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Benjamin HJ, Perri MM, Leemputte J, Lewallen L, DeVries C. Opioids and Youth Athletes. Sports Health 2024; 16:269-278. [PMID: 38366642 PMCID: PMC10916775 DOI: 10.1177/19417381241228629] [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: 02/18/2024] Open
Abstract
CONTEXT The ongoing opioid epidemic and associated adverse effects impart a large burden on our current healthcare system. The annual economic and noneconomic cost of opioid use disorder and fatal opioid overdose is currently estimated at $1 trillion. OBJECTIVE This review presents the prevalence, frequency of use, need, and effectiveness of opioid analgesia in the youth and adolescent athlete population. It identifies current indications for opioid versus nonopioid analgesic use in the setting of acute orthopaedic injuries, postoperative management, concussion, and chronic pain. Current knowledge of youth athlete opioid use, risks related to use, misuse, diversion, and addiction are reviewed. DATA SOURCES A PubMed, Medline, and Cochrane Library search was conducted in February 2023 to review opioid pain management strategies in the pediatric athlete population from 2000 to present. STUDY SELECTION Searches were restricted to English language articles and human subjects. Initial reviews of titles and abstracts were performed by all authors and relevant full-text articles were selected. Priority was given to systematic and narrative reviews, meta-analyses, and prospective studies. STUDY DESIGN Narrative review. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION First author name, publication year, study design, study country, subject demographics, and data on the frequency, type, and duration of analgesic treatments for musculoskeletal injuries, postsurgical care, chronic pain disorders, and concussion were extracted. RESULTS Pediatric athletes comprise a high-risk population seeking analgesic relief for injury-related pain. Participation in high school sports is associated with increased risk of opioid use. An average of 28% to 46% of high school athletes have used opioids in their lifetime. Participation in ≥1 high school sport puts adolescents at 30% greater odds of future opioid misuse. CONCLUSION The use of opioids in the pediatric athlete population is common and associated with both short- and long-term risks of misuse and addiction.
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Baxi S, Cabreros I, Meredith LS, Holliday SB, Martinez J, Piquado T. US Military Healthcare Professionals' Practice, Knowledge, and Misconceptions About Concussion. J Head Trauma Rehabil 2023; 38:391-400. [PMID: 36730959 DOI: 10.1097/htr.0000000000000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the US military healthcare professionals' knowledge and training preferences to improve diagnosis and management of concussion sustained in nondeployed settings. PARTICIPANTS US military healthcare professionals (physicians, physician assistants, and nurse practitioners) completed online surveys to investigate practices, knowledge, and attitudes about concussion diagnosis and treatment, as well as preferences on future training. There were 744 responses from active duty US military healthcare providers, all of whom had cared for at least one patient with mild traumatic brain injury (mTBI) in the previous 24 months. RESULTS The majority of physicians reported they were confident in their ability to evaluate a patient for a new mTBI (82.1%) and order appropriate imaging for mTBI (78.3%). Accuracy of identifying "red flag" symptoms ranged between 28.2% and 92.6%. A Likert scale from 1 ("not at all confident") to 4 ("very confident") was used to assess providers' confidence in their ability to perform services for patients with mTBI. With respect to barriers to optimal patient care, nurse practitioners consistently reported highest levels of barriers (90.8%). CONCLUSIONS Although US military providers regularly care for patients with concussion, many report experiencing barriers to providing care, low confidence in basic skills, and inadequate training to diagnose and manage these patients. Customized provider education based on branch of service and occupation, and broader dissemination and utilization of decision support tools or practice guidelines, and patient information tool kits could help improve concussion care.
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Does Increasing the Severity of Penalties Assessed in Association With the "Zero Tolerance for Head Contact" Policy Translate to a Reduction in Head Impact Rates in Youth Ice Hockey? Clin J Sport Med 2022; 32:e598-e604. [PMID: 35981453 DOI: 10.1097/jsm.0000000000001063] [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] [Received: 07/14/2021] [Accepted: 12/06/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The risk of concussion is high in Canadian youth ice hockey. Aiming to reduce this burden, in 2011, Hockey Canada implemented a national "zero tolerance for head contact (HC)" policy mandating the penalization of any player HC. In 2018 to 2020, Hockey Canada further amended this HC policy including stricter enforcement of severe HCs. This study aimed to compare HC rates, head impact location, and HC enforcement prepolicy, postpolicy, and after policy amendments in elite U15 Canadian youth ice hockey. DESIGN This is a prospective cohort study. SETTING A collection of events with the video camera located at the highest point near center ice in public ice hockey arenas in Calgary, Alberta. PARTICIPANTS A convenience sample of 10 AA U15 games prepolicy (2008-2009), 8 games postpolicy (2013-2014), and 10 games after policy amendments (2020-2021). INDEPENDENT VARIABLES An analysis of 3 cohort years regarding the HC-policy implementation and amendments. MAIN OUTCOME MEASURES Using Dartfish video-analysis software, all player contacts and HCs [direct (HC1), indirect (eg, boards, ice) (HC2)] were tagged using validated criteria. Univariate Poisson regression clustering by team-game offset by game length (minutes) was used to estimate incidence rates (IR) and incidence rate ratios (IRR) between cohorts. RESULTS With additional rule modifications, a 30% reduction in HC1s emerged (IRR 2013-2020 = 0.70, 95% CI, 0.51-0.95). Since the HC-policy implementation, HC1s decreased by 24% (IRR 2008-2020 = 0.76, 95% CI, 0.58-0.99). The proportion of HC1s penalized was similar across cohorts (P 2008-2009 = 14.4%; P 2013-2014 = 15.5%; P 2020-2021 = 16.2%). CONCLUSIONS The HC-policy amendments have led to decreased HC1 rates. However, referee enforcement can further boost the HC-policy effectiveness. These findings can help future referee training and potential rule modifications to increase player safety nationally.
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Baiden P, Morgan MA, Logan MW. Sports- and Physical Activity-Related Concussions, Binge Drinking and Marijuana Use among Adolescents: The Mediating Role of Depression and Suicidal Ideation. Subst Use Misuse 2022; 57:504-515. [PMID: 34967277 DOI: 10.1080/10826084.2021.2019779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although past studies have examined the adverse impact of sports- and physical activity-related concussions (SPACs) on health and mental health outcomes, there is a dearth of research investigating the association between SPACs and binge drinking and marijuana use. OBJECTIVE The objective of this study is to examine the cross-sectional association between SPACs and binge drinking and marijuana use among adolescents and whether symptoms of depression and suicidal ideation mediate this association. METHODS Data for this study came from the 2017 and 2019 National Youth Risk Behavior Survey. An analytic sample of 17,175 adolescents aged 14-18 years (50.2% male) was analyzed using binary logistic regression. RESULTS Of the 17,175 adolescents, 13.7% engaged in binge drinking and 19.3% used marijuana 30 days preceding the survey date. Approximately one in seven (14.1%) adolescents had SPACs during the past year. Upon controlling for the effects of other factors, adolescents who had SPACs had 1.74 times higher odds of engaging in binge drinking (AOR = 1.74, p<.001, 95% CI = 1.47-2.06) and 1.42 times higher odds of using marijuana (AOR = 1.42, p<.001, 95% CI = 1.24-1.62) than those who did not have SPACs. Symptoms of depression and suicidal ideation explained 12% of the association between SPACs and binge drinking, and 19% of the association between SPACs and marijuana use. CONCLUSIONS Understanding the association between SPACs and substance use and mental health could contribute to early identification of adolescents who may engage in substance use.
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Affiliation(s)
- Philip Baiden
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
| | - Mark A Morgan
- Department of Criminal Justice & Security Studies, University of Dayton, Dayton, Ohio, USA
| | - Matthew W Logan
- School of Criminal Justice & Criminology, Texas State University, San Marcos, Texas, USA
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Babl FE, Rausa VC, Borland ML, Kochar A, Lyttle MD, Phillips N, Gilhotra Y, Dalton S, Cheek JA, Furyk J, Neutze J, Bressan S, Davis GA, Anderson V, Williams A, Oakley E, Dalziel SR, Crowe LM, Hearps SJC. Characteristics of concussion based on patient age and sex: a multicenter prospective observational study. J Neurosurg Pediatr 2021; 28:647-656. [PMID: 34598158 DOI: 10.3171/2021.6.peds20953] [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] [Received: 01/12/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Children with concussion frequently present to emergency departments (EDs). There is limited understanding of the differences in signs, symptoms, and epidemiology of concussion based on patient age. Here, the authors set out to assess the association between age and acute concussion presentations. METHODS The authors conducted a multicenter prospective observational study of head injuries at 10 EDs in Australia and New Zealand. They identified children aged 5 to < 18 years, presenting with a Glasgow Coma Scale score of 13-15, presenting < 24 hours postinjury, with no abnormalities on CT if performed, and one or more signs or symptoms of concussion. They extracted demographic, injury-related, and signs and symptoms information and stratified it by age group (5-8, 9-12, 13 to < 18 years). RESULTS Of 8857 children aged 5 to < 18 years, 4709 patients met the defined concussion criteria (5-8 years, n = 1546; 9-12 years, n = 1617; 13 to < 18 years, n = 1546). The mean age of the cohort was 10.9 years, and approximately 70% of the patients were male. Sport-related concussion accounted for 43.7% of concussions overall, increasing from 19.1% to 48.9% to 63.0% in the 5-8, 9-12, and 13 to < 18 years age groups. The most common acute symptoms postinjury were headache (64.6%), disorientation (36.2%), amnesia (30.0%), and vomiting (27.2%). Vomiting decreased with increasing age and was observed in 41.7% of the 5-8 years group, 24.7% of the 9-12 years group, and 15.4% of the 13 to < 18 years group, whereas reported loss of consciousness (LOC) increased with increasing age, occurring in 9.6% in the 5-8 years group, 21.0% in the 9-12 years group, 36.7% in the 13 to < 18 years group, and 22.4% in the entire study cohort. Headache, amnesia, and disorientation followed the latter trajectory. Symptom profiles were broadly similar between males and females. CONCLUSIONS Concussions presenting to EDs were more sports-related as age increased. Signs and symptoms differed markedly across age groups, with vomiting decreasing and headache, LOC, amnesia, and disorientation increasing with increasing age.
