantly in both the aerobic exercise and stretching groups; however, this study suggests that only sub-symptom exacerbation aerobic training was potentially beneficial for neurocognitive recovery, particularly the fluid cognition subset in the NIH Toolbox. Limited sample size and variation in outcomes measures limited ability to detect between group differences. Future research should focus on developing larger studies to determine optimal timing post-injury and intensity of active rehabilitation to facilitate neurocognitive recovery and improve quality of life after mTBI. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02035579.
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Affiliation(s)
- Emily Gladstone
- Department of Physical Medicine and Rehabilitation, MetroHealth and Case Western Reserve College of Medicine, Cleveland, OH, United States
| | - Megan E Narad
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Fadhil Hussain
- College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Catherine C Quatman-Yates
- Division of Occupational Therapy and Physical Therapy, Department of Physical Therapy, Cincinnati Children's Hospital Medical Center, The Ohio State University, Columbus, OH, United States.,Division of Physical Therapy, Sports Medicine Research Institute, and Chronic Brain Injury Program, Columbus, OH, United States
| | - Jason Hugentobler
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Paul J Gubanich
- Division of Sports Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University College of Medicine, Cincinnati, OH, United States.,Department of Internal Medicine, University College of Medicine, Cincinnati, OH, United States
| | - Brad G Kurowski
- Division of Pediatric Rehabilitation Medicine, Departments of Pediatrics and Neurology and Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Ferraracci J, Anzalone C, Bridges RM, Moore RD, Decker SL. QEEG correlates of cognitive processing speed in children and adolescents with traumatic brain injuries. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 10:247-257. [PMID: 31613642 DOI: 10.1080/21622965.2019.1675523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Both quantitative electroencephalography (qEEG) and cognitive measures have been used to understand the underlying brain changes that occur in individuals after experiencing a traumatic brain injury, however, research exploring the relationship between qEEG patterns and cognitive test performance is scarcely studied in school-aged populations. The purpose of the present study was to explore first, the neuropsychological and academic deficits in young individuals with TBI; and second, the underlying relationship between qEEG patterns and cognitive test performance. Analyses included 21 school-aged participants whom have experienced a recent TBI and 15 school-aged participants whom have never experienced a TBI. Mean subtest and composite scores were compared and regression analyses were used to determine whether alpha band and beta band qEEG coherence values predicted processing speed measures. Results suggest that young individuals who experienced a recent TBI exhibit general deficits in cognition and academic skills beyond what would be expected in the general population. Further, beta band coherence with the frontal brain regions significantly predicted processing speed scores, providing evidence of a relationship between qEEG patterns and processing speed. This outlines a relatively inexpensive method for utilizing neural connectivity to verify cognitive deficits for school-aged individuals with a recent TBI.
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Affiliation(s)
- Joseph Ferraracci
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - Rachel M Bridges
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - R Davis Moore
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States of America
| | - Scott L Decker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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Ryan NP, Noone K, Godfrey C, Botchway EN, Catroppa C, Anderson V. Young adults’ perspectives on health-related quality of life after paediatric traumatic brain injury: A prospective cohort study. Ann Phys Rehabil Med 2019; 62:342-350. [DOI: 10.1016/j.rehab.2019.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 11/28/2022]
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Mayer AR, Stephenson DD, Wertz CJ, Dodd AB, Shaff NA, Ling JM, Park G, Oglesbee SJ, Wasserott BC, Meier TB, Witkiewitz K, Campbell RA, Yeo RA, Phillips JP, Quinn DK, Pottenger A. Proactive inhibition deficits with normal perfusion after pediatric mild traumatic brain injury. Hum Brain Mapp 2019; 40:5370-5381. [PMID: 31456319 PMCID: PMC6864901 DOI: 10.1002/hbm.24778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/11/2019] [Accepted: 08/16/2019] [Indexed: 12/14/2022] Open
Abstract
Although much attention has been generated in popular media regarding the deleterious effects of pediatric mild traumatic brain injury (pmTBI), a paucity of empirical evidence exists regarding the natural course of biological recovery. Fifty pmTBI patients (12–18 years old) were consecutively recruited from Emergency Departments and seen approximately 1 week and 4 months post‐injury in this prospective cohort study. Data from 53 sex‐ and age‐matched healthy controls (HC) were also collected. Functional magnetic resonance imaging was obtained during proactive response inhibition and at rest, in conjunction with independent measures of resting cerebral blood flow. High temporal resolution imaging enabled separate modeling of neural responses for preparation and execution of proactive response inhibition. A priori predictions of failed inhibitory responses (i.e., hyperactivation) were observed in motor circuitry (pmTBI>HC) and sensory areas sub‐acutely and at 4 months post‐injury. Paradoxically, pmTBI demonstrated hypoactivation (HC>pmTBI) during target processing, along with decreased activation within prefrontal cognitive control areas. Functional connectivity within motor circuitry at rest suggested that deficits were limited to engagement during the inhibitory task, whereas normal resting cerebral perfusion ruled out deficits in basal perfusion. In conclusion, current results suggest blood oxygen‐level dependent deficits during inhibitory control may exceed commonly held beliefs about physiological recovery following pmTBI, potentially lasting up to 4 months post‐injury.
