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Moley JP, Norman JL, Coccaro EF. Personality disorder and mild traumatic brain injury. Personal Ment Health 2022; 16:331-337. [PMID: 35598165 PMCID: PMC9675684 DOI: 10.1002/pmh.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 12/30/2022]
Abstract
Mild traumatic brain injury (mTBI) poses risk to the neurocognitive, emotional, and financial well-being of affected individuals. While aggression and impulsivity have been examined in relation to mTBI, little work has been done to evaluate the relationship between history of mTBI and personality disorder (PD). The authors examined the associations between history of mTBI and PD in a control group without history of mTBI (N = 1189) and individuals with history of mTBI (N = 267). Results demonstrated that any PD diagnosis is a significant risk factor for mTBI (p < 0.001). Cluster B diagnoses, particularly borderline and antisocial PD, were independently significant risk factors for mTBI. These data suggest a role for screening for a history of mTBI in patients with PDs and associated traits.
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Affiliation(s)
- James P Moley
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Joshua L Norman
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Emil F Coccaro
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
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2
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Taylor AA, McCauley SR, Strutt AM. Postconcussional Syndrome. Neurol Clin 2022; 41:161-176. [DOI: 10.1016/j.ncl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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3
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Villegas E, Hartsock MJ, Aben BL, Lenahan KN, Hernández TD, Spencer RL. ASSOCIATION BETWEEN ALTERED CORTISOL PROFILES AND NEUROBEHAVIORAL IMPAIRMENT FOLLOWING mTBI IN COLLEGE STUDENTS. J Neurotrauma 2022; 39:809-820. [PMID: 35196881 DOI: 10.1089/neu.2021.0495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mild Traumatic Brain Injury (mTBI) is the most common form of TBI, accounting for over 2.5 million TBI cases in the United States annually. Identification of easily obtainable biomarkers that track strongly with mTBI symptoms may improve our understanding of biological factors that contribute to mTBI symptom profiles and long-term outcomes. Notably, some individuals with mTBI exhibit circadian disruptions and elevated stress sensitivity, which in other clinical groups often correlate with disrupted secretion of cortisol, a glucocorticoid hormone that coordinates circadian and stress physiology. Here, we sought to determine whether cortisol profiles could serve as a biomarker to complement the assessment of neurobehavioral sequelae following mTBI. We partnered with our on-campus health clinic to recruit college students seeking medical care following mTBI (n=46) and compared this population to a well-matched non-injured student control group (n=44). We collected data at an initial visit (shortly after injury in mTBI subjects) and one week later. At each visit, we evaluated neurobehavioral function using the Automated Neuropsychological Assessment Metric (ANAM). Our subjects then provided cortisol samples through at-home saliva collection. We observed strong coherence between ANAM subjective and objective measures, indicating significant multidimensional impairment in those with mTBI. Further, female mTBI subjects exhibited diminished neurobehavioral function compared to males. Regardless of sex, decreased amplitude of diurnal cortisol and a blunted cortisol awakening response predicted mTBI symptom severity and neurobehavioral impairment. Taken together, these findings suggest that salivary cortisol profiles may be a sensitive biomarker for studying underlying biological factors that impact mTBI outcomes.
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Affiliation(s)
- Eduardo Villegas
- University of Colorado Boulder, 1877, Psychology and Neuroscience, Boulder, Colorado, United States;
| | - Matthew J Hartsock
- University of Colorado Boulder, 1877, Psychology and Neuroscience, Boulder, Colorado, United States;
| | - Bo Llg Aben
- University of Colorado Boulder, 1877, Psychology and Neuroscience, Boulder, Colorado, United States;
| | - Kristen Nicole Lenahan
- University of Colorado Boulder, 1877, Psychology and Neuroscience, Boulder, Colorado, United States;
| | - Theresa Dea Hernández
- University of Colorado Boulder, 1877, Psychology and Neuroscience, Boulder, Colorado, United States;
| | - Robert L Spencer
- University of Colorado Boulder, 1877, Psychology and Neuroscience, Boulder, Colorado, United States;
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Karaliute M, Saksvik SB, Smevik H, Follestad T, Einarsen C, Vik A, Håberg AK, Iverson GL, Skandsen T, Olsen A. Methodology Matters: Comparing Approaches for Defining Persistent Symptoms after Mild Traumatic Brain Injury. Neurotrauma Rep 2022; 2:603-617. [PMID: 35018362 PMCID: PMC8742292 DOI: 10.1089/neur.2021.0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Some people experience persistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI). A meaningful clinical classification and scientific progress are hampered by a lack of consensus regarding the phenomenology, assessment, and operationalization of PPCS. Here we demonstrate and evaluate how the methodology used to assess and define persistent symptoms after mTBI influences PPCS as a binary outcome. We present empirical data from 15 classification methods reflecting procedures found in the literature and clinical practice. In total, 221 patients with mTBI, 73 patients with orthopedic injuries, and 77 community controls were included in the study. The prevalence rate of PPCS in the mTBI group varied between 10% and 47%, depending on the method used to assess and define unfavorable outcome. There was generally low positive agreement between the different methods; even the two methods yielding the most similar prevalence rates (89.2% overall proportion agreement) agreed on less than half (45.5% positive agreement) of the PPCS cases. Using a liberal but not uncommon threshold for symptom severity, there was a considerable misclassification rate of PPCS in both comparison groups. Our results highlight the importance for researchers to be aware of the limitations of using binary approaches for classification of PPCS. The poor agreement between methods should be considered when (1) interpreting the heterogeneity in the existing PPCS literature and (2) developing new improved methods. An empirically informed consensus regarding classification of PPCS should be a priority for the research community.
