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Bailey C, Soden D, Maroon J, Selman W, Tangen C, Gunstad J, Briskin S, Miskovsky S, Miller E, Pieper AA. Elevated Autoantibodies to the GluA1 Subunit of the AMPA Receptor in Blood Indicate Risk of Cognitive Impairment in Contact Sports Athletes, Irrespective of Concussion. Neurotrauma Rep 2024; 5:552-562. [PMID: 39071979 PMCID: PMC11271151 DOI: 10.1089/neur.2023.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
To address the need for objective tests of concussion in athletes, we conducted a prospective clinical study in National Collegiate Athletic Association athletes of the relationship between neurocognitive performance and blood levels of the GluA1 subunit of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor peptides and autoantibodies to GluA1. Specifically, we compared 44 contact sport athletes to 16 noncontact sport athletes, with Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), as well as blood sample collection, before the start of the season and at the end of the season. Contact sport athletes exhibited significantly elevated serum GluA1 autoantibodies at the end of season, compared with preseason levels, irrespective of whether they sustained a concussion. Noncontact sport athletes showed no change in serum GluA1 autoantibodies, and neither group showed differences in GluA1 peptides. Amongst contact-sport athletes, the 'high GluA1 autoantibody group' (≥4 ng/mL) displayed impaired reaction time, a measure of cognitive impairment, while the 'low GluA1 autoantibody group' (<4 ng/mL) displayed normal reaction time. Our results reveal that contact sport athletes are at risk for developing cognitive impairment even without sustaining a diagnosed concussion and that serum GluA1 autoantibodies provide a blood-based biomarker of this risk. This could guide future studies on the differing susceptibility to cognitive impairment in contact sport athletes and facilitate efficient allocation of resources to contact sport athletes identified as having increased risk of developing cognitive impairment.
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Affiliation(s)
- Christopher Bailey
- Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Sports Medicine Concussion Center, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Daniel Soden
- University Hospitals Sports Medicine Concussion Center, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Joseph Maroon
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Warren Selman
- Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Sports Medicine Concussion Center, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Christopher Tangen
- Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Susannah Briskin
- Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Sports Medicine Concussion Center, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Shana Miskovsky
- Department of Neurology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Sports Medicine Concussion Center, University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Emiko Miller
- Brain Health Medicines Center, Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Geriatric Psychiatry, GRECC, Louis Stokes VA Medical Center, Cleveland, Ohio, USA
- Institute for Transformative Molecular Medicine, School of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Andrew A. Pieper
- Brain Health Medicines Center, Harrington Discovery Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Psychiatry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Geriatric Psychiatry, GRECC, Louis Stokes VA Medical Center, Cleveland, Ohio, USA
- Institute for Transformative Molecular Medicine, School of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Neurosciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Boden BP, Brown ID, Huckleby JM, Ahmed AE, Anderson SA. Sport-related Structural Brain Injury in High School and College American Football Athletes, 2002-2020: Effect of Lystedt Law. Sports Health 2023; 15:718-726. [PMID: 36457209 PMCID: PMC10467486 DOI: 10.1177/19417381221134112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND A previous report revealed an average of 7.2 (0.67 per 100,000 participants) sport-related structural brain injuries (SRSBIs) with macroscopic lesions per year in high school (HS) and college football players. The Lystedt law