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Affiliation(s)
- Andrew R Mayer
- The Mind Research Network/LBERI, Albuquerque, New Mexico.,Department of Psychology, University of New Mexico, Albuquerque, New Mexico.,Department of Neurology, University of New Mexico, Albuquerque, New Mexico.,Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico
| | | | | | - Andrew B Dodd
- The Mind Research Network/LBERI, Albuquerque, New Mexico
| | | | - Josef M Ling
- The Mind Research Network/LBERI, Albuquerque, New Mexico
| | - Grace Park
- Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Scott J Oglesbee
- Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
| | | | - Timothy B Meier
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Katie Witkiewitz
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Richard A Campbell
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico
| | - Ronald A Yeo
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - John P Phillips
- The Mind Research Network/LBERI, Albuquerque, New Mexico.,Department of Neurology, University of New Mexico, Albuquerque, New Mexico
| | - Davin K Quinn
- Department of Psychiatry, University of New Mexico, Albuquerque, New Mexico
| | - Amy Pottenger
- Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
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Karydakis P, Giakoumettis D, Themistocleous M. The 100 most cited papers about pediatric traumatic brain injury: a bibliometric analysis. Ir J Med Sci 2019; 189:315-325. [PMID: 31418153 DOI: 10.1007/s11845-019-02085-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The high incidence of traumatic brain injury (TBI) in children, combined with the challenges in diagnosis and treatment options, the difficulty of predicting the outcome of each case, and also the wide variety of possibly lifelong complications, has led to an extraordinary number of published papers regarding this topic. This bibliometric analysis is aimed at identifying and reviewing the 100 most cited papers in the most challenging and trending aspects of pediatric traumatic brain injury. METHODS A search was performed using the Web of Science database in October 2018. Results were organized by citation number, and the 100 most cited papers were further reviewed and analyzed. RESULTS Our search resulted in 2754 published papers from 1975 until October 2018, of which 1783 (64.74%) had been published in the last decade (2010-2018). The 100 most cited papers about traumatic brain injury in children have an average citation of 140.59 and have been published in 44 different journals. Four hundred thirty-five authors have contributed to these prominent articles, most of them from the USA. CONCLUSIONS By reviewing those highly cited papers, we sought to offer significant help not only for studying this challenging field but also for designing new studies.
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Affiliation(s)
- Ploutarchos Karydakis
- Department of Neurosurgery, 251 Hellenic Air Force General Hospital, Athanasiou Diakou 9 str., Cholargos, 15562, Athens, Greece.