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Affiliation(s)
- Migle Karaliute
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Neurology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Simen B Saksvik
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hanne Smevik
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, and Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Cathrine Einarsen
- Department of Physical Medicine and Rehabilitation, and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Asta K Håberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital and Spaulding Research Institute; MassGeneral Hospital for Children Sports Concussion Program; & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Toril Skandsen
- Department of Physical Medicine and Rehabilitation, and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Alexander Olsen
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, and St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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5
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Haarbauer-Krupa J, Pugh MJ, Prager EM, Harmon N, Wolfe J, Yaffe K. Epidemiology of Chronic Effects of Traumatic Brain Injury. J Neurotrauma 2021; 38:3235-3247. [PMID: 33947273 PMCID: PMC9122127 DOI: 10.1089/neu.2021.0062] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although many patients diagnosed with traumatic brain injury (TBI), particularly mild TBI, recover from their symptoms within a few weeks, a small but meaningful subset experience symptoms that persist for months or years after injury and significantly impact quality of life for the person and their family. Factors associated with an increased likelihood of negative TBI outcomes include not only characteristics of the injury and injury mechanism, but also the person’s age, pre-injury status, comorbid conditions, environment, and propensity for resilience. In this article, as part of the Brain Trauma Blueprint: TBI State of the Science framework, we examine the epidemiology of long-term outcomes of TBI, including incidence, prevalence, and risk factors. We identify the need for increased longitudinal, global, standardized, and validated assessments on incidence, recovery, and treatments, as well as standardized assessments of the influence of genetics, race, ethnicity, sex, and environment on TBI outcomes. By identifying how epidemiological factors contribute to TBI outcomes in different groups of persons and potentially impact differential disease progression, we can guide investigators and clinicians toward more-precise patient diagnosis, along with tailored management, and improve clinical trial designs, data evaluation, and patient selection criteria.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City, Salt Lake City, Utah, USA.,Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | | | | | - Kristine Yaffe
- Department of Neurology, University of California San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.,Departments of Epidemiology/Biostatistics and Psychiatry, University of California San Francisco, San Francisco, California, USA
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Guberman GI, Houde JC, Ptito A, Gagnon I, Descoteaux M. Structural abnormalities in thalamo-prefrontal tracks revealed by high angular resolution diffusion imaging predict working memory scores in concussed children. Brain Struct Funct 2020; 225:441-459. [PMID: 31894406 DOI: 10.1007/s00429-019-02002-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022]
Abstract
Because of their high prevalence, heterogeneous clinical presentation, and wide-ranging sequelae, concussions are a challenging neurological condition, especially in children. Shearing forces transmitted across the brain during concussions often result in white matter damage. The neuropathological impact of concussions has been discerned from animal studies and includes inflammation, demyelination, and axonal loss. These pathologies can overlap during the sub-acute stage of recovery. However, due to the challenges of accurately modeling complex white matter structure, these neuropathologies have not yet been differentiated in children in vivo. In the present study, we leveraged recent advances in diffusion imaging modeling, tractography, and tractometry to better understand the neuropathology underlying working memory problems in concussion. Studying a sample of 16 concussed and 46 healthy youths, we used novel tractography methods to isolate 11 working memory tracks. Along these tracks, we measured fractional anisotropy, diffusivities, track volume, apparent fiber density, and free water fraction. In three tracks connecting the right thalamus to the right dorsolateral prefrontal cortex (DLPFC), we found microstructural differences suggestive of myelin alterations. In another track connecting the left anterior-cingulate cortex with the left DLPFC, we found microstructural changes suggestive of axonal loss. Structural differences and tractography reconstructions were reproduced using test-retest analyses. White matter structure in the three thalamo-prefrontal tracks, but not the cingulo-prefrontal track, appeared to play a key role in working memory function. The present results improve understanding of working memory neuropathology in concussions, which constitutes an important step toward developing neuropathologically informed biomarkers of concussion in children.