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Affiliation(s)
- Franz E Babl
- 1Emergency Department, Royal Children's Hospital, Melbourne
- 3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Vanessa C Rausa
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
| | - Meredith L Borland
- 20Emergency Department, Perth Children's Hospital, Perth, Australia; and
- 21School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Australia
| | - Amit Kochar
- 7Emergency Department, Women's & Children's Hospital, Adelaide, Australia
| | - Mark D Lyttle
- 8Faculty of Health & Life Sciences, University of the West of England, Bristol, United Kingdom
| | - Natalie Phillips
- 9Emergency Department, Queensland Children's Hospital, Brisbane
- 10Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane
| | - Yuri Gilhotra
- 9Emergency Department, Queensland Children's Hospital, Brisbane
| | - Sarah Dalton
- 11Emergency Department, The Children's Hospital at Westmead, Sydney
| | - John A Cheek
- 1Emergency Department, Royal Children's Hospital, Melbourne
- 3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
- 12Emergency Department, Monash Medical Centre, Melbourne, Australia
| | - Jeremy Furyk
- 13Emergency Department, The Townsville Hospital, Townsville, Queensland
- 15School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Jocelyn Neutze
- 16Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Silvia Bressan
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
- 17Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gavin A Davis
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
- 4Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne
| | - Vicki Anderson
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
- 5School of Psychological Sciences, University of Melbourne, Melbourne
- 6Psychology Service, Royal Children's Hospital, Melbourne
| | - Amanda Williams
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
| | - Ed Oakley
- 1Emergency Department, Royal Children's Hospital, Melbourne
- 3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Stuart R Dalziel
- 18Emergency Department, Starship Children's Health, Auckland
- 19Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Louise M Crowe
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
- 3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
- 5School of Psychological Sciences, University of Melbourne, Melbourne
- 6Psychology Service, Royal Children's Hospital, Melbourne
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Radlicz C, Jackson K, Hautmann A, Shi J, Yang J. Influence of insurance type on rate and type of initial concussion-related medical visits among youth. BMC Public Health 2021; 21:1565. [PMID: 34407798 PMCID: PMC8375144 DOI: 10.1186/s12889-021-11586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background A growing number of studies report increased concussion-related health care utilization in recent years, but factors impacting care-seeking behaviors among youth following a concussion are not well described. This study aimed to evaluate the influence of insurance type on the rate and type of initial concussion visits and the time from injury to the initial visit in youth. Methods We extracted and analyzed initial concussion-related medical visits for youth ages 10 to 17 from electronic health records. Patients must have visited Nationwide Children’s Hospital’s (NCH) concussion clinic at least once between 7/1/2012 and 12/31/2017. We evaluated the trends and patterns of initial concussion visits across the study period using regression analyses. Results Of 4955 unique concussion visits included, 60.1% were males, 80.5% were white, and 69.5% were paid by private insurance. Patients’ average age was 13.9 years (SD = 3.7). The rate of the initial concussion visits per 10,000 NCH visits was consistently higher in privately insured than publicly insured youth throughout the study period (P < .0001). Privately insured youth had greater odds of initial concussion visits to sports medicine clinics (AOR = 1.45, 95% CI = 1.20, 1.76) but lower odds of initial concussion visits to the ED/urgent care (AOR = 0.74, 95% CI = 0.60, 0.90) than publicly insured youth. Days from injury to initial concussion visit significantly decreased among both insurance types throughout the study (P < .0001), with a greater decrease observed in publicly insured than privately insured youth (P = .011). Conclusions Results on the differences in the rate, type, and time of initial concussion-related visits may help inform more efficient care of concussion among youth with different types of insurance.
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Affiliation(s)
- Chris Radlicz
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA
| | - Kenneth Jackson
- Biostatistics Resource, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Amanda Hautmann
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA
| | - Junxin Shi
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA. .,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Kelly EA, Janky KL, Patterson JN. The Dizzy Child. Otolaryngol Clin North Am 2021; 54:973-987. [PMID: 34304898 DOI: 10.1016/j.otc.2021.06.002] [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: 11/17/2022]
Abstract
Dizziness occurs in children with an estimated prevalence of 0.45% to 15.0%. Vestibular disorders in the pediatric population can impact gross motor function development, visual acuity, and contribute to psychological distress. Appropriate case history and focused direct examination can be helpful when determining the etiology of dizziness. Vestibular testing can be completed in children and guide management of suspected vestibular dysfunction. Vestibular dysfunction is commonly seen in patients with sensorineural hearing loss. Migraine disorders are the most common cause of dizziness in childhood. Etiologies of dizziness in children differ from those commonly seen in adults.
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Affiliation(s)
- Elizabeth A Kelly
- Department of Otolaryngology, Boys Town National Research Hospital, 555 N 30th St., Omaha, NE 68131, USA.
| | - Kristen L Janky
- Department of Audiology, Boys Town National Research Hospital, 555 N 30th St., Omaha, NE 68131, USA
| | - Jessie N Patterson
- Department of Audiology, Boys Town National Research Hospital, 555 N 30th St., Omaha, NE 68131, USA
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Kneavel M, Ernst W, Brandsma L. Collegiate athletes' perceptions of the culture of concussion reporting. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:435-443. [PMID: 31662115 DOI: 10.1080/07448481.2019.1679816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
The current study was designed to understand the culture of concussion among college student-athletes. Participants: Eight men's lacrosse and seven women's soccer players. Methods: A focus group was conducted to understand thoughts, barriers, team culture, and what was needed to feel safe reporting symptoms. Thematic analysis was conducted to identify key themes. Results: Themes included concerns about being taken out, pushing through, wanting to play, severity influencing reporting, changes about concussion reporting, uncertainty about symptoms, concussion have changed the game, reporting a teammate, wanting someone else to make the call, desire to raise awareness, deception, wanting professors to have more understanding, circumstances influencing reporting, helmets specific for concussion, malingering, and the return to play protocol being too long. Conclusion: Factors ranging from intrinsic to more distal cultural and environmental factors appear to influence reporting concussions. Student-athletes identified factors unique to the college athlete environment.
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Affiliation(s)
- Meredith Kneavel
- Department of Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - William Ernst
- Department of Professional Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - Lynn Brandsma
- Department of Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
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Williamson RA, Kolstad AT, Krolikowski M, Nadeau L, Goulet C, Hagel BE, Emery CA. Incidence of Head Contacts, Penalties, and Player Contact Behaviors in Youth Ice Hockey: Evaluating the “Zero Tolerance for Head Contact” Policy Change. Orthop J Sports Med 2021; 9:2325967121992375. [PMID: 33748310 PMCID: PMC7940749 DOI: 10.1177/2325967121992375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background: To reduce the risk of concussion in youth ice hockey, Hockey Canada implemented a national “zero tolerance for head contact” (HC) policy in 2011. A previous cohort study revealed higher concussion rates after this implementation in players aged 11 to 14 years. However, it is unknown whether the elevated risk was due to higher HC rates or factors such as increased concussion awareness and reporting. Purpose: To compare the rates of primary and secondary HCs and HC policy enforcement in elite U15 ice hockey leagues (players <15 years) before (2008-2009) and after (2013-2014) the zero-tolerance policy change. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 32 elite U15 games before (n2008-2009 = 16; 510 players) and after (n2013-2014 = 16; 486 players) HC policy implementation were video recorded. Videos were analyzed with validated criteria for identifying HC types (primary/direct contact by players [HC1], secondary/indirect contact via boards, glass, or ice surface [HC2]) and other player-to-player contact behavior. Referee-assessed penalties were cross-referenced with the official Hockey Canada casebook, and penalty types were displayed using proportions. Univariate Poisson regression (adjusted for cluster by team game, offset by game length [minutes]) was used to estimate HC incidence rates (IRs) and incidence rate ratios (IRRs) between cohorts. Results: A total of 506 HCs were analyzed, 261 before HC policy implementation (IR, 16.6/100 team minutes) and 245 after implementation (IR, 15.5/100 team minutes). The HC1 rate (IRR, 1.05; 95% CI, 0.86-1.28) and HC2 rate (IRR, 0.74; 95% CI, 0.50-1.11) did not significantly differ before versus after implementation. Only 12.0% and 13.6% of HC1s were penalized pre- and postimplementation, respectively. Before implementation, HC1s were commonly penalized as roughing or elbowing penalties (59%), while after implementation, HC1s were penalized with the HC penalty (76%), and only 8% as roughing or elbowing. Conclusion: Despite implementation of the “zero tolerance for HC” policy, there was no difference in the rate of HC1s and HC2s or the proportion of HC1 penalized from before to after implementation. This research is instrumental in informing Hockey Canada’s future referee training and rule enforcement modifications.
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Affiliation(s)
- Rylen A. Williamson
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ash T. Kolstad
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Maciej Krolikowski
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Luc Nadeau
- Department of Physical Education, Faculty of Education, Université Laval, Québec City, Québec, Canada
| | - Claude Goulet
- Department of Physical Education, Faculty of Education, Université Laval, Québec City, Québec, Canada
| | - Brent E. Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Canada
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Chandran A, Nedimyer AK, Kerr ZY, O'Neal C, Mensch J, Yeargin SW. Concussion Knowledge, Attitudes, and Self-Reporting Intentions in Youth Athletes. J Athl Train 2020; 55:1027-1034. [PMID: 33032324 DOI: 10.4085/1062-6050-232-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Although it has been suggested that developmental and sociological factors play a role in concussion reporting, the empirical evidence related to this is limited. OBJECTIVE To examine the influences of sex, school level, school location, concussion-reporting history, and socioeconomic status on concussion-related knowledge, attitudes, and reporting intentions among middle school and high school athletes. DESIGN Cross-sectional study. SETTING Master students and High School athletes attending pre-participation examinations (PPEs) were asked to complete paper-based surveys. PATIENTS OR OTHER PARTICIPANTS Overall, 541 athletes representing 18 sports returned fully completed surveys. MAIN OUTCOME MEASURE(S) Outcomes were concussion-related knowledge, perceived seriousness, positive feelings about reporting, and self-reporting intentions. We examined group differences in these outcomes across levels of the explanatory variables of sex, school level (middle school versus high school), school location (urban versus rural), concussion self-reporting history (yes or no), and socioeconomic status (free or reduced-price lunch versus no free or reduced-price lunch) using Wilcoxon rank sum tests. Then we used multivariable ordinal logistic regression models to identify predictors of higher score levels for each outcome. Odds ratio (OR) estimates with 95% confidence intervals (CIs) excluding 1.00 were deemed significant. RESULTS Odds of higher levels of knowledge were higher in urban versus rural school student-athletes (ORAdjusted = 1.81; 95% CI = 1.03, 3.17), and lower in student-athletes on free or reduced-price lunch versus those not on free or reduced-price lunch (ORAdjusted = 0.52; 95% CI = 0.36, 0.77). Similarly, odds of higher levels of seriousness were lower in male versus female student-athletes (ORAdjusted = 0.48; 95% CI = 0.32, 0.72). Further, odds of higher levels of self-reporting intentions were lower among male versus female student-athletes (ORAdjusted = 0.53; 95% CI = 0.37, 0.75). CONCLUSIONS Developmental and sociological factors were differentially associated with concussion-related knowledge, attitudes, and self-reporting intentions. These results can inform medical providers, parents, and coaches with regard to context-specific clinical assessments of concussion symptoms.