| | - Dimitrios Giakoumettis
- Department of Neurosurgery, 'Evangelismos Hospital', University of Athens, Athens, Greece
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Takagi M, Hearps SJC, Babl FE, Anderson N, Bressan S, Clarke C, Davis GA, Doyle M, Dunne K, Lanyon C, Rausa V, Thompson E, Anderson V. Does a computerized neuropsychological test predict prolonged recovery in concussed children presenting to the ED? Child Neuropsychol 2019; 26:54-68. [PMID: 31364925 DOI: 10.1080/09297049.2019.1639653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Computerized neuropsychological tests (CNTs) are widely used internationally in concussion management. Their prognostic value for predicting recovery post-concussion is poorly understood, particularly in pediatric populations. The aim of the present study was to examine whether cognitive functioning (measured by CogSport) has prognostic value for predicting rapid versus slow recovery. This is a prospective longitudinal observational cohort study conducted at a state-wide tertiary pediatric hospital. Data were collected at 1-4, 14, and 90 days post-injury. Eligible children were aged ≥5 and <18 years presenting to the Emergency Department having sustained a concussion within 48 h. Concussion was defined according to the Zurich/Berlin Consensus Statement on Concussion in Sport. Dependent variables were reaction times and error rates on the CogSport Brief Battery. In total, 220 cases were analyzed; 98 in a rapid recovery group (asymptomatic at 14 days post-injury, mean age 11.5 [3.2], 73.5% male) and 122 in a slow recovery group (symptomatic at 14 days post-injury, mean age 12.0 [3.1], 69.7% male). Longitudinal GEE analyses modeled the trajectories of both mean log10-transformed reaction time and error rates between groups over time (1-4, 14 and 90 days). Both group main and interaction (time by group) terms for all models were non-significant (p > .05). Cognitive functioning, measured by CogSport and assessed within 1-4 days of concussion, does not predict prolonged recovery in a pediatric sample. Further, there were no significant group differences at any time point. Considering the widespread use and promotion of CNTs, it is important that clinicians understand the significant limitations of the CogSport battery.
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Affiliation(s)
- Michael Takagi
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen J C Hearps
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Franz E Babl
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Silvia Bressan
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Cathriona Clarke
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Gavin A Davis
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Melissa Doyle
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Chloe Lanyon
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Vanessa Rausa
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Emma Thompson
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
| | - Vicki Anderson
- Brain and Mind Group, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Psychology Service, The Royal Children's Hospital, Melbourne, Australia
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Abstract
Neuropsychologists play an important role in the clinical evaluation of many children and adolescents who have sustained concussions. This paper discusses clinical approaches and concerns in conducting neuropsychological evaluations of middle and high school aged students during the acute, subacute, and more chronic phases of concussion recovery. Issues of baseline testing and validity assessment are reviewed. Typical clinical recommendations arising from the neuropsychological evaluation are outlined, with an emphasis on the relationship between test findings and common academic accommodations.
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Affiliation(s)
- Neal McGrath
- Sports Concussion New England, Brookline, MA; Robert C. Cantu Concussion Center, Emerson Hospital, Concord, MA.
| | - Janelle Eloi
- Sports Concussion New England, Brookline, MA; Robert C. Cantu Concussion Center, Emerson Hospital, Concord, MA; William James College, Newton, MA
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Molaei-Langroudi R, Alizadeh A, Kazemnejad-Leili E, Monsef-Kasmaie V, Moshirian SY. Evaluation of Clinical Criteria for Performing Brain CT-Scan in Patients with Mild Traumatic Brain Injury; A New Diagnostic Probe. Bull Emerg Trauma 2019; 7:269-277. [PMID: 31392227 PMCID: PMC6681891 DOI: 10.29252/beat-0703010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 01/01/2019] [Accepted: 01/21/2019] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To investigate the risk factors that can be proper indications for performing brain computerized tomography (CT)-scan in patients with mild and moderate traumatic brain injury (TBI) in order to avoid unnecessary exposure to radiation, saving on costs as well as time wasted in emergency wards. METHODS Data of patients with mild traumatic brain injury (TBI) referring to Emergency Department with age ≥2 years and primary GCS of 13-15 were examined including focal neurological deficit, anisocoria, skull fracture, multiple trauma, superior injury of clavicle, decreased consciousness, and amnesia. Brain CT-scan was performed in all the patients. Kappa Coefficient was used to determine the ratio of agreement of the CT indications (+ and ⎼) and multiple logistic regression to determine the relative odds of positive CTs. RESULTS Overall we included 610 patients. One-hundred and one patients (16.5%) had positive and 509 (83.5%) had negative CT findings. Of positive CTs, the highest percentage was dedicated to high-energy mechanism of trauma. High-energy trauma mechanism (OR=1.056, 95% CI, OR, 1.03-1.04, P<0.001), superior injury of clavicle (OR=1.07, 95% CI, OR, 1.03-1.1, P<0.001) and moderate to severe headache (OR=1.04, 95% CI, OR, 1.02-1.05, P<0.001) were positive predictors of CT findings. The combined mean of positive symptoms equaled 0.29 ± 0.64 in negative CTs, but 5.13 ± 2.4 in positive CTs, showing a significant difference. (P<0.001). CONCLUSION Abnormal positive brain CT in victims with mild TBI is predictable if one or several risk factors are taken into account such as moderate to severe headache, decreased consciousness, skull fracture, high-energy trauma mechanism, superior injury of clavicle and GCS of 13-14. The more the symptoms, the more likely the positive CT results would be.