and other rule changes have been implemented with intent to reduce the risk of brain injury in football. HYPOTHESIS To update the profile of SRSBIs in HS and college football players and evaluate the efficacy of legislation intended to reduce brain injuries. STUDY DESIGN Descriptive epidemiology study. LEVEL OF EVIDENCE Level 4. METHODS We retrospectively reviewed 18 academic years (July 2002 through June 2020) of SRSBIs catalogued by the National Registry of Catastrophic Sports Injuries. The incidence of SRSBIs was assessed at the HS level during the pre (July 2002 through June 2009), transitional (July 2009 through June 2014), and post (July 2014 through June 2020) universal adoption time periods of the Lystedt law. In addition, the incidence of SRSBIs during the second half of the study (2011-2012 through 2019-2020) was compared with the first half of the study (2002-2003 through 2010-2011). RESULTS During the study period, there was a total of 228 SRSBIs (12.7 per year, 1.01 per 100,000 participants): 212 (93%, 11.8 per year, 1.00 per 100,000) in HS athletes and 16 (7%, 0.89 per year, 1.17 per 100,000) in college athletes. There were 52 fatalities (2.9 per year, 0.22 per 100,000 participants) with 46 (2.56 per year, 0.22 per 100,000) in HS athletes and 6 (0.33 per year, 0.43/100,000) in college athletes. There was no significant difference in risk of HS total SRSBIs or fatalities during the 3 Lystedt periods. The risk of combined SRSBI cases [relative risk (RR) = 1.22, P = 0.13] and fatalities (RR = 1.20, P = 0.52) was similar in the second half of the study compared with the first half of the study. CONCLUSION Despite implementation of rule changes intended to reduce head injury, in particular the Lystedt law, the incidence of SRSBIs has remained unchanged. Further research is necessary to develop effective prevention programs for SRSBIs. CLINICAL RELEVANCE SRSBIs remain a persistent problem in HS and college American football. The recent head injury rule changes have not been effective at reducing SRSBIs.
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Affiliation(s)
- Barry P. Boden
- The Orthopedic Center, a division of CAO, Rockville, Maryland
| | - Isaiah D.J. Brown
- The University of Chicago Pritzer School of Medicine, Chicago, Illinois
| | - Jeremy M. Huckleby
- Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Anwar E. Ahmed
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Scott A. Anderson
- Department of Intercollegiate Athletics, University of Oklahoma, Norman, Oklahoma
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Sports-Related Concussion Is a Personalized Issue—Evaluation of Medical Assessment and Subjective Feeling of the Athlete in a German Level 1 Trauma Center. J Pers Med 2022; 12:jpm12101596. [PMID: 36294735 PMCID: PMC9605563 DOI: 10.3390/jpm12101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
Abstract
Sports-related concussions (SRC) have developed into a highly discussed topic in sports medicine over the last few years and demonstrate a severe issue in the personalized treatment of patients. This retrospective cohort study investigated 86 patients with sports-related concussions in a level 1 trauma center, relating to the mechanism, symptoms, medical history, acute therapy including first assessment and the return to sport. The research is based on medical records as well as questionnaires six months after hospitalization. Loss of consciousness for under 30 min (41.2%), headache (36.5%) and amnesia (29.4%) were the most frequent symptoms when presenting in the emergency room. During the hospitalization, mainly headache and vertigo were documented. Most concussions occurred after incidents in equitation and cycling sports; the most common mechanism was falling to the ground with a subsequent impact (59.3%). At the time of discharge from hospital, in 13.4% of all cases, concussion symptoms were still documented in medical records, in contrast to 39.5% of the concerned athletes who reported symptoms for longer than 24 h, and 41.0% who reported ongoing post-concussion symptoms after six months. Concussions are difficult-to-treat disorders with a challenging diagnostic process and many symptoms in various values and levels of persistence. Therefore, a patient-involving treatment with a complaint-dependent return to sport process should be applied to concerned athletes.