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Affiliation(s)
- Guido I Guberman
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada.
- Montreal Neurological Institute, 3801 University, Montreal, QC, H3A 2B4, Canada.
| | | | - Alain Ptito
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Isabelle Gagnon
- Department of Pediatrics, Faculty of Medicine, Montreal Children's Hospital, McGill University, Quebec, Canada
| | - Maxime Descoteaux
- Department of Computer Science, Sherbrooke University, Sherbrooke, QC, Canada
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Guberman GI, Robitaille MP, Larm P, Ptito A, Vitaro F, Tremblay RE, Hodgins S. A Prospective Study of Childhood Predictors of Traumatic Brain Injuries Sustained in Adolescence and Adulthood. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:36-45. [PMID: 31623445 PMCID: PMC6966253 DOI: 10.1177/0706743719882171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Traumatic brain injuries (TBIs) are sustained by approximately 17% of males in the general population, many of whom subsequently present mental disorders, cognitive, and physical problems. Little is known about predictors of TBIs and how to prevent them. The present study aimed to determine whether inattention-hyperactivity and/or all externalizing problems presented by boys at age 10 predict subsequent TBIs to age 34 after taking account of previous TBIs and family social status (FSS). METHOD 742 Canadian males were followed, prospectively, from age 6 to 34. Diagnoses of TBIs were extracted from health files, parents-reported sociodemographic and family characteristics at participants' age 6, and teachers-rated participants' behaviors at age 10. Separate logistic regression models predicted TBIs sustained from age 11 to 17 and from age 18 to 34. For each age period, two models were computed, one included previous TBIs, inattention-hyperactivity, FSS, and interaction terms, the second included previous TBIs, externalizing problems, FSS, and interaction terms. RESULTS In models that included inattention-hyperactivity, TBIs sustained from age 11 to 17 were predicted by age 10 inattention-hyperactivity (odds ratio [OR] = 1.46, 1.05 to 2.05) and by TBIs prior to age 11 (OR = 3.50, 1.48 to 8.24); TBIs sustained from age 18 to 34 were predicted by age 10 inattention-hyperactivity (OR = 1.31, 1.01 to 170). In models that included all externalizing problems, TBIs from age 11 to 17 were predicted by prior TBIs (OR = 3.66, 1.51 to 8.39); TBIs sustained from age 18 to 34 were predicted by age 10 externalizing problems (OR = 1.45, 1.12 to 1.86). Neither FSS nor interaction terms predicted TBIs in any of the models. CONCLUSIONS Among males, using evidence-based treatments to reduce inattention-hyperactivity and externalizing problems among boys could, potentially, decrease the risk of TBIs to age 34. Further, boys who sustain TBIs in childhood require monitoring to prevent recurrence in adolescence.
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Affiliation(s)
- Guido I Guberman
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Marie-Pier Robitaille
- Groupe de Recherche sur l'Inadaptation Psychosociale, Université de Montréal, Quebec, Canada
| | - Peter Larm
- School of Health, Care and Social Welfare, Mälardalens University, Västerås, Sweden
| | - Alain Ptito
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Frank Vitaro
- Groupe de Recherche sur l'Inadaptation Psychosociale, Université de Montréal, Quebec, Canada
| | - Richard E Tremblay
- Groupe de Recherche sur l'Inadaptation Psychosociale, Université de Montréal, Quebec, Canada.,Department of Pediatrics, Université de Montréal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Quebec, Canada.,School of Public Health, University College Dublin, Ireland
| | - Sheilagh Hodgins
- Groupe de Recherche sur l'Inadaptation Psychosociale, Université de Montréal, Quebec, Canada.,Centre de Recherche, Institut Universitaire de Santé Mentale de Montréal, Département de Psychiatrie et Addictologie, Université de Montréal, Quebec, Canada
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Voormolen DC, Haagsma JA, Polinder S, Maas AI, Steyerberg EW, Vuleković P, Sewalt CA, Gravesteijn BY, Covic A, Andelic N, Plass AM, von Steinbuechel N. Post-Concussion Symptoms in Complicated vs. Uncomplicated Mild Traumatic Brain Injury Patients at Three and Six Months Post-Injury: Results from the CENTER-TBI Study. J Clin Med 2019; 8:jcm8111921. [PMID: 31717436 PMCID: PMC6912209 DOI: 10.3390/jcm8111921] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to assess the occurrence of post-concussion symptoms and post-concussion syndrome (PCS) in a large cohort of patients after complicated and uncomplicated mild traumatic brain injury (mTBI) at three and six months post-injury. Patients were included through the prospective cohort study: Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI). Patients enrolled with mTBI (Glasgow Coma Scale 13-15) were further differentiated into complicated and uncomplicated mTBI based on the presence or absence of computed tomography abnormalities, respectively. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) assessed post-concussion symptoms and PCS according to the mapped ICD-10 classification method. The occurrence of post-concussion symptoms and syndrome at both time points was calculated. Chi square tests were used to test for differences between and within groups. Logistic regression was performed to analyse the association between complicated versus uncomplicated mTBI and the prevalence of PCS. Patients after complicated mTBI reported slightly more post-concussion symptoms compared to those after uncomplicated mTBI. A higher percentage of patients after complicated mTBI were classified as having PCS at three (complicated: 46% vs. uncomplicated: 35%) and six months (complicated: 43% vs. uncomplicated 34%). After adjusting for baseline covariates, the effect of complicated versus uncomplicated mTBI at three months appeared minimal: odds ratio 1.25 (95% confidence interval: 0.95-1.66). Although patients after complicated mTBI report slightly more post-concussion symptoms and show higher PCS rates compared to those after uncomplicated mTBI at three and six months, complicated mTBI was only found a weak indicator for these problems.