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Affiliation(s)
- Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.,Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina at Chapel Hill
| | - Aliza K Nedimyer
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill.,Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina at Chapel Hill
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.,Matthew Gfeller Sport-Related TBI Research Center, University of North Carolina at Chapel Hill
| | - Cathleen O'Neal
- Department of Exercise Science, University of South Carolina, Columbia
| | - James Mensch
- Department of Exercise Science, University of South Carolina, Columbia
| | - Susan W Yeargin
- Department of Exercise Science, University of South Carolina, Columbia
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MacMullin P, Hodgson N, Damar U, Lee HHC, Hameed MQ, Dhamne SC, Hyde D, Conley GM, Morriss N, Qiu J, Mannix R, Hensch TK, Rotenberg A. Increase in Seizure Susceptibility After Repetitive Concussion Results from Oxidative Stress, Parvalbumin-Positive Interneuron Dysfunction and Biphasic Increases in Glutamate/GABA Ratio. Cereb Cortex 2020; 30:6108-6120. [PMID: 32676666 DOI: 10.1093/cercor/bhaa157] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/29/2020] [Accepted: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic symptoms indicating excess cortical excitability follow mild traumatic brain injury, particularly repetitive mild traumatic brain injury (rmTBI). Yet mechanisms underlying post-traumatic excitation/inhibition (E/I) ratio abnormalities may differ between the early and late post-traumatic phases. We therefore measured seizure threshold and cortical gamma-aminobutyric acid (GABA) and glutamate (Glu) concentrations, 1 and 6 weeks after rmTBI in mice. We also analyzed the structure of parvalbumin-positive interneurons (PVIs), their perineuronal nets (PNNs), and their electroencephalography (EEG) signature (gamma frequency band power). For mechanistic insight, we measured cortical oxidative stress, reflected in the reduced/oxidized glutathione (GSH/GSSG) ratio. We found that seizure susceptibility increased both early and late after rmTBI. However, whereas increased Glu dominated the E/I 1 week after rmTBI, Glu concentration normalized and the E/I was instead characterized by depressed GABA, reduced per-PVI parvalbumin expression, and reduced gamma EEG power at the 6-week post-rmTBI time point. Oxidative stress was increased early after rmTBI, where transient PNN degradation was noted, and progressed throughout the monitoring period. We conclude that GSH depletion, perhaps triggered by early Glu-mediated excitotoxicity, leads to late post-rmTBI loss of PVI-dependent cortical inhibitory tone. We thus propose dampening of Glu signaling, maintenance of redox state, and preservation of PVI inhibitory capacity as therapeutic targets for post-rmTBI treatment.
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Affiliation(s)
| | | | - Ugur Damar
- F.M. Kirby Neurobiology Center, Department of Neurology
| | | | - Mustafa Q Hameed
- F.M. Kirby Neurobiology Center, Department of Neurology.,Department of Neurosurgery
| | | | - Damon Hyde
- F.M. Kirby Neurobiology Center, Department of Neurology
| | - Grace M Conley
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Nicholas Morriss
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jianhua Qiu
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Rebekah Mannix
- Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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12
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Peltonen K, Launes J, Koskinen S, Vartiainen M, Pajunen S, Pertab J, Laitala T, Hokkanen L. On‐field signs of concussion predict deficits in cognitive functioning: Loss of consciousness, amnesia, and vacant look. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Kati Peltonen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Jyrki Launes
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Sanna Koskinen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Matti Vartiainen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Sara Pajunen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
| | - Jon Pertab
- Neurosciences Institute Intermountain Medical Center Murray UT USA
| | - Tiina Laitala
- Institute of Biomedicine University of Turku Turku Finland
| | - Laura Hokkanen
- Department of Psychology and Logopedics University of Helsinki Helsinki Finland
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13
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Chen W, Post A, Karton C, Gilchrist MD, Robidoux M, Hoshizaki TB. A comparison of frequency and magnitude of head impacts between Pee Wee And Bantam youth ice hockey. Sports Biomech 2020; 22:728-751. [PMID: 32538288 DOI: 10.1080/14763141.2020.1754450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this research was to compare the frequency and magnitude of head impact events between Pee Wee and Bantam ice hockey players. Videos of Pee Wee and Bantam boys' ice hockey were analysed to determine the frequency and type of head impact events. The head impact events were then reconstructed in the laboratory using physical and finite element models to determine the magnitude of strain in the brain tissues. The results showed that Pee Wee boys experienced more head impacts from elbows and boards, while Bantam players had more head impacts to the glass. Pee Wee and Bantam players experienced similar frequency and magnitudes of very low, low, and medium and above (med+) levels of strain to the brain. This research suggests to ice hockey leagues and coaches that to reduce the incidence of these levels of brain trauma, consideration must be given to either reducing the level of contact along the boards or the removal of body checking. In addition, companies who innovate in ice hockey should develop protective devices and equipment strategies that aim to reduce the risk of head injury from shoulder and glass impacts for Bantam players.
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Affiliation(s)
- Wesley Chen
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Post
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
| | - Clara Karton
- Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael D. Gilchrist
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
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14
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Ernst W, Kneavel ME. Development of a Peer Education Program to Improve Concussion Knowledge and Reporting in Collegiate Athletes. J Athl Train 2020; 55:448-455. [PMID: 32250640 DOI: 10.4085/1062-6050-212-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT A novel peer concussion-education program (PCEP) was developed to enhance concussion knowledge and reporting among collegiate student-athletes. OBJECTIVE To describe the PCEP and its development and implementation. DESIGN Program development consisting of a literature review, focus group, and pilot implementation. SETTING Athletics department at a college participating at the National Collegiate Athletic Association Division II-sanctioned competition level. PATIENTS OR OTHER PARTICIPANTS Fifteen student-athletes from the women's soccer and men's lacrosse teams participated in the focus group. Four peer concussion educators (PCEs) were debriefed after the pilot implementation of the PCEP with the women's soccer and men's lacrosse teams. DATA COLLECTION AND ANALYSIS Focus-group data were analyzed qualitatively. The PCEs were debriefed, and responses were organized into recommendation types. RESULTS The literature review contributed information that supported the development of the PCEP's conceptual model. Focus-group results provided information used to train the PCEs and refine the PCEP's education modules. The pilot implementation and PCE debriefing supplied information used to further revise the education modules, PCE training, and PCEP implementation procedure. CONCLUSIONS The PCEP was developed based on the Theory of Reasoned Action and Planned Behavior and uses a peer-mediated, cognitive-behavioral, and interdisciplinary model to enhance concussion knowledge of and reporting by collegiate student-athletes. After a focus-group discussion and pilot implementation, we revised the PCEP and its education modules and developed an online manual to facilitate broad dissemination.
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15
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The Epidemiology of Sport-Related Concussion: What the Rehabilitation Clinician Needs to Know. J Orthop Sports Phys Ther 2019; 49:768-778. [PMID: 31672116 DOI: 10.2519/jospt.2019.9105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sport-related concussion is common in full-contact and collision sports. Epidemiology studies use different types of surveillance systems and concussion definitions. Concussion incidence rates vary across age, sex, sport, and level of competition. Incidence rates are increasing, likely due to higher rates of reporting following improved knowledge and increased regulations. In this review, we summarize 7 key concepts related to concussion epidemiology: concussion definition, changes in concussion knowledge, reliability and accuracy of injury surveillance systems, conservative management and return to play, reliability of self-report, incidence of concussion across levels of play, and understanding the behaviors of players, coaches, and medical personnel from a multidisciplinary management perspective. J Orthop Sports Phys Ther 2019;49(11):768-778. doi:10.2519/jospt.2019.9105.
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16
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Benign Paroxysmal Positional Vertigo (BPPV) in Children and Adolescents: Clinical Features and Response to Therapy in 110 Pediatric Patients. Otol Neurotol 2019; 39:344-350. [PMID: 29287036 DOI: 10.1097/mao.0000000000001673] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to characterize the clinical features and outcomes of benign paroxysmal positional vertigo (BPPV) in the pediatric population. STUDY DESIGN Retrospective case review. SETTING Tertiary care center. PATIENTS One hundred ten patients, aged 5 to 19 years old, diagnosed with BPPV. MAIN OUTCOME MEASURES Patient demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. RESULTS BPPV was diagnosed in 19.8% of patients seen for dizziness during the study period. Patient age ranged 5 to 19 years old (mean =13.4 ± 3.4 yr). Female:male ratio was 3:2. The most prevalent comorbidities were concussion (n = 42, 38.2%) and migraine disorders (n = 33, 30.0%). Average time to diagnosis from symptom onset was 178.2 ± 190.8 days. The posterior canal was most frequently affected (n = 80, 72.7%), followed by the lateral canal (n = 37, 33.6%) and superior canal (n = 21, 19.1%), and 36.4% (n = 40) of patients had multiple canals affected. Treatment requiring more than or equal to five maneuvers to achieve resolution was observed in 11.8% of cases (n = 13). Recurrence was observed in 18.2% of cases. A logistic regression analysis demonstrated that patients with vestibular migraine or benign paroxysmal vertigo of childhood had five times higher odds of recurrence of BPPV, p = 0.003, 95% [1.735, 15.342], than those who did not have either. CONCLUSIONS BPPV is a relatively common cause of dizziness in the pediatric population. Children and adolescents with BPPV can be successfully treated with repositioning maneuvers but may be at risk for treatment resistance and recurrence. Increased awareness of BPPV in pediatric patients may reduce delays in identification and treatment.
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17
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Abstract
Concussions have gained attention in medical literature, legal literature, and lay media over the past several years as a public health affecting children, particularly those who do not improve in the first few days after an injury. We discuss strategies for acute management immediately after a concussion and an introduction to medical and non-medical options for treatment of the complex symptoms that persist in some patients with concussions. We examine the role of rest and exercise during recovery. We briefly discuss the role of the multidisciplinary approach to concussion in a setting that engages multiple specialists. Finally, we address policy changes related to sport-concussions and their efficacy in improving long term outcomes.
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Affiliation(s)
- Karameh Kuemmerle
- Neurology Foundation, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115; Harvard Medical School, Boston, MA.
| | - William P Meehan
- Harvard Medical School, Boston, MA; Division of Sports Medicine, Boston Children's Hospital, Boston, MA.