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Sullivan L, Newton A, Shi J, Chang TJ, Yang J. Concussion-Related Health Care Utilization Among Medicaid Insured Children in Ohio: Rural and Urban Differences. J Rural Health 2021; 37:479-486. [PMID: 32744752 PMCID: PMC10949251 DOI: 10.1111/jrh.12484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE The current study examines rural-urban differences in trends in rates and type of concussion-related health care utilization over time from 2008 to 2016 among Medicaid insured children in Ohio. METHODS We analyzed Medicaid claims for health care utilization for diagnosed concussions among children aged ≤18 years between April 1, 2008, and December 31, 2016. We compared the trends in rates of concussion-related health care utilization between children who lived in rural and urban areas using Poisson regressions. We examined trends in the type of concussion-related health care utilization by location of residence using linear regressions. FINDINGS We found a significant increase in health care utilization for concussion over time, with rates of treated concussion consistently higher in rural children compared to urban children (P < .0001) throughout the study period. Although initial care at the Emergency Department (ED) remained the most common type of initial concussion-related health care utilization for rural children throughout the study period, the most common type of initial care sought by urban children shifted over time from the ED to primary care providers (PCPs). For both rural and urban children, PCPs remained the most common type of follow-up care sought throughout the study period, with no significant rural-urban differences in the trends of follow-up care sought through PCPs over time. CONCLUSIONS We observed significant rural-urban differences in the trends in rates and types of concussion-related health care utilization over time from 2008 to 2016. Future studies are needed to further our understanding of the effect of these observed rural-urban differences on concussion recovery.
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Affiliation(s)
- Lindsay Sullivan
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Alison Newton
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Junxin Shi
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Teng-Jen Chang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University, College of Medicine, Columbus, Ohio
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Yang J, Harvey HH, Sullivan L, Huang L, Dawn Comstock R. Association Between Design Elements of Concussion Laws and Reporting of Sports-Related Concussions Among US High School Athletes, 2009-2017. Public Health Rep 2021; 136:745-753. [PMID: 33626288 DOI: 10.1177/0033354920988611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Studies that evaluate the effectiveness of concussion laws often use only a single variable (ie, presence of the law), failing to account for law complexity. We examined the association between multiple design elements of state concussion laws and rates of sports-related concussion reporting among US high school athletes. METHODS We derived 3 design elements of concussion laws from the 2009-2017 LawAtlas database: (1) strength of law, (2) number of law revisions, and (3) speed of law adoption. We examined the association between these design elements and rates of new and recurrent sports-related concussion reporting from the 2009-2010 through 2016-2017 academic years in a nationally representative sample of high school athletes participating in High School Report Information Online, an online data collection tool. RESULTS A total of 7064 sports-related concussions (6332 [89.6%] new and 732 [10.4%] recurrent concussions) were reported during the study period, with an overall rate of 39.7 sports-related concussions per 100 000 athletic exposures (eg, game or practice). Rates of new concussion reporting were higher among high schools in states with medium- or high-strength concussion laws than in states with low-strength concussion laws and in states with at least 1 concussion law revision than in states with no concussion law revisions. Rates of recurrent concussion reporting were lower among high schools in states with ≥2 concussion law revisions than in states with <2 concussion law revisions. Early law adoption was associated with higher rates of new and recurrent concussion reporting, and late law adoption was associated with lower rates of new and recurrent concussion reporting. CONCLUSION Our findings may help inform legislators of the public health effect of concussion laws.