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Affiliation(s)
| | - Ahmad Alizadeh
- Department of Radiology, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Vahid Monsef-Kasmaie
- Department of Emergency Medicine, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
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Mild Traumatic Brain Injury: Striking Postconcussion Symptoms Due to Inadequate Management. Pediatr Emerg Care 2019; 35:e99-e103. [PMID: 31136453 DOI: 10.1097/pec.0000000000001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric mild traumatic brain injury is a frequent cause for emergency consultations. Very often, management decisions focus only on acute neurological problems, without considering possible long-term impairment. Our case describes a 14-year-old girl who developed a pronounced and prolonged postconcussive syndrome and subsequent posttraumatic stress symptoms after (mild) traumatic brain injury. Early discharge without adequate instructions about the appropriate time to return to school and daily life activities promoted these striking problems. Only the delayed interventions including reduction of school workload and initiation of physiotherapy led to an improvement of symptoms. CONCLUSIONS: Traumatologists, pediatricians, and general practitioners should call families' and teachers' attention to the risk of potential postconcussive syndrome and advise them on appropriate coping strategies. Thorough clinical examination should rule out potentially treatable physical impairments. Prescription of physical and cognitive rest at an early stage is mandatory and should be part of concussion management already at emergency department. Pediatricians or general practitioners should follow up patients and support their gradually working back into full activity.
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Galicia-Alvarado M, Alducin-Castillo J, Ramírez-Flores MJ, Sánchez Quezada AL, Yáñez-Suárez O, Flores-Ávalos B. Cognitive and spectral coherence of EEG alterations in resting state in children with chronic TBI. SALUD MENTAL 2019. [DOI: 10.17711/sm.0185-3325.2019.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. TBI is associated with alterations in cortico-subcortical connectivity. However, little attention has been paid to its clinical characteristics and functional connectivity in pediatric patients with chronic TBI. Objective. To evaluate the cognitive performance and spectral coherence of a group of children with TBI in non-acute phase. Method. Cross-sectional study of 15 children with chronic TBI and 17 healthy children. The Neuropsychological Assessment of Children (Evaluación Neuropsicológica Infantil, ENI) was used and the resting activity of the EEG with eyes-closed was recorded. Offline, two-second epochs of the EEG of each participant were chosen and the spectral coherence was estimated in a range of 1.6 to 30 Hz. The cognitive performance between groups was compared with T-test/Mann-Whitney U Test and MANOVA for the coherence values. Results. The TBI group showed a lower performance (p ≤ 0.05) in metalinguistic, visuospatial skills, attention, memory, non-verbal flexibility, planning, and organization. Differences (p ≤ 0.000) were found both inter and intrahemispherically in the spectral coherence between the groups, particularly on F1-F3 (95% CI: 0.543 - 0.557) over the whole frequency range and F3-C3 (95% CI: 0.503 - 0.515) in delta, theta, alpha2, and beta frequencies. Discussion and conclusión. Our findings suggest alterations of hypo and hyper functional connectivity, particularly on the frontal and parietal lobes of both hemispheres, even after several years of a TBI. It is possible that a subtle difference in the degree of connectivity is crucial in the genesis or successful development of attentional, mnesic, executive, and visuospatial processes.