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18
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Halstead ME, Walter KD, Moffatt K, LaBella CR, Brooks MA, Canty G, Diamond AB, Hennrikus W, Logan K, Nemeth BA, Pengel KB, Peterson AR, Stricker PR. Sport-Related Concussion in Children and Adolescents. Pediatrics 2018; 142:peds.2018-3074. [PMID: 30420472 DOI: 10.1542/peds.2018-3074] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sport-related concussion is an important topic in nearly all sports and at all levels of sport for children and adolescents. Concussion knowledge and approaches to management have progressed since the American Academy of Pediatrics published its first clinical report on the subject in 2010. Concussion's definition, signs, and symptoms must be understood to diagnose it and rule out more severe intracranial injury. Pediatric health care providers should have a good understanding of diagnostic evaluation and initial management strategies. Effective management can aid recovery and potentially reduce the risk of long-term symptoms and complications. Because concussion symptoms often interfere with school, social life, family relationships, and athletics, a concussion may affect the emotional well-being of the injured athlete. Because every concussion has its own unique spectrum and severity of symptoms, individualized management is appropriate. The reduction, not necessarily elimination, of physical and cognitive activity is the mainstay of treatment. A full return to activity and/or sport is accomplished by using a stepwise program while evaluating for a return of symptoms. An understanding of prolonged symptoms and complications will help the pediatric health care provider know when to refer to a specialist. Additional research is needed in nearly all aspects of concussion in the young athlete. This report provides education on the current state of sport-related concussion knowledge, diagnosis, and management in children and adolescents.
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Affiliation(s)
| | - Kevin D. Walter
- Department of Orthopaedic Surgery, Pediatric Sports Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
| | - Kody Moffatt
- Creighton University School of Medicine, Omaha, Nebraska
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19
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Adams JW, Alvarez VE, Mez J, Huber BR, Tripodis Y, Xia W, Meng G, Kubilus CA, Cormier K, Kiernan PT, Daneshvar DH, Chua AS, Svirsky S, Nicks R, Abdolmohammadi B, Evers L, Solomon TM, Cherry JD, Aytan N, Mahar I, Devine S, Auerbach S, Alosco ML, Nowinski CJ, Kowall NW, Goldstein LE, Dwyer B, Katz DI, Cantu RC, Stern RA, Au R, McKee AC, Stein TD. Lewy Body Pathology and Chronic Traumatic Encephalopathy Associated With Contact Sports. J Neuropathol Exp Neurol 2018; 77:757-768. [PMID: 30053297 PMCID: PMC6097837 DOI: 10.1093/jnen/nly065] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Traumatic brain injury has been associated with increased risk of Parkinson disease and parkinsonism, and parkinsonism and Lewy body disease (LBD) can occur with chronic traumatic encephalopathy (CTE). To test whether contact sports and CTE are associated with LBD, we compared deceased contact sports athletes (n = 269) to cohorts from the community (n = 164) and the Boston University Alzheimer disease (AD) Center (n = 261). Participants with CTE and LBD were more likely to have β-amyloid deposition, dementia, and parkinsonism than CTE alone (p < 0.05). Traditional and hierarchical clustering showed a similar pattern of LBD distribution in CTE compared to LBD alone that was most frequently neocortical, limbic, or brainstem. In the community-based cohort, years of contact sports play were associated with neocortical LBD (OR = 1.30 per year, p = 0.012), and in a pooled analysis a threshold of >8 years of play best predicted neocortical LBD (ROC analysis, OR = 6.24, 95% CI = 1.5-25, p = 0.011), adjusting for age, sex, and APOE ɛ4 allele status. Clinically, dementia was significantly associated with neocortical LBD, CTE stage, and AD; parkinsonism was associated with LBD pathology but not CTE stage. Contact sports participation may increase risk of developing neocortical LBD, and increased LBD frequency may partially explain extrapyramidal motor symptoms sometimes observed in CTE.
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Affiliation(s)
- Jason W Adams
- Boston University Alzheimer’s Disease and CTE Center
| | - Victor E Alvarez
- Department of Neurology
- Framingham Heart Study, Boston University School of Medicine, Boston, MA
- VA Boston Healthcare System, Boston, MA
| | - Jesse Mez
- Department of Neurology
- Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | | | - Yorghos Tripodis
- Boston University Alzheimer’s Disease and CTE Center
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Weiming Xia
- Boston University Alzheimer’s Disease and CTE Center
- Department of Veterans Affairs Medical Center, Bedford, MA
| | - Gaoyuan Meng
- Boston University Alzheimer’s Disease and CTE Center
- VA Boston Healthcare System, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
| | | | - Kerry Cormier
- Boston University Alzheimer’s Disease and CTE Center
| | | | | | - Alicia S Chua
- Boston University Alzheimer’s Disease and CTE Center
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Sarah Svirsky
- Boston University Alzheimer’s Disease and CTE Center
| | - Raymond Nicks
- Boston University Alzheimer’s Disease and CTE Center
| | | | - Laney Evers
- Boston University Alzheimer’s Disease and CTE Center
| | | | | | | | | | - Sherral Devine
- Department of Neurology
- Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | - Sanford Auerbach
- Department of Neurology
- Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | - Michael L Alosco
- Department of Neurology
- Framingham Heart Study, Boston University School of Medicine, Boston, MA
| | | | - Neil W Kowall
- Department of Neurology
- VA Boston Healthcare System, Boston, MA
| | - Lee E Goldstein
- Boston University Alzheimer’s Disease and CTE Center
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Brigid Dwyer
- Department of Neurology
- Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, MA
| | - Douglas I Katz
- Department of Neurology
- Brain Injury Program, Braintree Rehabilitation Hospital, Braintree, MA
| | - Robert C Cantu
- Boston University Alzheimer’s Disease and CTE Center
- Concussion Legacy Foundation
- Department of Anatomy and Neurobiology
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA
- Department of Neurosurgery, Emerson Hospital, Concord, MA
| | - Robert A Stern
- Department of Neurology
- Department of Anatomy and Neurobiology
- Department of Neurosurgery, Boston University School of Medicine, Boston, MA
| | - Rhoda Au
- Department of Neurology
- Framingham Heart Study, Boston University School of Medicine, Boston, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Ann C McKee
- Department of Neurology
- Framingham Heart Study, Boston University School of Medicine, Boston, MA
- VA Boston Healthcare System, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
| | - Thor D Stein
- Boston University Alzheimer’s Disease and CTE Center
- Framingham Heart Study, Boston University School of Medicine, Boston, MA
- VA Boston Healthcare System, Boston, MA
- Department of Veterans Affairs Medical Center, Bedford, MA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA
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20
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Peltonen K, Vartiainen M, Laitala-Leinonen T, Koskinen S, Luoto T, Pertab J, Hokkanen L. Adolescent athletes with learning disability display atypical maturational trajectories on concussion baseline testing: Implications based on a Finnish sample. Child Neuropsychol 2018; 25:336-351. [DOI: 10.1080/09297049.2018.1474865] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Kati Peltonen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Matti Vartiainen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - Sanna Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Teemu Luoto
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Jon Pertab
- Neurosciences Institute, Intermountain Healthcare, Murray, UT, USA
| | - Laura Hokkanen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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21
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Asken BM, Bauer RM, Guskiewicz KM, McCrea MA, Schmidt JD, Giza CC, Snyder AR, Houck ZM, Kontos AP, McAllister TW, Broglio SP, Clugston JR, Anderson S, Bazarian J, Brooks A, Buckley T, Chrisman S, Collins M, DiFiori J, Duma S, Dykhuizen B, Eckner JT, Feigenbaum L, Hoy A, Kelly L, Langford TD, Lintner L, McGinty G, Mihalik J, Miles C, Ortega J, Port N, Putukian M, Rowson S, Svoboda S. Immediate Removal From Activity After Sport-Related Concussion Is Associated With Shorter Clinical Recovery and Less Severe Symptoms in Collegiate Student-Athletes. Am J Sports Med 2018; 46:1465-1474. [PMID: 29558195 PMCID: PMC6988451 DOI: 10.1177/0363546518757984] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Timely removal from activity after concussion symptoms remains problematic despite heightened awareness. Previous studies indicated potential adverse effects of continuing to participate in physical activity immediately after sustaining a concussion. Hypothesis/Purpose: The purpose was to determine the effect of timing of removal from play after concussion on clinical outcomes. It was hypothesized that immediate removal from activity after sport-related concussion (SRC) would be associated with less time missed from sport, a shorter symptomatic period, and better outcomes on acute clinical measures. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data were reported from the National Collegiate Athletic Association and Department of Defense Grand Alliance: Concussion Awareness, Research, and Education (CARE) Consortium. Participants with 506 diagnosed SRCs from 18 sports and 25 institutions and military service academies were analyzed and classified as either immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA). Outcomes of interest included time missed from sport attributed to their SRC, symptom duration, and clinical assessment scores. RESULTS There were 322 participants (63.6%) characterized as D-RFA. I-RFA status was associated with significantly less time missed from sport ( R2 change = .022-.024, P < .001 to P = .001) and shorter symptom duration ( R2 change = .044-.046, P < .001 [all imputations]) while controlling for other SRC recovery modifiers. These athletes missed approximately 3 fewer days from sport participation. I-RFA athletes had significantly less severe acute SRC symptoms and were at lower risk of recovery taking ≥14 days (relative risk = .614, P < .001, small-medium effect size) and ≥21 days (relative risk = .534, P = .010, small effect size). CONCLUSION I-RFA is a protective factor associated with less severe acute symptoms and shorter recovery after SRC. Conveying this message to athletes, coaches, and others involved in the care of athletes may promote timely injury reporting.