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Affiliation(s)
- Jingzhen Yang
- 51711 Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, College of Medicine and Department of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Hosea H Harvey
- 33661 Beasley School of Law, Temple University, Philadelphia, PA, USA
| | - Lindsay Sullivan
- 51711 Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Discipline of Children's Studies, National University of Ireland, Galway, Ireland
| | - Lihong Huang
- 51711 Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - R Dawn Comstock
- 144805 Department of Epidemiology, University of Colorado School of Public Health, Aurora, CO, USA
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Newton A, Yang J, Shi J, Sullivan L, Huang L, Singichetti B, Zhu M, Felix AS. Sports and non-sports-related concussions among Medicaid-insured children: health care utilization before and after Ohio's concussion law. Inj Epidemiol 2020; 7:55. [PMID: 33131503 PMCID: PMC7604964 DOI: 10.1186/s40621-020-00283-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/11/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate patterns of health care utilization for sports-related concussions (SRCs) and non-sports-related concussions (NSRCs) among Medicaid-insured children before and after the enactment of Ohio’s concussion law in April 2013. Methods We analyzed claim data from the Partners For Kids (PFK) Ohio Medicaid database. Concussion diagnoses were identified between April 1, 2008 and June 30, 2017. We compared frequency of concussions by age and sex across the law period. We evaluated type of health care utilization before and after law enactment using multinomial logistic regression. Results Over the 9 year study period, 6157 concussions were included, most of which (70.4%) were NSRCs. The proportion of SRCs increased with age. Among children younger than 5 years old, the majority (96.1%) of concussions were NSRCs. During the post-law period, greater odds of primary care visits than emergency department (ED) visits were observed for both SRCs (OR = 1.53; 95% CI 1.34, 1.75) and NSRCs (OR = 1.73; 95% CI 1.58, 1.90) compared to the pre-law period. Conclusions We observed higher proportions of health care utilization for NSRCs than SRCs in Medicaid insured children and a shift in health care utilization from the ED to primary care in the post-law period. SRCs and NSRCs are likely to have different patterns of health care utilization before and after the enactment of Ohio’s concussion law. Our results demonstrate that Ohio’s youth concussion law had a quantifiable impact on health care utilization.
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Affiliation(s)
- Alison Newton
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA.,College of Public Health, Department of Epidemiology, Ohio State University, Columbus, OH, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA. .,College of Public Health, Department of Epidemiology, Ohio State University, Columbus, OH, USA.
| | - Junxin Shi
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA
| | - Lindsay Sullivan
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA
| | - Lihong Huang
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA
| | - Bhavna Singichetti
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA
| | - Motao Zhu
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive - RBIII, Columbus, OH, 43205, USA.,College of Public Health, Department of Epidemiology, Ohio State University, Columbus, OH, USA
| | - Ashley S Felix
- College of Public Health, Department of Epidemiology, Ohio State University, Columbus, OH, USA
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Huang L, Sullivan L, Yang J. Analyzing the impact of a state concussion law using an autoregressive integrated moving average intervention analysis. BMC Health Serv Res 2020; 20:898. [PMID: 32972408 PMCID: PMC7517644 DOI: 10.1186/s12913-020-05742-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Existing studies analyzing the impact of state concussion laws have found an increase in concussion-related medical encounters post-law, in some instances, such increases were observed during the pre-law period due to a potential "spillover" effect. This study assessed the effects of Ohio's concussion law, while accounting for such a "spillover" effect, on the trends in monthly rates of concussion-related medical encounters in Medicaid insured children using autoregressive integrated moving average (ARIMA) analysis. METHODS We analyzed claim data obtained from the Partners For Kids database, a pediatric accountable care organization in Ohio. Concussion-related medical encounters for Medicaid-insured children (ages 0-18 years) treated between April 1, 2008 to December 31, 2016 were selected and analyzed. We assessed pre- and post-law trends in concussion-related medical encounters using an ARIMA intervention model. We also used traditional regression methods to validate the study results. RESULTS A total of 16,943 concussion-related medical encounters sustained by 15,545 unique patients were included. Monthly rates of concussion-related medical encounters significantly increased from 4.64 per 10,000 member months during the pre-law period to 6.69 per 10,000 member months in the post-law period (P < 0.0001). Three upward breaks in the monthly rates of concussion-related medical encounters were observed between 2009 and 2016, with two breaks observed during the pre-law period. Specifically, the increased breakpoint observed in July 2011 (P = 0.0186) was significantly associated with an estimated 7.3% increase (95% CI: 1.1-13.7) in the rate of concussion-related medical encounters. This finding was confirmed in the Poisson regression and curve fitting models. Furthermore, a seasonal trend in concussion-related medical encounters was observed with the highest rates in September and October of each year. CONCLUSIONS Two of the three upward breaks identified in the monthly rate of concussion-related medical encounters occurred before the enactment of Ohio's concussion law, suggesting a potential "spillover" effect. Further research is needed to confirm such an effect in children with other types of medical insurance.