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Affiliation(s)
- Daphne C. Voormolen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
- Correspondence: ; Tel.: +316-28-683-742
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital, 2650 Edegem, Belgium;
- Department of Neurosurgery, University of Antwerp, 2000 Edegem, Belgium
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Petar Vuleković
- Clinic of Neurosurgery, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia;
| | - Charlie A. Sewalt
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
| | - Benjamin Y. Gravesteijn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Göttingen (UMG), 37075 Göttingen, Germany; (A.C.); (A.M.P.); (N.v.S.)
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0372 Oslo, Norway;
- Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, 0318 Oslo, Norway
| | - Anne Marie Plass
- Institute of Medical Psychology and Medical Sociology, University Medical Göttingen (UMG), 37075 Göttingen, Germany; (A.C.); (A.M.P.); (N.v.S.)
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Göttingen (UMG), 37075 Göttingen, Germany; (A.C.); (A.M.P.); (N.v.S.)
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The Recovery of GABAergic Function in the Hippocampus CA1 Region After mTBI. Mol Neurobiol 2019; 57:23-31. [DOI: 10.1007/s12035-019-01753-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
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10
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Haug Nordenmark T, Karic T, Røe C, Sorteberg W, Sorteberg A. The post-aSAH syndrome: a self-reported cluster of symptoms in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2019; 132:1556-1565. [PMID: 31003212 DOI: 10.3171/2019.1.jns183168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although many patients recover to a good functional outcome after aneurysmal subarachnoid hemorrhage (aSAH), residual symptoms are very common and may have a large impact on the patient's daily life. The particular cluster of residual symptoms after aSAH has not previously been described in detail and there is no validated questionnaire that covers the typical problems reported after aSAH. Many of the symptoms are similar to post-concussion syndrome, which often is evaluated with the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). In the present study, the authors therefore performed an exploratory use of the RPQ as a template to describe post-aSAH syndrome. METHODS The RPQ was administered to 128 patients in the chronic phase after aSAH along with a battery of quality-of-life questionnaires. The patients also underwent a medical examination besides cognitive and physical testing. Based on their RPQ scores, patients were dichotomized into a "syndrome" group or "recovery" group. RESULTS A post-aSAH syndrome was seen in 33% of the patients and their symptom burden on all RPQ subscales was significantly higher than that of patients who had recovered on all RPQ subscales. The symptom cluster consisted mainly of fatigue, cognitive problems, and emotional problems. Physical problems were less frequently reported. Patients with post-aSAH syndrome scored significantly worse on mobility and pain scores, as well as on quality-of-life questionnaires. They also had significantly poorer scores on neuropsychological tests of verbal learning, verbal short- and long-term memory, psychomotor speed, and executive functions. Whereas 36% of the patients in the recovery group were able to return to their premorbid occupational status, this was true for only 1 patient in the syndrome group. CONCLUSIONS Approximately one-third of aSAH patients develop a post-aSAH syndrome. These patients struggle with fatigue and cognitive and emotional problems. Patients with post-aSAH syndrome report more pain and reduced quality of life compared to patients without this cluster of residual symptoms and have larger cognitive deficits. In this sample, patients with post-aSAH syndrome were almost invariably excluded from return to work. The RPQ is a simple questionnaire covering the specter of residual symptoms after aSAH. Being able to acknowledge these patients' complaints as a defined syndrome using the RPQ should help patients to accept and cope, thereby alleviating possible secondary distress produced.