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Affiliation(s)
- Breton M. Asken
- Address correspondence to Breton M. Asken, MS, ATC, Department of Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610, USA ()
| | | | | | | | | | | | | | | | | | | | | | | | | | - Scott Anderson
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Jeff Bazarian
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Alison Brooks
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Thomas Buckley
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Sara Chrisman
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Michael Collins
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - John DiFiori
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Stefan Duma
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Brian Dykhuizen
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - James T Eckner
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Luis Feigenbaum
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - April Hoy
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Louise Kelly
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - T Dianne Langford
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Laura Lintner
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Gerald McGinty
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Jason Mihalik
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Christopher Miles
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Justus Ortega
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Nicholas Port
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Margot Putukian
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Steve Rowson
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
| | - Steven Svoboda
- Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense (Defense Health Program funds).,Investigation performed at the University of Florida, Gainesville, Florida, USA
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22
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Brodsky JR, Shoshany TN, Lipson S, Zhou G. Peripheral Vestibular Disorders in Children and Adolescents with Concussion. Otolaryngol Head Neck Surg 2018; 159:365-370. [PMID: 29685082 DOI: 10.1177/0194599818770618] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To review peripheral vestibular disorders in pediatric patients with dizziness following concussion. Study Design Case series with chart review. Setting Pediatric vestibular clinic and pediatric multidisciplinary concussion clinic at a tertiary level pediatric hospital. Subjects and Methods We retrospectively reviewed 109 patients seen for dizziness following a concussion between September 2012 and July 2015. Patients were ≤20 years of age at the time of concussion. Incidences of specific peripheral vestibular disorders were assessed along with timing of diagnosis relative to the date of injury, diagnostic test findings, and treatment interventions associated with those diagnoses. Results Twenty-eight patients (25.7%) were diagnosed with peripheral vestibular disorders. None of these disorders were diagnosed prior to evaluation in our pediatric vestibular clinic or our multidisciplinary concussion clinic, which occurred a mean of 133 days (95% confidence interval, 89.2-177.3) after injury. Benign paroxysmal positioning vertigo was diagnosed in 19 patients, all of whom underwent successful canalith repositioning maneuvers. Other diagnoses included temporal bone fracture (n = 3), labyrinthine concussion (n = 2), perilymphatic fistula (n = 2), and superior semicircular canal dehiscence (n = 2). Both patients with perilymphatic fistula and 1 patient with superior semicircular canal dehiscence underwent successful surgical management, while 1 patient with superior semicircular canal dehiscence was managed nonsurgically. Conclusion Peripheral vestibular disorders may occur in pediatric patients with dizziness following concussion, but these disorders may not be recognized until symptoms have persisted for several weeks. An algorithm is proposed to guide the diagnosis and management of peripheral vestibular disorders in pediatric patients with concussion.
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Affiliation(s)
- Jacob R Brodsky
- 1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Harvard Medical School, Boston, Massachusetts, USA
| | - Talia N Shoshany
- 1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Harvard Medical School, Boston, Massachusetts, USA
| | - Sophie Lipson
- 1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Harvard Medical School, Boston, Massachusetts, USA
| | - Guangwei Zhou
- 1 Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, USA.,2 Harvard Medical School, Boston, Massachusetts, USA
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23
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Thoma RJ, Cook JA, McGrew C, King JH, Pulsipher DT, Yeo RA, Monnig MA, Mayer A, Pommy J, Campbell RA. Convergent and discriminant validity of the ImPACT with traditional neuropsychological measures. COGENT PSYCHOLOGY 2018; 5. [PMID: 32999895 PMCID: PMC7523917 DOI: 10.1080/23311908.2018.1430199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Neuropsychological assessment of cognitive sequelae secondary to sports concussion is limited by lengthy administration
times and lack of readily available neuropsychologists. Brief computerized test batteries are now under development to address
this, but the validity of these measures is not yet established. The validity of one such computerized test battery, the Immediate
Post-Concussion Assessment and Cognitive Testing (ImPACT), was administered to 93 healthy NCAA Division I athletes, aged
18–24, along with a battery of traditional, well-described neuropsychological tests. Convergent and discriminant validity
between the ImPACT and traditional measures was investigated using multitrait-multimethod matrix (MTMM) analysis. As an example,
the ImPACT Visual Motor Speed composite demonstrated reasonably good convergent validity secondary to moderate correlations with
traditional measures of processing speed, but it demonstrated relatively poor discriminant validity as it significantly correlated
with the Reaction Time composite score. MTMM results were variable across ImPACT composites and data for each are presented. The
ImPACT composite’s validity was further investigated using exploratory factor analysis (EFA). Six principal components were
termed processing speed, visual memory, verbal memory, attention & working memory, and verbal fluency, based upon traditional
test loadings, and a sixth loaded only on the ImPACT Reaction Time composite. EFA indicated content validity of moderate strength
for the Visual Motor Speed and Visual Memory composites, but revealed problems with specificity for the other composites. Based
upon the present findings, validity problems render the interpretability of the ImPACT composites somewhat questionable, and more
research is necessary prior to using the ImPACT for assessment of clinical populations.
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Affiliation(s)
- Robert J Thoma
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA.,Department of Psychology, University of New Mexico, Albuquerque, NM, USA.,Mind Research Network, Albuquerque, NM, USA
| | - Julia A Cook
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA.,Division of Plastic & Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher McGrew
- Department of Family and Community Medicine and Department of Orthopedics and Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - John H King
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Dalin T Pulsipher
- Akron Children's Hospital, Neuro Developmental Sciences Center, Akron, OH, USA
| | - Ronald A Yeo
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA.,Mind Research Network, Albuquerque, NM, USA
| | - Mollie A Monnig
- Center for Alcohol & Addiction Studies, Brown University, Providence, RI, USA
| | | | - Jessica Pommy
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Richard A Campbell
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA
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24
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Bramley H, Foley KC, Williams R, Lewis MM, Kong L, Silvis M. Impact of Body Mass Index on Postconcussion Symptoms in Teenagers Aged 13 to 18 Years. Perm J 2018; 22:17-211. [PMID: 30005723 PMCID: PMC6045505 DOI: 10.7812/tpp/17-211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Adolescent obesity and sports-related concussion are rising in prevalence, yet there is minimal research exploring the relationship between these two conditions. OBJECTIVE To assess the impact of body mass index (BMI) percentile on duration of recovery and reported symptoms after sports-related concussion in adolescents. DESIGN Retrospective chart review at a regional concussion program located at an academic medical center. Medical records of all patients aged 13 to 18 years treated from March 2006 through January 2012 were reviewed. Two hundred fifty-two patients met the inclusion criteria of sports-related concussion and having BMI data. MAIN OUTCOME MEASURES Outcome variables included reported emotional symptoms, sleep-related symptoms, physical symptoms (headache), and time to recovery after a concussion. Explanatory variables in this analysis were BMI percentile and sex. RESULTS More male patients were obese and overweight than were females (42% vs 27%, p = 0.02). There was no statistically significant difference in recovery time between obese and overweight patients and others. Obese and overweight patients were more likely than healthy-weight patients to report symptoms of irritability (p = 0.05) and impulsivity (p = 0.01), and less likely to report headache (p = 0.03). CONCLUSION After concussion, irritability and impulsivity may be more likely than headaches in overweight and obese patients. There was no difference in recovery time between obese and healthy-weight teens. These findings may have importance in the evaluation, treatment, and anticipatory guidance of patients with concussions.
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Affiliation(s)
- Harry Bramley
- Associate Professor of Pediatrics at Penn State Hershey Children's Hospital in PA.
| | - Kathryn C Foley
- Resident at Alfred I DuPont Hospital for Children in Wilmington, DE.
| | - Ronald Williams
- Professor of Pediatrics and Medicine at Penn State Hershey Children's Hospital in PA.
| | - Mechelle M Lewis
- Associate Professor of Neurology at Penn State Health Milton S Hershey Medical Center in PA.
| | - Lan Kong
- Professor of Biostatistics in Public Health Services at Penn State Health Milton S Hershey Medical Center in PA.
| | - Matthew Silvis
- Professor of Family and Community Medicine and Orthopedics and Rehabilitation Medicine at Penn State Health Milton S Hershey Medical Center in PA.
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25
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O'Brien MJ, Howell DR, Pepin MJ, Meehan WP. Sport-Related Concussions: Symptom Recurrence After Return to Exercise. Orthop J Sports Med 2017; 5:2325967117732516. [PMID: 29085846 PMCID: PMC5648095 DOI: 10.1177/2325967117732516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Current guidelines dictate a gradual exercise progression after a concussion; however, it is unclear what proportion of athletes experience a recurrence of symptoms once they are symptom free at rest. Estimating the proportion of athletes and predictors of symptom recurrence would help shape return-to-play protocols. Purpose: To determine the proportion and associated risk factors of athletes who have a recurrence of concussion symptoms with exercise after being symptom free at rest. Study Design: Case-control study; Level of evidence, 3. Methods: Between October 1, 2009 and July 31, 2011, we studied patients from a sport concussion clinic located within a tertiary care regional children’s hospital. Patients were queried at every visit using a standardized questionnaire. Our main outcome variable was recurrence of symptoms with exercise after being symptom free at rest at some point in their recovery. Cofactors included age, sex, loss of consciousness with injury, prior concussion (diagnosed and undiagnosed), Post-Concussion Symptom Scale (PCSS) score, time until clinical presentation, and duration of symptoms. Results: Of the 217 patients included, 25 (12%) experienced a return of symptoms. Losing consciousness at the time of injury and a longer duration between injury and clinical presentation were associated with a decreased risk of symptoms recurring with exercise. Conversely, athletes who had sustained previously undiagnosed concussions and had suffered a longer duration of symptoms at rest were at an increased risk of symptom recurrence with exercise. Conclusion: Relatively few athletes who are symptom free at rest after a concussion will have a recurrence of symptoms when they resume exercise. The risk of symptoms recurring with exercise may be greater among those athletes who sustained previously undiagnosed concussions and had a longer period of symptoms at rest. The early identification of athletes who may be at risk of symptom recurrence will help mold treatment guidelines and exercise progression protocols.
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Affiliation(s)
- Michael J O'Brien
- Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael J Pepin
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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26
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Arbogast KB, Curry AE, Metzger KB, Kessler RS, Bell JM, Haarbauer-Krupa J, Zonfrillo MR, Breiding MJ, Master CL. Improving Primary Care Provider Practices in Youth Concussion Management. Clin Pediatr (Phila) 2017; 56:854-865. [PMID: 28521519 PMCID: PMC6082149 DOI: 10.1177/0009922817709555] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary care providers are increasingly providing youth concussion care but report insufficient time and training, limiting adoption of best practices. We implemented a primary care-based intervention including an electronic health record-based clinical decision support tool ("SmartSet") and in-person training. We evaluated consequent improvement in 2 key concussion management practices: (1) performance of a vestibular oculomotor examination and (2) discussion of return-to-learn/return-to-play (RTL/RTP) guidelines. Data were included from 7284 primary care patients aged 0 to 17 years with initial concussion visits between July 2010 and June 2014. We compared proportions of visits pre- and post-intervention in which the examination was performed or RTL/RTP guidelines provided. Examinations and RTL/RTP were documented for 1.8% and 19.0% of visits pre-intervention, respectively, compared with 71.1% and 72.9% post-intervention. A total of 95% of post-intervention examinations were documented within the SmartSet. An electronic clinical decision support tool, plus in-person training, may be key to changing primary care provider behavior around concussion care.