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Affiliation(s)
- Lihong Huang
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, 200032 China
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, RB3-WB5403, Columbus, OH 43205 USA
| | - Lindsay Sullivan
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, RB3-WB5403, Columbus, OH 43205 USA
- Discipline of Children’s Studies, College of Arts, Social Sciences, & Celtic Studies, National University of Ireland, Galway, Galway, Ireland
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, 700 Children’s Drive, RB3-WB5403, Columbus, OH 43205 USA
- The Ohio State University, College of Medicine, Columbus, OH 43205 USA
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Stelzer JW, Esplin NE, Sbeih F, Ben Khallouq BA, Field M. Commentary: The Florida Youth Concussion Law: A Survey-Based Observational Study of Physician Practices and Their Legislative Awareness. Neurosurgery 2020; 85:E592-E598. [PMID: 31215636 DOI: 10.1093/neuros/nyz217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- John W Stelzer
- University of Central Florida, College of Medicine, Orlando, Florida
| | - Nathan E Esplin
- University of Central Florida, College of Medicine, Orlando, Florida
| | - Firas Sbeih
- University of Central Florida, College of Medicine, Orlando, Florida
| | | | - Melvin Field
- Florida Hospital Neuroscience Institute, Orlando, Florida
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Tarimala A, Singichetti B, Yi H, Huang L, Doerschuk R, Tiso M, Yang J. Initial Emergency Department Visit and Follow-Up Care for Concussions among Children with Medicaid. J Pediatr 2019; 206:178-183. [PMID: 30442410 DOI: 10.1016/j.jpeds.2018.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/17/2018] [Accepted: 10/10/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe the rates and patterns of initial emergency department (ED) encounters and follow-up care for concussions among Medicaid-insured children before and after the 2013 enactment of Ohio concussion law. STUDY DESIGN Using a time-series design, this study analyzed concussion claim data obtained from Partners for Kids, a pediatric accountable-care organization in Ohio. A total of 12 512 concussions and 48 238 associated claims for services between January 1, 2008, and June 30, 2017, with an initial ED encounter among Medicaid-insured children (ages 0-18 years) were analyzed. The effect of the law on the odds of follow-up care were assessed using generalized estimating equations models, adjusted for sex, age group, and residence location. RESULTS Of the total 12 512 concussions, 63.9% occurred in male patients, 70.1% in patients ages 10-18 years, and 65.2% in patients from urban areas. The rate of initial ED encounters for concussions increased from 2008 to 2014 (2.8 to 4.9 per 10 000 members), followed by a decrease in 2016 (4.2 per 10 000 members). A significant increase in follow-up care after the initial ED encounter was observed from pre-law to post-law (OR 1.73, 95% CI 1.61, 1.86). A shift in follow-up care was observed from radiology and ambulance services in pre-law to primary care providers in post-law. CONCLUSIONS The Ohio concussion law may have influenced the patterns of initial ED visit and follow-up care for concussions among Medicaid-insured children. Future studies evaluating the impact of the law should analyze the utilization patterns among children with various insurance/payment types.
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Affiliation(s)
- Anirudh Tarimala
- Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH
| | - Bhavna Singichetti
- Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH
| | - Honggang Yi
- Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH; Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Lihong Huang
- Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH
| | | | - Michael Tiso
- The Ohio State University College of Medicine, Columbus, OH
| | - Jingzhen Yang
- Nationwide Children's Hospital, Center for Injury Research and Policy, Columbus, OH; The Ohio State University College of Medicine, Columbus, OH.