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Affiliation(s)
| | - Tanja Karic
- Departments of1Physical Medicine and Rehabilitation and
| | - Cecilie Røe
- Departments of1Physical Medicine and Rehabilitation and.,3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Angelika Sorteberg
- 2Neurosurgery, Oslo University Hospital; and.,3Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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11
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Balakrishnan B, Rus RM, Chan KH, Martin AG, Awang MS. Prevalence of Postconcussion Syndrome after Mild Traumatic Brain Injury in Young Adults from a Single Neurosurgical Center in East Coast of Malaysia. Asian J Neurosurg 2019; 14:201-205. [PMID: 30937035 PMCID: PMC6417307 DOI: 10.4103/ajns.ajns_49_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Context: Postconcussion syndrome (PCS) is a set of symptoms occurred after a mild traumatic brain injury (MTBI). Aims: This study aims to determine the prevalence of PCS in a young adult population from a single Neurological Centre in Malaysia's East Coast and to evaluate the factors associated with PCS in MTBI patients. Settings and Design: This was a cross-sectional study conducted in a Neurological Centre at Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia, from January 2016 to December 2016. Subjects and Methods: A total of 209 patients; 133 males and 76 females, in the age range of 16–84 years, were randomly recruited for this study. All the selected patients were subjected to the checklist for diagnosis of PCS as per International Statistical Classification of Diseases and Related Health Problems 10th edition classification at a 2-week interval. Statistical Analysis Used: Descriptive statistic and Multivariable Logistic Regression Model were used for frequency and percentage analyses of categorical variables, using SPSS version 23.0. Results: Only 20 patients were identified with PCS. There were more female (70%) patients with PCS than the male (30%) patients. The prevalence of PCS for 2 weeks, 3 and 6 months since injuries were 9.6%, 8.1%, and 8.1% respectively. Majority (80%) of the patients were found to have PCS due to road traffic accidents, while the remaining were attributed to assault (15%), and falls (5%). Among the sample population, 25% were smokers, while 10% of them had either skull fracture or premorbidity. Conclusion: Less than 10% of patients with MTBI had PCS after 6 months’ following trauma. None of the variables tested were significant factors for the development of PCS symptoms.
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Affiliation(s)
- Buveinthiran Balakrishnan
- Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
| | - Razman Mohd Rus
- Department of Community Medicine, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
| | - Kin Hup Chan
- Department of Neurosurgery, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
| | - Arvind Gerard Martin
- Department of Neurosurgery, Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | - Mohamed Saufi Awang
- Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia.,Department of Neurosurgery, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
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Voormolen DC, Cnossen MC, Polinder S, von Steinbuechel N, Vos PE, Haagsma JA. Divergent Classification Methods of Post-Concussion Syndrome after Mild Traumatic Brain Injury: Prevalence Rates, Risk Factors, and Functional Outcome. J Neurotrauma 2018; 35:1233-1241. [PMID: 29350085 PMCID: PMC6909759 DOI: 10.1089/neu.2017.5257] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a common diagnosis and approximately one third of mTBI patients experience a variety of cognitive, emotional, psychosocial, and behavioral post-concussion symptoms. When a cluster of these symptoms persists for more than 3 months they are often classified as post-concussion syndrome (PCS). The objective of this study was to determine prevalence rates, risk factors, and functional outcome associated with PCS 6 months after mTBI, applying divergent classification methods. Follow-up questionnaires at 6 months after mTBI included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and the Glasgow Outcome Scale Extended (GOSE). The RPQ was analyzed according to different classification methods: the mapped International Classification of Diseases, 10th revision (ICD-10)/Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the RPQ total score, the RPQ3 and the three-factor model using two different cutoff points (mild or worse and moderate or worse). Our results from a sample of 731 mTBI patients showed that prevalence rates of PCS ranged from 11.4% to 38.7% using divergent classification methods. According to all eight methods, 6.3% (n = 46) of mTBI patients experienced PCS. Applying the divergent classification methods resulted in a different set of predictors being statistically significantly associated with PCS, and a different percentage of overlap with functional impairment, measured with the GOSE. In conclusion, depending on the classification method and rating score used, prevalence rates of PCS deviated considerably. For future research, consensus regarding the diagnostic criteria for PCS and the analysis of the RPQ should be reached, to enhance comparability of studies regarding PCS after mTBI.