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Affiliation(s)
- Marlene Galicia-Alvarado
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico
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Lace JW, Emmert NA, Merz ZC, Zane KL, Grant AF, Aylward S, Dorflinger J, Gfeller JD. Investigating the BRIEF and BRIEF-SR in Adolescents with Mild Traumatic Brain Injury. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2018. [DOI: 10.1007/s40817-018-00063-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Minney MJ, Roberts RM, Mathias JL, Raftos J, Kochar A. Service and support needs following pediatric brain injury: perspectives of children with mild traumatic brain injury and their parents. Brain Inj 2018; 33:168-182. [PMID: 30396278 DOI: 10.1080/02699052.2018.1540794] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To provide a qualitative examination of the service and support needs of children who have had a mild traumatic brain injury (mTBI), and their parents, in order to improve clinical services. METHODS Semi-structured interviews were conducted with 9 children (8-12 years; M = 10.6 years, SD = 0.8) and their parents (n = 9) 29-55 days (M = 34 days; SD = 9.3) after presenting to an Australian Paediatric Emergency Department (PED) for mTBI. Children's post-concussive symptoms (PCS) were additionally measured using the Post-Concussive Symptom Inventory (PCSI). Audio recordings were transcribed, and a thematic analysis was conducted. RESULTS Post-injury needs were reflected in four main themes: Communication; Family Burden; Continuity of Care; and Social and Community Support. These themes reflected children's and parents' needs for information, emotional/social/community support, and follow-up care. Both the children's and parents' needs, and the extent to which they were met, appeared to be related to the severity and duration of the child's PCS. CONCLUSIONS Dedicated pediatric mTBI follow-up services that build on family's resources and meet their individual needs for information, emotional support, and referral may assist in optimizing post-injury outcomes.
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Affiliation(s)
- M J Minney
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - R M Roberts
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J L Mathias
- a School of Psychology , University of Adelaide , Adelaide , Australia
| | - J Raftos
- b Pediatric Emergency Department , Women's & Children's Hospital , North Adelaide , Australia
| | - A Kochar
- b Pediatric Emergency Department , Women's & Children's Hospital , North Adelaide , Australia
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Haarbauer-Krupa J, Lee AH, Bitsko RH, Zhang X, Kresnow-Sedacca MJ. Prevalence of Parent-Reported Traumatic Brain Injury in Children and Associated Health Conditions. JAMA Pediatr 2018; 172:1078-1086. [PMID: 30264150 PMCID: PMC6248161 DOI: 10.1001/jamapediatrics.2018.2740] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Traumatic brain injury (TBI) in children results in a high number of emergency department visits and risk for long-term adverse effects. OBJECTIVES To estimate lifetime prevalence of TBI in a nationally representative sample of US children and describe the association between TBI and other childhood health conditions. DESIGN, SETTING, AND PARTICIPANTS Data were analyzed from the 2011-2012 National Survey of Children's Health, a cross-sectional telephone survey of US households with a response rate of 23%. Traumatic brain injury prevalence estimates were stratified by sociodemographic characteristics. The likelihood of reporting specific health conditions was compared between children with and without TBI. Age-adjusted prevalence estimates were computed for each state. Associations between TBI prevalence, insurance type, and parent rating of insurance adequacy were examined. Data analysis was conducted from February 1, 2016, through November 1, 2017. MAIN OUTCOMES AND MEASURES Lifetime estimate of TBI in children, associated childhood health conditions, and parent report of health insurance type and adequacy. RESULTS The lifetime estimate of parent-reported TBI among children was 2.5% (95% CI, 2.3%-2.7%), representing over 1.8 million children nationally. Children with a lifetime history of TBI were more likely to have a variety of health conditions compared with those without a TBI history. Those with the highest prevalence included learning disorders (21.4%; 95% CI, 18.1%-25.2%); attention-deficit/hyperactivity disorder (20.5%; 95% CI, 17.4%-24.0%); speech/language problems (18.6%; 95% CI, 15.8%-21.7%); developmental delay (15.3%; 95% CI, 12.9%-18.1%); bone, joint, or muscle problems (14.2%; 95% CI, 11.6%-17.2%); and anxiety problems (13.2%; 95% CI, 11.0%-16.0%). States with a higher prevalence of childhood TBI were more likely to have a higher proportion of children with private health insurance and higher parent report of adequate insurance. Examples of states with higher prevalence of TBI and higher proportion of private insurance included Maine, Vermont, Pennsylvania, Washington, Montana, Wyoming North Dakota, South Dakota, and Colorado. CONCLUSIONS AND RELEVANCE A large number of US children have experienced a TBI during childhood. Higher TBI prevalence in states with greater levels of private insurance and insurance adequacy may suggest an underrecognition of TBI among children with less access to care. For more comprehensive monitoring, health care professionals should be aware of the increased risk of associated health conditions among children with TBI.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Unintentional Injury, National Centers for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xinjian Zhang