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Matveev R, Sergio L, Fraser-Thomas J, Macpherson AK. Trends in concussions at Ontario schools prior to and subsequent to the introduction of a concussion policy - an analysis of the Canadian hospitals injury reporting and prevention program from 2009 to 2016. BMC Public Health 2018; 18:1324. [PMID: 30497446 PMCID: PMC6267048 DOI: 10.1186/s12889-018-6232-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Concussion is a preventable injury that can have long-term health consequences for children and youth. In Ontario, the Policy/Program Memorandum # 158 (PPM) was introduced by the Ministry of Education of Ontario in March 2014. The PPM's main purpose is to require each school board in the province to create and implement a concussion policy. The purpose of this paper is to examine trends in school-based concussions prior to and subsequent to the introduction of the PPM. METHODS This report examined emergency department (ED) visits in 5 Ontario hospitals that are part of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), and compared trends over time in diagnosed concussions, and suspected concussions identified as "other head injury" in children and youth aged 4-18. RESULTS From 2009 to 2016 study years, there were 21,094 suspected concussions, including 8934 diagnosed concussions in youth aged 4-18. The average number of diagnosed concussions in the 5 years before the PPM was 89 concussions/month, compared to approximately 117 concussions per month after; a 30% increase in the monthly rate of concussions presenting to the ED. The total number of concussion or head injury-related ED visits remained relatively unchanged but the proportion of diagnosed concussions rose from 31% in 2009 to 53% in 2016. The proportion of diagnosed concussions in females also increased from 38% in 2013 to 46% in 2016. The percent of all diagnosed concussions occurring at schools increased throughout the study reaching almost 50% in 2016 with most injuries taking place at the playground (24%), gymnasium (22%) or sports field (20%). CONCLUSIONS The introduction of the PPM may have contributed to a general increase in concussion awareness and an improvement in concussion identification at the school level in children and youth aged 4-18.
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Affiliation(s)
- Roman Matveev
- School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Lauren Sergio
- School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Jessica Fraser-Thomas
- School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Alison K Macpherson
- School of Kinesiology & Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
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Trends in Pediatric Emergency Department Utilization for Mild Traumatic Brain Injury Before and After Legislation. J Head Trauma Rehabil 2018; 33:E30-E37. [DOI: 10.1097/htr.0000000000000397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cuff SC, Coxe K, Young JA, Li H, Yi H, Yang J. Concussion clinic presentation and symptom duration for pediatric sports-related concussions following Ohio concussion law. Res Sports Med 2018; 27:11-20. [PMID: 30027763 DOI: 10.1080/15438627.2018.1502186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In 2013, Ohio enacted a law to mitigate consequences of pediatric sports-related concussions. This study aimed to describe changes in clinic visits and symptom duration for pediatric sports-related concussions before and after this law. 3,133 new visits by 2,861 unique patients (10-18 years) presenting between April 2012 and April 2015 for sports-related concussions within 30 days of injury were included. There were 937 (29.9%), 1,132 (36.1%) and 1,064 (34.0%) concussion visits for pre-law, immediate-post law, and post-law periods, respectively. A greater proportion of concussion visits was observed among females from pre-law to post-law (P < 0.0001). No differences were observed across the three periods in symptom scores at injury (P = 0.5028) or at first clinic visit (P = 0.5686). However, patients presented to concussion clinics significantly earlier (17.6 vs. 22.8 days, P < 0.0001) and had quicker recovery (26.5 vs. 40.6 days, P < 0.0001) post-law than pre-law.