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Affiliation(s)
- Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison E. Curry
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kristina B. Metzger
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ronni S. Kessler
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jeneita M. Bell
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Juliet Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark R. Zonfrillo
- Hasbro Children’s Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Matthew J. Breiding
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina L. Master
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Sport Medicine and Performance Center, The Children’s Hospital of Philadelphia, PA, USA
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27
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Patel DR, Parachuri V, Shettigar A. Evaluation and management of sport-related concussions in adolescent athletes. Transl Pediatr 2017; 6:121-128. [PMID: 28795001 PMCID: PMC5532189 DOI: 10.21037/tp.2017.03.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 03/15/2017] [Indexed: 11/06/2022] Open
Abstract
Sport-related concussions in young athletes are common, generally under reported and often go unrecognized. Concussion in sport may result either from a direct impact to the head or from indirect forces transmitted to the brain from impact elsewhere on the body. Concussions may also result from sudden acceleration, deceleration or rotational forces to the brain. The key features of concussion include confusion, impaired memory and reduced speed of information processing. Recovery may occur from a few days to several weeks or months. Both physical and cognitive rests are recommended for recovery. Long-term cognitive and behavioral complications are a concern. Preventive strategies include education, modification of sport rules, use of equipment such as headgears, face masks and mouth guards, and neck muscle training. Evidence is limited to support effectiveness of these preventive measures with the exception of rule modification in some sports. Laws have been enacted that require medical evaluation and clearance prior to return to play; however, evidence thus far does not show that laws have been effective in reducing the incidence of concussions in sport. More research is needed in all areas of preventive measures. Sports participation is a complex personal decision on the part of adolescent and his or her family. They should be provided with all information on inherent risks so that they can make an informed decision.
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Affiliation(s)
- Dilip R. Patel
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo Michigan 49008, USA
| | | | - Amrith Shettigar
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo Michigan 49008, USA
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28
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Factors Influencing the Underreporting of Concussion in Sports: A Qualitative Study of Minor Hockey Participants. Clin J Sport Med 2017; 27:375-380. [PMID: 28653965 DOI: 10.1097/jsm.0000000000000372] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The present study is to identify factors contributing to underreporting of concussion in adolescent athletes. DESIGN Qualitative interviews. SETTING Participants were interviewed in an office environment. PARTICIPANTS Interviews were conducted with 31 minor hockey players, 10 parents, 6 coaches, 4 trainers, 2 managers, and one game official. Players were 13 to 15 year old. With selective sampling, an inductive approach of analyzing the interviews was undertaken and themes were identified and analyzed. ASSESSMENT OF RISK FACTORS Underreporting is a complex phenomenon. A number of risk factors related to hockey culture, players, reference others, and rules of play were assessed. MAIN OUTCOME MEASURES Reasons not reporting concussion is accepted in minor hockey. RESULTS Aspects of hockey culture such as an overemphasis on winning games and upheld misperceptions about the risks associated with concussion were identified as relevant to the underreporting of concussions. Various factors relevant to the underreporting of concussions include player's motivation to win, group membership dynamics such as a player's role as the team's "enforcer," coaches' own motivation to win to further their own opportunities in the sport, and parents' personal financial interest or alternative agenda in terms of time commitments and their child's future career prospects. CONCLUSIONS Our findings indicate that underreporting of concussion among those players interviewed appears to be prevalent and associated with misconceptions about injury risk, and a culture that both reinforces and encourages underreporting with tacit or overt complicity of parents and coaches. Our findings support the need to alter the culture of violence and tough play in hockey by education, rule changes, economic measures, and changes in governance of the sport. Interviewing more stakeholders and policy makers would shed light on such potential interventions.
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29
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Bishop SA, Neary JP. Assessing prefrontal cortex oxygenation after sport concussion with near-infrared spectroscopy. Clin Physiol Funct Imaging 2017. [DOI: 10.1111/cpf.12447] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Scott A. Bishop
- Faculty of Kinesiology and Health Studies; University of Regina; Regina SK Canada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health Studies; University of Regina; Regina SK Canada
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30
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Abstract
For several years both cognitive and physical rest remained at the forefront in pediatric postconcussion management. However, the concept of "rest" has not been well defined and there remains significant variability both in terms of rest recommendations provided as well as adherence to such recommendations. More recently, there has been growing evidence to suggest that an earlier return to light or moderate activity is not detrimental and may, in fact, facilitate symptomatic improvement, thereby highlighting a new role for active rehabilitation in recovery from concussion. In this article, we compare historic recommendations for rest with emerging strategies focused on active rehabilitation. [Pediatr Ann. 2017;46(4):e139-e144.].
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31
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Black AM, Hagel BE, Palacios-Derflingher L, Schneider KJ, Emery CA. The risk of injury associated with body checking among Pee Wee ice hockey players: an evaluation of Hockey Canada’s national body checking policy change. Br J Sports Med 2017; 51:1767-1772. [DOI: 10.1136/bjsports-2016-097392] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 11/03/2022]
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32
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Zemek RL, Grool AM, Rodriguez Duque D, DeMatteo C, Rothman L, Benchimol EI, Guttmann A, Macpherson AK. Annual and Seasonal Trends in Ambulatory Visits for Pediatric Concussion in Ontario between 2003 and 2013. J Pediatr 2017; 181:222-228.e2. [PMID: 27843008 DOI: 10.1016/j.jpeds.2016.10.067] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/14/2016] [Accepted: 10/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate annual and seasonal trends in physician office and emergency department (ED) visit rates for pediatric concussion in Ontario between 2003 and 2013. STUDY DESIGN A retrospective, population-based study was conducted using linked health administrative data from all concussion-related visits to ED and physician office by children aged 5 through 18 years. Time series analysis was used to assess whether periodic components exist in the monthly number of concussion-related visits. RESULTS Over the 11-year study period, there were 176 685 pediatric visits for concussion in EDs and physician offices in Ontario. Standardized concussion-related visits showed a 4.4-fold (95% CI 4.37-4.45) increase per 100 000 from 2003 to 2013, with nearly 35 000 total visits in 2013. Concussion-related visits demonstrated a steep increase from 2010 onward. The greatest increases in standardized visits were in females (6.3-fold, 95% CI 6.23-6.46 vs 3.6-fold, 95% CI 3.56-3.64 in males) and 13-18.99 year olds (5.0-fold, 95% CI 4.93-5.08 vs 4.1-fold, 95% CI 3.99-4.27 in 9-12 years and 2.3-fold, 95% CI 2.23-2.42 in 5-8 years). A strong seasonal variability (R2autoreg = 0.87, P < .01) in the number of concussion-related visits was present, with most occurring in fall and winter. CONCLUSIONS Pediatric concussion-related ED and physician office visit rates have greatly increased in the last decade, particularly since 2010. Prevention strategies may be targeted at those most at risk and at seasonal-related activities carrying the greatest risk of concussion.
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Affiliation(s)
- Roger L Zemek
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
| | - Anne M Grool
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | | | - Carol DeMatteo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Linda Rothman
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Eric I Benchimol
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Alison K Macpherson
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, Canada
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33
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Krolikowski MP, Black AM, Palacios-Derflingher L, Blake TA, Schneider KJ, Emery CA. The Effect of the "Zero Tolerance for Head Contact" Rule Change on the Risk of Concussions in Youth Ice Hockey Players. Am J Sports Med 2017; 45:468-473. [PMID: 27789471 DOI: 10.1177/0363546516669701] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ice hockey is a popular winter sport in Canada. Concussions account for the greatest proportion of all injuries in youth ice hockey. In 2011, a policy change enforcing "zero tolerance for head contact" was implemented in all leagues in Canada. PURPOSE To determine if the risk of game-related concussions and more severe concussions (ie, resulting in >10 days of time loss) and the mechanisms of a concussion differed for Pee Wee class (ages 11-12 years) and Bantam class (ages 13-14 years) players after the 2011 "zero tolerance for head contact" policy change compared with players in similar divisions before the policy change. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The retrospective cohort included Pee Wee (most elite 70%, 2007-2008; n = 891) and Bantam (most elite 30%, 2008-2009; n = 378) players before the rule change and Pee Wee (2011-2012; n = 588) and Bantam (2011-2012; n = 242) players in the same levels of play after the policy change. Suspected concussions were identified by a team designate and referred to a sport medicine physician for diagnosis. Incidence rate ratios (IRRs) were estimated based on multiple Poisson regression analysis, controlling for clustering by team and other important covariates and offset by game-exposure hours. Incidence rates based on the mechanisms of a concussion were estimated based on univariate Poisson regression analysis. RESULTS The risk of game-related concussions increased after the head contact rule in Pee Wee (IRR, 1.85; 95% CI, 1.20-2.86) and Bantam (IRR, 2.48; 95% CI, 1.17-5.24) players. The risk of more severe concussions increased after the head contact rule in Pee Wee (IRR, 4.12; 95% CI, 2.00-8.50) and Bantam (IRR, 7.91; 95% CI, 3.13-19.94) players. The rates of concussions due to body checking and direct head contact increased after the rule change. CONCLUSION The "zero tolerance for head contact" policy change did not reduce the risk of game-related concussions in Pee Wee or Bantam class ice hockey players. Increased concussion awareness and education after the policy change may have contributed to the increased risk of concussions found after the policy change.
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Affiliation(s)
- Maciej P Krolikowski
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda M Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Luz Palacios-Derflingher
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tracy A Blake
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
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34
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Bishop S, Dech R, Baker T, Butz M, Aravinthan K, Neary JP. Parasympathetic baroreflexes and heart rate variability during acute stage of sport concussion recovery. Brain Inj 2017; 31:247-259. [DOI: 10.1080/02699052.2016.1226385] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Scott Bishop
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Ryan Dech
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Taylor Baker
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Matthew Butz
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kaishan Aravinthan
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
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35
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Yorke AM, Smith L, Babcock M, Alsalaheen B. Validity and Reliability of the Vestibular/Ocular Motor Screening and Associations With Common Concussion Screening Tools. Sports Health 2016; 9:174-180. [PMID: 27834667 PMCID: PMC5349391 DOI: 10.1177/1941738116678411] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sustaining a concussion commonly results in vestibular impairments that may be associated with balance deficits. To screen for vestibular impairments after a concussion, the Vestibular/Ocular Motor Screening (VOMS) tool was developed. The relationship between the VOMS and other concussion screening tools, such as the Balance Error Scoring System (BESS) and King-Devick (K-D), have not been explored. HYPOTHESES (1) VOMS would provide reliable results and not provoke symptoms in healthy adolescents and (2) VOMS test items would measure related aspects of vestibular function that are not measured through the BESS or K-D. STUDY DESIGN Cross-sectional, descriptive. LEVEL OF EVIDENCE Level 4. METHODS A total of 105 healthy adolescents (53 male, 52 female; mean age, 15.4 years) completed the VOMS, BESS, and K-D tests. A subsample of 21 adolescents (16 male, 5 female; mean age, 15.5 years) completed the VOMS twice. RESULTS The median total symptom score for all 7 VOMS items was 0 (0-5). The majority of the individual VOMS test items total symptom scores demonstrated a significant correlation with each other ( rs = 0.25-0.66, P < 0.02). The individual VOMS items did not demonstrate a significant relationship to the BESS or K-D. VOMS items demonstrated high agreement in total symptom scores between testing trials, with near point convergence (NPC) distance demonstrating an intraclass correlation coefficient (ICC) of 0.95 (95% CI, 0.89-0.98; P < 0.001). The MDC95 (minimal detectable change with 95 confidence) for NPC distance was 4 cm. CONCLUSION The VOMS did not provoke vestibular symptoms in healthy adolescents. The VOMS items measured unique aspects of vestibular function other than those measured by the BESS or K-D with good reliability. CLINICAL RELEVANCE Clinicians should consider implementing the VOMS as part of a comprehensive concussion assessment if vestibular impairment is suspected. If NPC distance is measured twice, a difference of >4 cm would be considered real change outside of measurement error.