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Affiliation(s)
- Daphne C. Voormolen
- Department of Public Health, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Maryse C. Cnossen
- Department of Public Health, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, Georg-August-University, Göttingen, Germany
| | - Pieter E. Vos
- Department of Neurology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus University Medical Center Rotterdam, The Netherlands
- Department of Emergency Medicine, Erasmus University Medical Center Rotterdam, The Netherlands
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Chen JX, Lindeborg M, Herman SD, Ishai R, Knoll RM, Remenschneider A, Jung DH, Kozin ED. Systematic review of hearing loss after traumatic brain injury without associated temporal bone fracture. Am J Otolaryngol 2018; 39:338-344. [PMID: 29506762 DOI: 10.1016/j.amjoto.2018.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 01/31/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE While hearing loss following temporal bone fracture is a well-described phenomenon, few data exist on auditory dysfunction in patients with traumatic brain injury (TBI) without temporal bone fracture. Herein, we aim to systematically review hearing loss after TBI without bony fracture and describe its etiologies. DATA SOURCES Pubmed, Embase, Cochrane databases. REVIEW METHODS A systematic review of the literature from 1966 to January 2017 was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. Data were obtained from studies that investigated hearing loss in TBI without skull fracture according to an a priori protocol with inclusion and exclusion criteria. Variables included type and severity of hearing loss, as well as pathophysiology of hearing loss. RESULTS There were 13 studies with 773 patients that met study criteria. Overall, there was one prospective cohort study, four retrospective cohort studies, two case-control studies, and six case reports. The studies with the highest level of evidence report a change in hearing of at least 10-15 dB across a range of frequencies in as many as 58% percent of TBI patients without bony fracture, which was transient or chronic. The mechanism/severity of injury may impact the rate of hearing loss. CONCLUSIONS Hearing loss after TBI in the absence of bony injury appears to be a clinically significant but poorly characterized phenomenon.
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Mosti C, Coccaro EF. Mild Traumatic Brain Injury and Aggression, Impulsivity, and History of Other- and Self-Directed Aggression. J Neuropsychiatry Clin Neurosci 2018; 30:220-227. [PMID: 29505319 PMCID: PMC6081254 DOI: 10.1176/appi.neuropsych.17070141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Mild traumatic brain injury (mTBI) is highly prevalent, with an estimated occurrence in the United States of more than 1.3 million per year. While one consequence of mTBI is impulsive aggressive behavior, very few studies have examined the relationship between history of mTBI and aggressive behavior in impulsively aggressive individuals. The authors examined the relationship between history of mTBI in a healthy control group (HC; N=453), a control group with psychiatric disorders (PC; N=486), and individuals with intermittent explosive disorder (IED; N=695), a disorder of primary impulsive aggression. Results demonstrated that IED study participants were significantly more likely to have a history of mTBI (with or without history of a brief loss of consciousness [LOC]) compared with both HC and PC participants. A similar observation was made with regard to self-directed aggression (i.e., suicidal or self-injurious behavior), although group differences were only among those with mTBI with LOC. For both other- and self-directed aggression variables, the authors observed a stepwise increase in dimensional aggression and impulsivity scores across participants as a function of mTBI history. Given that impulsive aggressive behavior begins very early in life, these data are consistent with the hypothesis that lifelong presence of an impulsive aggressive temperament places impulsive aggressive individuals in circumstances that put them at greater risk for mTBI compared with other individuals with and without nonimpulsive aggressive psychopathology.
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Affiliation(s)
- Caterina Mosti
- From the Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago (CM, EFC)
| | - Emil F Coccaro
- From the Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago (CM, EFC)
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Lee JY, Yoon YH, Lewis RJ, Tolles J. Frequency of Post-Concussion Syndrome in Korean Patients with Minor Head Injury. JOURNAL OF TRAUMA AND INJURY 2017. [DOI: 10.20408/jti.2017.30.2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ji Young Lee
- Department of Emergency Medicine, Korea University, Guro Hospital, Seoul, Korea
| | - Young Hoon Yoon
- Department of Emergency Medicine, Korea University, Guro Hospital, Seoul, Korea
| | - Roger J. Lewis
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Los Angeles Biomedical Research Institute, Torrance, California
- David Geffen School of Medicine, University of California, Los Angeles
| | - Juliana Tolles
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Los Angeles Biomedical Research Institute, Torrance, California
- David Geffen School of Medicine, University of California, Los Angeles
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McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One 2017; 12:e0174847. [PMID: 28399158 PMCID: PMC5388340 DOI: 10.1371/journal.pone.0174847] [Citation(s) in RCA: 279] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/16/2017] [Indexed: 11/26/2022] Open
Abstract
Mild traumatic brain injury (mTBI), or concussion, is the most common type of traumatic brain injury. With mTBI comes symptoms that include headaches, fatigue, depression, anxiety and irritability, as well as impaired cognitive function. Symptom resolution is thought to occur within 3 months post-injury, with the exception of a small percentage of individuals who are said to experience persistent post-concussion syndrome. The number of individuals who experience persistent symptoms appears to be low despite clear evidence of longer-term pathophysiological changes resulting from mTBI. In light of the incongruency between these longer-term changes in brain pathology and the number of individuals with longer-term mTBI-related symptoms, particularly impaired cognitive function, we performed a scoping review of the literature that behaviourally assessed short- and long-term cognitive function in individuals with a single mTBI, with the goal of identifying the impact of a single concussion on cognitive function in the chronic stage post-injury. CINAHL, Embase, and Medline/Ovid were searched July 2015 for studies related to concussion and cognitive impairment. Data relating to the presence/absence of cognitive impairment were extracted from 45 studies meeting our inclusion criteria. Results indicate that, in contrast to the prevailing view that most symptoms of concussion are resolved within 3 months post-injury, approximately half of individuals with a single mTBI demonstrate long-term cognitive impairment. Study limitations notwithstanding, these findings highlight the need to carefully examine the long-term implications of a single mTBI.