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Affiliation(s)
- Steven C Cuff
- a Division of Sports Medicine , Nationwide Children's Hospital , Columbus , OH , USA.,e Department of Pediatrics , College of Medicine, The Ohio State University , Columbus , OH , USA
| | - Kathryn Coxe
- b Center for Injury Research and Policy , The Research Institute at Nationwide Children's Hospital , Columbus , OH , USA
| | - Julie A Young
- a Division of Sports Medicine , Nationwide Children's Hospital , Columbus , OH , USA
| | - Hongmei Li
- b Center for Injury Research and Policy , The Research Institute at Nationwide Children's Hospital , Columbus , OH , USA.,c Department of Epidemiology and Biostatistics , School of Public Health, Medical College of Soochow University , Suzhou , Jiangsu , China
| | - Honggang Yi
- b Center for Injury Research and Policy , The Research Institute at Nationwide Children's Hospital , Columbus , OH , USA.,d Department of Biostatistics , School of Public Health, Nanjing Medical University , Nanjing , Jiangsu , China
| | - Jingzhen Yang
- b Center for Injury Research and Policy , The Research Institute at Nationwide Children's Hospital , Columbus , OH , USA.,e Department of Pediatrics , College of Medicine, The Ohio State University , Columbus , OH , USA
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13
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Hassen GW, Tinnesz N, Popkin M, Mirkovic J, Pingle A, Umandap C, Sethuraman V, Warren R, Villa JAC, Kalantari H. Concussion awareness among children and their care givers. Am J Emerg Med 2018; 36:2328-2331. [PMID: 29752164 DOI: 10.1016/j.ajem.2018.04.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Getaw Worku Hassen
- Department of Emergency Medicine, Metropolitan Hospital Center, United States.
| | - Nicholas Tinnesz
- Department of Emergency Medicine, Metropolitan Hospital Center, United States
| | - Michelle Popkin
- Department of Emergency Medicine, Metropolitan Hospital Center, United States
| | | | - Abhishek Pingle
- Case Western Reserve University, Cleveland, OH, United States
| | - Christine Umandap
- Department of Pediatrics, Metropolitan Hospital Center, United States
| | | | | | | | - Hossein Kalantari
- Department of Emergency Medicine, Metropolitan Hospital Center, United States
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14
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Affiliation(s)
- Ann Glang
- Center on Brain Injury Research & Training, University of Oregon, Eugene, Oregon
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15
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Coxe K, Hamilton K, Harvey HH, Xiang J, Ramirez MR, Yang J. Consistency and Variation in School-Level Youth Sports Traumatic Brain Injury Policy Content. J Adolesc Health 2018; 62:255-264. [PMID: 28970062 DOI: 10.1016/j.jadohealth.2017.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/07/2017] [Accepted: 07/08/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of the study was to examine the consistency and variation in content of high school written traumatic brain injury (TBI) policies in relation to the three key tenets of youth sports TBI laws. METHODS A content analysis was conducted on written TBI policies retrieved from 71 high schools currently participating in High School Reporting Information Online. Each policy was independently analyzed by two trained coders. The number and percent of the policies reflecting the three key tenets of state youth sports TBI laws were described and compared on policy enforcement (i.e., strictness of language), policy description (i.e., details and definitions of the requirements), and policy implementation steps (i.e., specific steps for implementing the requirements). Direct quotes were identified to support quantitative findings. RESULTS All 71 high school TBI policies contained at least two of the three main TBI law tenets, where 98.6% (n = 70) included the return to play tenet, 83.1% (n = 59) included the removal from play tenet, and 59.2% (n = 42) specified the distribution of TBI information sheets to student-athletes and their parents. Nearly half of the policies (49.3%, n = 35) required parents' signature while only 39.4% (n = 28) required students' signature on the TBI information sheet. The language exhibited wide variance across the 71 TBI policies regarding policy enforcement, policy description, and policy implementation specifications. CONCLUSIONS All 71 TBI policies covered at least two of the three youth sports TBI law tenets, but with considerable variation. Future research should assess variations by schools within the same state and their impact on TBI rates in school athletics.
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Affiliation(s)
- Kathryn Coxe
- Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio; Department of Quality, Planning, and Research, The Ohio Department of Mental Health and Addiction Services, Columbus, Ohio
| | | | - Hosea H Harvey
- Beasley School of Law, Temple University, Philadelphia, Pennsylvania
| | - Joe Xiang
- Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio; Center for Intervention Research in Schools, Ohio University, Athens, Ohio
| | - Marizen R Ramirez
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Jingzhen Yang
- Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio.