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Affiliation(s)
- Amy M Yorke
- Physical Therapy Department, University of Michigan-Flint, Flint, Michigan
| | - Laura Smith
- Physical Therapy Department, University of Michigan-Flint, Flint, Michigan
| | - Mitch Babcock
- Physical Therapy Department, University of Michigan-Flint, Flint, Michigan
| | - Bara Alsalaheen
- Physical Therapy Department, University of Michigan-Flint, Flint, Michigan
- Department of Neurology, University of Michigan-Ann Arbor, Ann Arbor, Michigan
- Michigan NeuroSport, University of Michigan Health System, Ann Arbor, Michigan
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36
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Trojian T, Violano P, Hall M, Duncan C. The effects of a state concussion law on the frequency of sport-related concussions as seen in two emergency departments. Inj Epidemiol 2016; 2:2. [PMID: 27747734 PMCID: PMC5005728 DOI: 10.1186/s40621-015-0034-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Connecticut (CT) passed its original sport-related concussion (SRC) law (PA 10-62) in 2010. The law requires that a health-care professional evaluate high school athletes with concussion symptoms. The purpose of this study was to evaluate two level 1 Trauma Center Emergency Department (ED) records for SRC before and after the Connecticut Public Act (CT PA) 10-62 to determine if the law had an effect on the presentation to the ED of SRCs. METHODS A retrospective analysis of two level 1 Trauma Center Emergency Departments database was performed. Monthly data on SRCs treated in the study EDs from July 2003 through June 2012 were collected and analyzed using the autoregressive integrated moving average model. The number of SRCs in the youth (under age 14 years), high school (age 14 to 18 years), and adult (age >18 years) populations prior to CT PA 10-62 was compared to the number of SRCs post implementation of CT PA 10-62 for each academic school year, fall sports season, and summertime. RESULTS Monthly SRCs in high school students treated in the study EDs increased from 2.5 cases to 5.9 cases between pre and post implementation of CT PA 10-62 (p < 0.001). Statistical modeling revealed that implementation of CT PA 10-62 was associated with significantly increased SRCs treated in the study EDs and that the increase was limited to the high school students in the fall season and during the school year. CONCLUSIONS There has been a marked increase in the frequency of SRCs treated in the emergency departments in the high school population in Connecticut after the implementation of the sport-related concussion law. The results suggest that the sport-related concussion law in Connecticut is effective in improving the evaluation and detection of SRCs in high school students.
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Affiliation(s)
- Thomas Trojian
- Division of Sports Medicine, Drexel University College of Medicine, 10 Shurs Lane, Philadelphia, PA, 19127, USA.
| | - Pina Violano
- Trauma Department, Yale-New Haven Hospital, 300 George Street, 4th Floor, Room 443, New Haven, CT, 06510, USA.,Injury Free Coalition for Kids of New Haven, Yale-New Haven Children's Hospital, 300 George St 4th Floor, Room 443, New Haven, CT, 06510, USA
| | - Matthew Hall
- Department of Orthopaedics, Sports Concussion Program, UCHC, 263 Farmington Avenue, Farmington, CT, 06263, USA
| | - Charles Duncan
- Department of Neurosurgery, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
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Abstract
Traumatic Brain Injury (TBI) was chosen as an Emergency Neurological Life Support topic due to its frequency, the impact of early intervention on outcomes for patients with TBI, and the need for an organized approach to the care of such patients within the emergency setting. This protocol was designed to enumerate the practice steps that should be considered within the first critical hour of neurological injury.
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Weerdenburg K, Schneeweiss S, Koo E, Boutis K. Concussion and its management: What do parents know? Paediatr Child Health 2016; 21:e22-6. [PMID: 27398059 DOI: 10.1093/pch/21.3.e22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To determine the sensitivity of parental suspicion of concussion relative to paediatric emergency physicians in children who presented to an emergency department (ED) with a head injury. A secondary objective was to examine the variables associated with parental suspicion of concussion concordant with that of a physician. METHODS Parents of children five to 18 years of age presenting to an urban paediatric ED with a nonstructural head injury completed a 24-item questionnaire. RESULTS Of the 577 eligible parents, 495 (85.8%) consented to participate. The sensitivity of parental suspicion for concussion was 40.0% (95% CI 33.2% to 47.2%), while the specificity was 58.3% (95% CI 52.4% to 64.0%). The variable of child age ≥10 years was associated with an increased odds (OR 3.0) of a parental suspicion of concussion concordant with that of a physician; parent age, parent sex, mechanism of head injury and history of concussion in the child were not. Although 453 (91.5%) parents would stop activity if they believed their child sustained a concussion, only 159 (32.1%) were familiar with return-to-play guidelines. CONCLUSIONS Parents often did not suspect a concussion when it was ultimately diagnosed by a paediatric emergency physician, although they were more likely to do so in older children. Only approximately one-third were aware of return-to-play guidelines. To enhance the potential for parent-driven advocacy in the recognition and management of concussion, these data support the need for increased parental education on this injury.
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Affiliation(s)
- Kirstin Weerdenburg
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Suzan Schneeweiss
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Ellen Koo
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Kathy Boutis
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
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Dillard C, Ditchman N, Nersessova K, Foster N, Wehman P, West M, Riedlinger B, Monasterio E, Shaw B, Neblett J. Post-concussion symptoms in mild traumatic brain injury: findings from a paediatric outpatient clinic. Disabil Rehabil 2016; 39:544-550. [DOI: 10.3109/09638288.2016.1152602] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Charles Dillard
- Pediatric TBI Program, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Nicole Ditchman
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Karine Nersessova
- Pediatric TBI Program, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Nicola Foster
- Pediatric TBI Program, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Paul Wehman
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
- Rehabilitation Research and Training Center, Virginia Commonwealth University Richmond, VA, USA
| | - Michael West
- Rehabilitation Research and Training Center, Virginia Commonwealth University Richmond, VA, USA
| | - Brendalin Riedlinger
- Pediatric TBI Program, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Eugenio Monasterio
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
| | - Bill Shaw
- Pediatric TBI Program, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
| | - Julie Neblett
- Pediatric TBI Program, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
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Seals RM, Hansen J, Gredal O, Weisskopf MG. Physical Trauma and Amyotrophic Lateral Sclerosis: A Population-Based Study Using Danish National Registries. Am J Epidemiol 2016; 183:294-301. [PMID: 26825926 DOI: 10.1093/aje/kwv169] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/22/2015] [Indexed: 11/14/2022] Open
Abstract
Prior studies have suggested that physical trauma might be associated with the development of amyotrophic lateral sclerosis (ALS). We conducted a population-based, individually matched case-control study in Denmark to assess whether hospitalization for trauma is associated with a higher risk of developing ALS. There were 3,650 incident cases of ALS in the Danish National Patient Register from 1982 to 2009. We used risk-set sampling to match each case to 100 age- and sex-matched population controls alive on the date of the case's diagnosis. Odds ratios and 95% confidence intervals were calculated using a conditional logistic regression model. History of trauma diagnosis was also obtained from the Danish Patient Register. When traumas in the 5 years prior to the index date were excluded, there was a borderline association between any trauma and ALS (odds ratio (OR) = 1.09, 95% confidence interval (CI): 0.99, 1.19). A first trauma before age 55 years was associated with ALS (OR = 1.22, 95% CI: 1.08, 1.37), whereas first traumas at older ages were not (OR = 0.97, 95% CI: 0.85, 1.10). Our data suggest that physical trauma at earlier ages is associated with ALS risk. Age at first trauma could help explain discrepancies in results of past studies of trauma and ALS.
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Abstract
OBJECTIVE To investigate concussion rates and reporting frequencies in high school and collegiate athletes in 2013, compare results to those obtained from 1999 to 2002, and examine to what extent the 2012 Wisconsin state concussion law affected reporting in 2013. DESIGN Retrospective 2013 survey compared with prior survey. SETTING High schools and colleges in the Milwaukee, Wisconsin, area. PARTICIPANTS Athletes (N = 784) from multiple sports were surveyed in 2013. Football players (N = 1532) from 1999 to 2002 completed the same measure. MAIN OUTCOME MEASURES Both surveys assessed concussion history, concussion incidence during the current season, whether incident concussions were reported, who concussions were reported to, and reasons for not reporting. The 2013 survey also assessed awareness of the Wisconsin state law and its effect on reporting. RESULTS Rates of concussion in the surveyed season were comparable to previous findings from 1999 to 2002 (16.6% vs 15.3%, P = 0.558). Notably, athletes were significantly more likely to report their concussions in 2013 (70.6% vs 47.3% previously, P = 0.011). Among high school athletes surveyed, 59.5% were aware of the Wisconsin state law, with 55.1% stating it would make them more likely to report a concussion. CONCLUSIONS Rates of concussion for 1 sport season have not changed significantly over the past 14 years. The percentage of concussions that are reported to someone has increased significantly. Awareness of the Wisconsin state law does not fully account for the increase in concussion reporting. CLINICAL RELEVANCE Given the finite amount of knowledge regarding the influence of concussion-related cultural and legal changes, these findings will help to inform clinicians of the current concussion milieu from the perspective of athletes. It will inform practitioners involved in concussion management to what extent athletes are aware of and report concussions.