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Affiliation(s)
- Kerry McInnes
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christopher L. Friesen
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Diane E. MacKenzie
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David A. Westwood
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shaun G. Boe
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
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Abstract
OBJECTIVE To examine factors relating to return to work (RTW) following mild traumatic brain injury (mTBI). PARTICIPANTS One hundred and nine patients (Age: M = 37.4 years, SD = 13.2; 52.3% women) who sustained an mTBI. DESIGN Inception cohort design with questionnaires and neuropsychological testing completed approximately 3 to 4 weeks postinjury. SETTING Emergency Department of Tampere University Hospital, Finland. MAIN OUTCOME MEASURES Self-report (postconcussion symptoms, depression, fatigue, and general health) and neurocognitive measures (attention and memory). RESULTS The cumulative RTW rates were as follows: 1 week = 46.8%, 2 weeks = 59.6%, 3 weeks = 67.0%, 4 weeks = 70.6%, 2 months = 91.7%, and 1 year = 97.2%. Four variables were significant predictors of the number of days to RTW: age, multiple bodily injuries, intracranial abnormality at the day of injury, and fatigue ratings (all P < .001). The largest amount of variance accounted for by these variables in the prediction of RTW was at 30 days following injury (P < .001, R = 0.504). Participants who returned to work fewer than 30 days after injury (n = 82, 75.2%) versus more than 30 days (n = 27, 24.8%) did not differ on demographic or neuropsychological variables. CONCLUSIONS The vast majority of this cohort returned to work within 2 months. Predictors of slower RTW included age, multiple bodily injuries, intracranial abnormality at the day of injury, and fatigue.
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The influence of BMX gene polymorphisms on clinical symptoms after mild traumatic brain injury. BIOMED RESEARCH INTERNATIONAL 2014; 2014:293687. [PMID: 24860816 PMCID: PMC4016905 DOI: 10.1155/2014/293687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/04/2014] [Indexed: 12/27/2022]
Abstract
Mild traumatic brain injury (mTBI) is one of the most common neurological disorders. Most patients diagnosed with mTBI could fully recover, but 15% of patients suffer from persistent symptoms. In recent studies, genetic factors were found to be associated with recovery and clinical outcomes after TBI. In addition, results from our previous research have demonstrated that the bone marrow tyrosine kinase gene in chromosome X (BMX), a member of the Tec family of kinases, is highly expressed in rats with TBI. Therefore, our aim in this study was to identify the association between genetic polymorphisms of BMX and clinical symptoms following mTBI. Four tagging single nucleotide polymorphisms (tSNPs) of BMX with minimum allele frequency (MAF) >1% were selected from the HapMap Han Chinese database. Among these polymorphisms, rs16979956 was found to be associated with the Beck anxiety inventory (BAI) and dizziness handicap inventory (DHI) scores within the first week after head injury. Additionally, another SNP, rs35697037, showed a significant correlation with dizziness symptoms. These findings suggested that polymorphisms of the BMX gene could be a potential predictor of clinical symptoms following mTBI.