- Division of Analysis, Research and Practice Integration, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marcie-jo Kresnow-Sedacca
- Division of Analysis, Research and Practice Integration, Centers for Disease Control and Prevention, Atlanta, Georgia
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Haarbauer-Krupa J, Ciccia A, Dodd J, Ettel D, Kurowski B, Lumba-Brown A, Suskauer S. Service Delivery in the Healthcare and Educational Systems for Children Following Traumatic Brain Injury: Gaps in Care. J Head Trauma Rehabil 2018; 32:367-377. [PMID: 28060211 PMCID: PMC6027591 DOI: 10.1097/htr.0000000000000287] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a review of evidence and consensus-based description of healthcare and educational service delivery and related recommendations for children with traumatic brain injury. METHODS Literature review and group discussion of best practices in management of children with traumatic brain injury (TBI) was performed to facilitate consensus-based recommendations from the American Congress on Rehabilitation Medicine's Pediatric and Adolescent Task Force on Brain Injury. This group represented pediatric researchers in public health, medicine, psychology, rehabilitation, and education. RESULTS Care for children with TBI in healthcare and educational systems is not well coordinated or integrated, resulting in increased risk for poor outcomes. Potential solutions include identifying at-risk children following TBI, evaluating their need for rehabilitation and transitional services, and improving utilization of educational services that support children across the lifespan. CONCLUSION Children with TBI are at risk for long-term consequences requiring management as well as monitoring following the injury. Current systems of care have challenges and inconsistencies leading to gaps in service delivery. Further efforts to improve knowledge of the long-term TBI effects in children, child and family needs, and identify best practices in pathways of care are essential for optimal care of children following TBI.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Haarbauer-Krupa); Department of Psychological Sciences, Program in Communication Sciences, Cleveland, Ohio (Dr Ciccia); Department of Psychology, St Louis Children's Hospital, and Washington University School of Medicine, St Louis, Missouri (Dr Dodd); Education Support Services, Eugene School District #4J, Oregon (Dr Ettel); Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, Department of Pediatrics and Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Ohio (Dr Kurowski); Pediatric Emergency Medicine, Washington University School of Medicine, St Louis Children's Hospital, Missouri (Dr Lumba-Brown); and Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Suskauer)
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Variations in Mechanisms of Injury for Children with Concussion. J Pediatr 2018; 197:241-248.e1. [PMID: 29627189 PMCID: PMC6029621 DOI: 10.1016/j.jpeds.2018.01.075] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/22/2017] [Accepted: 01/26/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess the distribution of injury mechanisms and activities among children with concussions in a large pediatric healthcare system. STUDY DESIGN All patients, age 0-17 years, who had at least 1 clinical encounter with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of concussion in the Children's Hospital of Philadelphia's electronic health record system from July 1, 2012 to June 30, 2014, were selected (N = 8233) and their initial concussion-related visit identified. Approximately, 20% of the patients (n = 1625) were randomly selected for manual record review to examine injury mechanisms and activities. RESULTS Overall, 70% of concussions were sports related; however, this proportion varied by age. Only 18% of concussions sustained by children aged 0-4 were sports related, compared with greater proportions for older children (67% for age 5-11, 77% for age 12-14, and 73% for age 15-17). When the concussion was not sports related, the primary mechanisms of injury were struck by an object (30%) and falls (30%). CONCLUSIONS Sports-related injuries in children older than 6 years of age contributed to the majority of concussions in this cohort; however, it is important to note that approximately one-third of concussions were from non-sports-related activities. Although there is increased participation in community and organized sports activities among children, a focus on prevention efforts in other activities where concussions occur is needed.