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16
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Yang J, Comstock RD, Yi H, Harvey HH, Xun P. New and Recurrent Concussions in High-School Athletes Before and After Traumatic Brain Injury Laws, 2005-2016. Am J Public Health 2017; 107:1916-1922. [PMID: 29048967 DOI: 10.2105/ajph.2017.304056] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To examine the trends of new and recurrent sports-related concussions in high-school athletes before and after youth sports traumatic brain injury laws. METHODS We used an interrupted time-series design and analyzed the concussion data (2005-2016) from High School Reporting Injury Online. We examined the trends of new or recurrent concussion rates among US representative high-school athletes participating in 9 sports across prelaw, immediate-postlaw, and postlaw periods by using general linear models. We defined 1 athlete exposure as attending 1 competition or practice. RESULTS We included a total of 8043 reported concussions (88.7% new, 11.3% recurrent). The average annual concussion rate was 39.8 per 100 000 athlete exposures. We observed significantly increased trends of reported new and recurrent concussions from the prelaw, through immediate-postlaw, into the postlaw period. However, the recurrent concussion rate showed a significant decline 2.6 years after the laws went into effect. Football exhibited different trends compared with other boys' sports and girls' sports. CONCLUSIONS Observed trends of increased concussion rates are likely attributable to increased identification and reporting. Additional research is needed to evaluate intended long-term impact of traumatic brain injury laws.
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Affiliation(s)
- Jingzhen Yang
- Jingzhen Yang is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, College of Medicine and Department of Epidemiology, College of Public Health, The Ohio State University, Columbus. R. Dawn Comstock is with the Department of Epidemiology, The Colorado School of Public Health, and the Department of Pediatrics, Emergency Medicine, School of Medicine, University of Colorado Anschutz, Aurora. Honggang Yi is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and the Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China. Hosea H. Harvey is with the Beasley School of Law, Temple University, Philadelphia, PA. Pengcheng Xun is with the Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington
| | - R Dawn Comstock
- Jingzhen Yang is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, College of Medicine and Department of Epidemiology, College of Public Health, The Ohio State University, Columbus. R. Dawn Comstock is with the Department of Epidemiology, The Colorado School of Public Health, and the Department of Pediatrics, Emergency Medicine, School of Medicine, University of Colorado Anschutz, Aurora. Honggang Yi is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and the Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China. Hosea H. Harvey is with the Beasley School of Law, Temple University, Philadelphia, PA. Pengcheng Xun is with the Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington
| | - Honggang Yi
- Jingzhen Yang is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, College of Medicine and Department of Epidemiology, College of Public Health, The Ohio State University, Columbus. R. Dawn Comstock is with the Department of Epidemiology, The Colorado School of Public Health, and the Department of Pediatrics, Emergency Medicine, School of Medicine, University of Colorado Anschutz, Aurora. Honggang Yi is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and the Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China. Hosea H. Harvey is with the Beasley School of Law, Temple University, Philadelphia, PA. Pengcheng Xun is with the Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington
| | - Hosea H Harvey
- Jingzhen Yang is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, College of Medicine and Department of Epidemiology, College of Public Health, The Ohio State University, Columbus. R. Dawn Comstock is with the Department of Epidemiology, The Colorado School of Public Health, and the Department of Pediatrics, Emergency Medicine, School of Medicine, University of Colorado Anschutz, Aurora. Honggang Yi is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and the Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China. Hosea H. Harvey is with the Beasley School of Law, Temple University, Philadelphia, PA. Pengcheng Xun is with the Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington
| | - Pengcheng Xun
- Jingzhen Yang is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, College of Medicine and Department of Epidemiology, College of Public Health, The Ohio State University, Columbus. R. Dawn Comstock is with the Department of Epidemiology, The Colorado School of Public Health, and the Department of Pediatrics, Emergency Medicine, School of Medicine, University of Colorado Anschutz, Aurora. Honggang Yi is with the Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, and the Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China. Hosea H. Harvey is with the Beasley School of Law, Temple University, Philadelphia, PA. Pengcheng Xun is with the Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington
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