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Berz K, Divine J, Foss KB, Heyl R, Ford KR, Myer GD. Sex-specific differences in the severity of symptoms and recovery rate following sports-related concussion in young athletes. PHYSICIAN SPORTSMED 2013; 41:58-63. [PMID: 23703518 DOI: 10.3810/psm.2013.05.2015] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION While research on adult recovery from concussion indicates sex-specific symptoms and recovery rates, there is little existing data on younger patient populations. OBJECTIVE To determine sex-specific differences in the severity of presenting symptoms and recovery rate between groups of young athletes who presented ≤ 7 or > 7 days after sports-related concussion. METHODS This study was a retrospective review of athletes aged 9 to 17 years who were referred for evaluation of a sports-related concussion over a 24-month period. The study groups were divided by sex and post-injury presentation to the clinic at ≤ 7 days and > 7 days from the date of injury. Athletes with learning disabilities were excluded from the study and data analysis. Age, height, and weight were recorded for each subject. Each subject also reported their initial degree of confusion, amnesia, or loss of consciousness, and whether a helmet was worn when the injury was sustained. A 22-item post-concussion symptom score (SS) scale was completed by both groups on initial assessment (SS1) and follow-up visit (SS2). The recovery rate (SSR) was calculated as (SS2-SS1)/days between SS2 and SS1. Sex and group comparisons for SS1 and SSR were performed using 2 × 2 analysis of variance. A similar analysis was also performed for effects of sex on SS1 and SSR in patients who were not wearing a helmet. RESULTS Thirty-seven athletes aged 15.0 ± 1.9 years were evaluated. Males, regardless of day of presentation, had a lower SS1 evaluation than females (15.8 vs 30.9; P < 0.05). Males without helmets did not differ from females without helmets, but this was not significantly different (14.1 vs 29.6; P = 0.1). There was not a significant difference in SS1 evaluation between the groups who presented at ≤ 7 or > 7 days. The overall mean SSR was -1.2/day, with no significant difference seen between groups or sex. There were no significant differences in degree of loss of consciousness, amnesia, confusion, or age between the sexes or groups. CONCLUSION Whether presenting at ≤ 7 or > 7 days following a sports-related concussion, female athletes reported a higher SS1 evaluation. With SSR being similar between sexes, the current data suggest that young, female athletes may take longer to become symptom free following sports-related concussion. This information may be an important factor in returning a young athlete to sport after sports-related concussion.
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Affiliation(s)
- Kate Berz
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Puljula J, Cygnel H, Mäkinen E, Tuomivaara V, Karttunen V, Karttunen A, Hillbom M. Mild traumatic brain injury diagnosis frequently remains unrecorded in subjects with craniofacial fractures. Injury 2012; 43:2100-4. [PMID: 22552039 DOI: 10.1016/j.injury.2012.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 03/09/2012] [Accepted: 04/07/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traumatic brain injuries (TBI) in subjects with craniofacial fractures are usually diagnosed by emergency room physicians. We investigated how often TBI remains unrecorded in these subjects, and whether diagnostic accuracy has improved after the implementation of new TBI guidelines. METHODS All subjects with craniofacial fractures admitted to Oulu University Hospital in 1999 and in 2007 were retrospectively identified. New guidelines for improving the diagnostic accuracy of TBI were implemented between 2000 and 2006. Clinical symptoms of TBI were gathered from notes on hospital charts and compared to the recorded diagnoses at discharge. Logistic regression was used to identify independent predictors for TBI to remain unrecorded. RESULTS Of 194 subjects with craniofacial fracture, 111(57%) had TBI, 40 in 1999 and 71 in 2007. Fifty-one TBIs (46%) remained unrecorded at discharge, 48 being mild and 3 moderate-to-severe. Subjects with unrecorded TBI were significantly less frequently referred to follow-up visits. Failures to record the TBI diagnosis were less frequent (29/71, 41%) in 2007 than in 1999 (22/40, 55%), but the difference was not statistically significant. The most significant independent predictor for this failure was the clinical specialty (other than neurology/neurosurgery) of the examining physician (p<0.001). The subject's alcohol intoxication did not hamper the diagnosis of TBI. CONCLUSIONS TBIs remain frequently unrecorded in subjects with craniofacial fractures. Recording of mild TBI slightly but insignificantly improved after the implementation of new guidelines.
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Affiliation(s)
- Jussi Puljula
- Department of Neurology, Oulu University Hospital, Finland.
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Postconcussion Syndrome: A Physiatrist's Approach. PM R 2011; 3:S396-405. [DOI: 10.1016/j.pmrj.2011.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 01/11/2023]
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Internationale und nationale Leitlinien für die Indikation zur Bildgebung bei Verdacht auf leichtes Schädel-Hirn-Trauma. Notf Rett Med 2011. [DOI: 10.1007/s10049-011-1422-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Berrigan L, Marshall S, McCullagh S, Velikonja D, Bayley M. Quality of clinical practice guidelines for persons who have sustained mild traumatic brain injury. Brain Inj 2011; 25:742-51. [DOI: 10.3109/02699052.2011.580317] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Das „leichte“Schädel-Hirn-Trauma. Notf Rett Med 2011. [DOI: 10.1007/s10049-011-1421-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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