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Guerriero RM, Rivkin MJ. Reversible vasoconstriction syndrome involving the basilar artery in an adolescent: imaging and clinical features. Pediatr Neurol 2015; 52:635-7. [PMID: 25891819 DOI: 10.1016/j.pediatrneurol.2015.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/19/2015] [Accepted: 02/19/2015] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Reversible cerebral vasoconstriction syndrome is characterized by recurrent episodes of "thunderclap headache" and by transient, multifocal vasoconstriction of cerebral vasculature. Here we present an adolescent boy whose clinical features fit the diagnostic criteria and whose neurovascular imaging revealed reversible vasoconstriction of the basilar artery alone. OBSERVATION A previously healthy 14-year-old boy presented with repeated severe sudden thunderclap headaches following exercise. These symptoms were accompanied by isolated basilar artery stenosis. CONCLUSION Reversible cerebral vasoconstriction syndrome is a condition with several clinical triggers. Its pathophysiology is poorly understood. This patient adds to a broadening spectrum of clinical features of this disorder.
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Affiliation(s)
- Réjean M Guerriero
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael J Rivkin
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
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Bramley H, Heverley S, Lewis MM, Kong L, Rivera R, Silvis M. Demographics and treatment of adolescent posttraumatic headache in a regional concussion clinic. Pediatr Neurol 2015; 52:493-8. [PMID: 25728223 DOI: 10.1016/j.pediatrneurol.2015.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/13/2015] [Accepted: 01/17/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Mild traumatic brain injury affects over one million pediatric patients annually. Minimal data and no guidelines exist regarding treatment of posttraumatic headache (PTH). The current study investigated treatment and outcomes in patients with posttraumatic headache. METHODS Medical records of all patients (age 13-18 years of age) seen at a regional concussion program from 2006 to 2011 were reviewed. Statistical analysis using SAS 9.2 was conducted to determine the effectiveness of treatment as well as the association of gender, concussion history, and football participation on the duration of posttraumatic headache. RESULTS Four hundred subjects met the inclusion criteria. Females were more likely to report posttraumatic headache than males (90% vs. 79%, P = 0.004), more likely to be prescribed amitriptyline (24% vs. 13%, P = 0.004), and had a significantly longer recovery time (median, 80 days versus 34 days, P < 0.001). Seventeen percent of subjects were prescribed amitriptyline for treatment of posttraumatic headache, of which 82% reported a beneficial effect. There was no difference in the percentage of posttraumatic headache or recovery time in football players versus other male athletes from other sport mechanisms. CONCLUSION Females are more likely to report posttraumatic headache than males and also take longer to recover. Amitriptyline appears to be well-tolerated and an effective treatment strategy for patients with posttraumatic headache. Among pediatric patients evaluated in a concussion clinic, there is no difference in the proportion of football players reporting headaches compared with male players of other sports.
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Affiliation(s)
- Harry Bramley
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Steven Heverley
- Adolescent pediatrician, Tan & Garcia Pediatrics, Harrisburg, Pennsylvania
| | - Mechelle M Lewis
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Lan Kong
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Rowena Rivera
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Matthew Silvis
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Zhou G, Brodsky JR. Objective vestibular testing of children with dizziness and balance complaints following sports-related concussions. Otolaryngol Head Neck Surg 2015; 152:1133-9. [PMID: 25820582 DOI: 10.1177/0194599815576720] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/18/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To conduct objective assessment of children with balance and vestibular complaints following sports-related concussions and identify the underlying deficits by analyzing laboratory test outcomes. STUDY DESIGNS Case series with chart review. SETTING Pediatric tertiary care facility. SUBJECTS AND METHODS Medical records were reviewed of 42 pediatric patients with balance and/or vestibular complaints following sports-related concussions who underwent comprehensive laboratory testing on their balance and vestibular function. Patients' characteristics were summarized and results analyzed. RESULTS More than 90% of the children with protracted dizziness or imbalance following sports-related concussion had at least 1 abnormal finding from the comprehensive balance and vestibular evaluation. The most frequent deficit was found in dynamic visual acuity test, followed by Sensory Organization Test and rotational test. Patient's balance problem associated with concussion seemed to be primarily instigated by vestibular dysfunction. Furthermore, semicircular canal dysfunction was involved more often than dysfunction of otolith organs. Yet, <10% of the children experienced a hearing loss following sports-related concussion. CONCLUSIONS Vestibular impairment is common among children with protracted dizziness or imbalance following sports-related concussion. Our study demonstrated that proper and thorough evaluation is imperative to identify these underlying deficits and laboratory tests were helpful in the diagnosis and recommendation of following rehabilitations.
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Affiliation(s)
- Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Waltham, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Waltham, Massachusetts, USA Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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Daniels DJ, Clarke MJ, Puffer R, Luo TD, McIntosh AL, Wetjen NM. High occurrence of head and spine injuries in the pediatric population following motocross accidents. J Neurosurg Pediatr 2015; 15:261-5. [PMID: 25555116 DOI: 10.3171/2014.9.peds14149] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Off-road motorcycling is a very popular sport practiced by countless people worldwide. Despite its popularity, not much has been published on the severity and distribution of central nervous system-related injuries associated with this activity in the pediatric population. The purpose of this study was to confirm, characterize, and document the rate of head and spine injuries associated with off-road motorcycling in this population. METHODS All patients aged 18 years or less who were treated for a motorbike injury at the authors' institution (a Level 1 regional trauma center) between 2000 and 2007 were identified through in-house surgical and trauma registries. Type, mechanism, and severity of CNS-related injuries were assessed, including: incidence of traumatic brain injury (TBI), loss of consciousness (LOC), Glasgow Coma Scale (GCS) score, head CT findings, neurological deficits, spinal fractures, cervical strain, and use of protective gear, including helmets. RESULTS During the 8-year period of study, 298 accidents were evaluated in 248 patients. The patients' mean age at the time of injury was 14.2 ± 2.7 years. Head injury or TBI was identified in 60 (20.1%) of 298 cases (involving 58 of 248 patients). Fifty-seven cases were associated with LOC, and abnormalities were identified on head CT in 10 patients; these abnormalities included skull fractures and epidural, subdural, subarachnoid, and intraparenchymal hemorrhages. The GCS score was abnormal in 11 cases and ranged from 3 to 15, with an overall mean of 14.5. No patients required cranial surgery. Helmet use was confirmed in 43 (71.6%) of the cases involving TBI. Spine fractures were identified in 13 patients (4.3%) and 5 required surgical fixation for their injury. CONCLUSIONS The authors found a high occurrence of head injuries following pediatric off-road motorcycle riding or motocross accidents despite the use of helmets. Additionally, this study severely underestimates the rate of mild TBIs in this patient population. Our data indicate that motocross is a high-risk sport despite the use of protective gear. Riders and parents should be counseled accordingly about the risks prior to participation.
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Henry LC, Sandel N. Adolescent Subtest Norms for the ImPACT Neurocognitive Battery. APPLIED NEUROPSYCHOLOGY-CHILD 2014; 4:266-76. [DOI: 10.1080/21622965.2014.911094] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Hanson E, Stracciolini A, Mannix R, Meehan WP. Management and prevention of sport-related concussion. Clin Pediatr (Phila) 2014; 53:1221-30. [PMID: 24419264 DOI: 10.1177/0009922813518429] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Emily Hanson
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA Boston Children's Hospital, Boston, MA, USA
| | - Andrea Stracciolini
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA Boston Children's Hospital, Boston, MA, USA
| | | | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA Boston Children's Hospital, Boston, MA, USA
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Titus DJ, Furones C, Atkins CM, Dietrich WD. Emergence of cognitive deficits after mild traumatic brain injury due to hyperthermia. Exp Neurol 2014; 263:254-62. [PMID: 25447938 DOI: 10.1016/j.expneurol.2014.10.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/16/2014] [Accepted: 10/22/2014] [Indexed: 02/04/2023]
Abstract
Mild elevations in core temperature can occur in individuals involved in strenuous activities that are risky for potentially sustaining a mild traumatic brain injury (mTBI) or concussion. Recently, we have discovered that mild elevations in brain temperature can significantly aggravate the histopathological consequences of mTBI. However, whether this exacerbation of brain pathology translates into behavioral deficits is unknown. Therefore, we investigated the behavioral consequences of elevating brain temperature to mildly hyperthermic levels prior to mTBI. Adult male Sprague Dawley rats underwent mild fluid-percussion brain injury or sham surgery while normothermic (37 °C) or hyperthermic (39 °C) and were allowed to recover for 7 days. Animals were then assessed for cognition using the water maze and cue and contextual fear conditioning. We found that mTBI alone at normothermia had no effect on long-term cognitive measures whereas mTBI animals that were hyperthermic for 15 min prior to and for 4h after brain injury were significantly impaired on long-term retention for both the water maze and fear conditioning. In contrast, hyperthermic mTBI animals cooled within 15 min to normothermia demonstrated no significant long-term cognitive deficits. Mild TBI irrespective of temperature manipulations resulted in significant short-term working memory deficits. Cortical atrophy and contusions were detected in all mTBI treatment groups and contusion volume was significantly less in hyperthermic mTBI animals that were cooled as compared to hyperthermic mTBI animals that remained hyperthermic. These results indicate that brain temperature is an important variable for mTBI outcome and that mildly elevated temperatures at the time of injury result in persistent cognitive deficits. Importantly, cooling to normothermia after mTBI prevents the development of long-term cognitive deficits caused by hyperthermia. Reducing temperature to normothermic levels soon after mTBI represents a rational approach to potentially mitigate the long-term consequences of mTBI.
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Affiliation(s)
- David J Titus
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Concepcion Furones
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Coleen M Atkins
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - W Dalton Dietrich
- The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Echlin PS, Johnson AM, Holmes JD, Tichenoff A, Gray S, Gatavackas H, Walsh J, Middlebro T, Blignaut A, MacIntyre M, Anderson C, Fredman E, Mayinger M, Skopelja EN, Sasaki T, Bouix S, Pasternak O, Helmer KG, Koerte IK, Shenton ME, Forwell LA. The Sport Concussion Education Project. A brief report on an educational initiative: from concept to curriculum. J Neurosurg 2014; 121:1331-6. [PMID: 25280091 DOI: 10.3171/2014.8.jns132804] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Current research on concussion is primarily focused on injury identification and treatment. Prevention initiatives are, however, important for reducing the incidence of brain injury. This report examines the development and implementation of an interactive electronic teaching program (an e-module) that is designed specifically for concussion education within an adolescent population. This learning tool and the accompanying consolidation rubric demonstrate that significant engagement occurs in addition to the knowledge gained among participants when it is used in a school curriculum setting.
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50
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Sandel N, Henry LC, French J, Lovell MR. Parent Perceptions of Their Adolescent Athlete's Concussion: A Preliminary Retrospective Study. APPLIED NEUROPSYCHOLOGY-CHILD 2014; 4:211-6. [DOI: 10.1080/21622965.2013.850692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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