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48
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Schmidt J, Hayward KS, Brown KE, Zwicker JG, Ponsford J, van Donkelaar P, Babul S, Boyd LA. Imaging in Pediatric Concussion: A Systematic Review. Pediatrics 2018; 141:peds.2017-3406. [PMID: 29678928 DOI: 10.1542/peds.2017-3406] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging indexes brain injury and outcome after pediatric mTBI, but remains largely unexplored. OBJECTIVE To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, and age at injury were also considered. DATA SOURCES A systematic review was conducted up to July 6, 2016. STUDY SELECTION Studies were independently screened by 2 authors and included if they met predetermined eligibility criteria: (1) children/youth (5-18 years of age), (2) diagnosis of mTBI, and (3) use of neuroimaging. DATA EXTRACTION Two authors independently appraised study quality and extracted demographic and outcome data. RESULTS Twenty-two studies met the eligibility criteria, involving 448 participants with mTBI (mean age = 12.7 years ± 2.8). Time postinjury ranged from 1 day to 5 years. Seven different neuroimaging methods were investigated in included studies. The most frequently used method, diffusion tensor imaging (41%), had heterogeneous findings with respect to the specific regions and tracts that showed group differences. However, group differences were observed in many regions containing the corticospinal tract, portions of the corpus callosum, or frontal white-matter regions; fractional anisotropy was increased in 88% of the studies. LIMITATIONS This review included a heterogeneous sample with regard to participant ages, time since injury, symptoms, and imaging methods which prevented statistical pooling/modelling. CONCLUSIONS These data highlight essential priorities for future research (eg, common data elements) that are foundational to progress the understanding of pediatric concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada; .,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kathryn S Hayward
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,Florey Institute of Neuroscience and Mental Health, National Health and Medical Research Council and University of Melbourne, Parkville, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Katlyn E Brown
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jill G Zwicker
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | | | - Paul van Donkelaar
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Shelina Babul
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | - Lara A Boyd
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
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Haarbauer-Krupa J, Lundine JP, DePompei R, King TZ. Rehabilitation and school services following traumatic brain injury in young children. NeuroRehabilitation 2018; 42:259-267. [DOI: 10.3233/nre-172410] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Jennifer P. Lundine
- School of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA
- Division of Clinical Therapies and Inpatient Rehabilitation Program, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Roberta DePompei
- School of Speech-Language Pathology, University of Akron, Akron, OH, USA
| | - Tricia Z. King
- Department of Psychology and the Neuroscience Institute, Georgia State University, Atlanta, GA, USA
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Goreth MB, Palokas M. The association of premorbid neuropsychological conditions with pediatric mild traumatic brain injury/concussion recovery time and symptom severity: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:603-608. [PMID: 29521858 DOI: 10.11124/jbisrir-2017-003447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
REVIEW QUESTION The question of this review is: What is the association of premorbid neuropsychological conditions with mild traumatic brain injury/concussion recovery time and symptom severity in children?
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Affiliation(s)
- Michelle Borzik Goreth
- School of Nursing, University of Mississippi Medical Center, Jackson, United States
- UMMC School of Nursing Evidence Based Practice and Research Team: a Joanna Briggs Institute Affiliated Group
| | - Michelle Palokas
- School of Nursing, University of Mississippi Medical Center, Jackson, United States
- UMMC School of Nursing Evidence Based Practice and Research Team: a Joanna Briggs Institute Affiliated Group
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