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Mavroudis I, Petridis F, Petroaie AD, Ciobica A, Kamal FZ, Honceriu C, Iordache A, Ionescu C, Novac B, Novac O. Exploring Symptom Overlaps: Post-COVID-19 Neurological Syndrome and Post-Concussion Syndrome in Athletes. Biomedicines 2024; 12:1587. [PMID: 39062160 PMCID: PMC11274969 DOI: 10.3390/biomedicines12071587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/06/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
The COVID-19 pandemic has introduced new challenges in managing neurological conditions, particularly among athletes. This paper explores the intersection of post-COVID-19 neurological syndrome (PCNS/PASC) and post-concussion syndrome (PCS), focusing on their implications in sports medicine. Our analysis covers the symptomatology, pathophysiology, and management strategies for PCNS/PASC and PPCS, with special attention paid to the unique challenges faced by athletes recovering from these conditions, including the risk of symptom exacerbation and prolonged recovery. Key findings reveal that both PCNS/PASC and PPCS present with overlapping symptoms such as cognitive difficulties, exercise intolerance, and mental health issues, but differ in specific manifestations like anosmia and ageusia, unique to COVID-19. Pathophysiological analysis reveals similarities in blood-brain barrier disruption (BBB) but differences in the extent of immune activation. Management strategies emphasize a gradual increase in physical activity, close symptom monitoring, and psychological support, with a tailored approach for athletes. Specific interventions include progressive aerobic exercises, resistance training, and cognitive rehabilitation. Furthermore, our study highlights the importance of integrating neurology, psychiatry, physical therapy, and sports medicine to develop comprehensive care strategies. Our findings underscore the dual challenge of COVID-19 and concussion in athletes, necessitating a nuanced, interdisciplinary approach to effective management. Future research should focus on the long-term neurological effects of both conditions and optimizing treatment protocols to improve patient outcomes. This comprehensive understanding is crucial for advancing the management of athletes affected by these overlapping conditions and ensuring their safe return to sports.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals NHS Trust, Leeds LS2 9JT, UK;
- Faculty of Medicine, Leeds University, Leeds LS2 9JT, UK
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Antoneta Dacia Petroaie
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania; (A.C.); (C.I.)
- Centre of Biomedical Research, Romanian Academy, Bd. Carol I, no. 8, 700506 Iasi, Romania
- Academy of Romanian Scientists, Str. Splaiul Independentei no. 54, Sector 5, 050094 Bucharest, Romania
- “Ioan Haulica” Institute, Apollonia University, Pãcurari Street 11, 700511 Iasi, Romania
| | - Fatima Zahra Kamal
- Higher Institute of Nursing Professions and Health Techniques, Marrakesh 40000, Morocco
- Laboratory of Physical Chemistry of Processes and Materials, Faculty of Sciences and Techniques, Hassan First University, B.P. 539, Settat 26000, Morocco
| | - Cezar Honceriu
- Faculty of Physical Education, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania;
| | - Alin Iordache
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Cătălina Ionescu
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Bd. Carol I no. 20A, 700505 Iasi, Romania; (A.C.); (C.I.)
- Clinical Department, Apollonia University, Păcurari Street 11, 700511 Iasi, Romania
| | - Bogdan Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
| | - Otilia Novac
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street No. 16, 700115 Iasi, Romania; (A.I.); (O.N.)
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Izzy S, Yahya T, Albastaki O, Cao T, Schwerdtfeger LA, Abou-El-Hassan H, Chopra K, Ekwudo MN, Kurdeikaite U, Verissimo IM, LeServe DS, Lanser TB, Aronchik M, Oliveira MG, Moreira T, Rezende RM, El Khoury J, Cox LM, Weiner HL, Zafonte R, Whalen MJ. High-salt diet induces microbiome dysregulation, neuroinflammation and anxiety in the chronic period after mild repetitive closed head injury in adolescent mice. Brain Commun 2024; 6:fcae147. [PMID: 39045090 PMCID: PMC11264151 DOI: 10.1093/braincomms/fcae147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/09/2024] [Accepted: 04/30/2024] [Indexed: 07/25/2024] Open
Abstract
The associations between human concussions and subsequent sequelae of chronic neuropsychiatric and cardiovascular diseases such as hypertension have been reported; however, little is known about the underlying biological processes. We hypothesized that dietary changes, including a high-salt diet, disrupt the bidirectional gut-brain axis, resulting in worsening neuroinflammation and emergence of cardiovascular and behavioural phenotypes in the chronic period after repetitive closed head injury in adolescent mice. Adolescent mice were subjected to three daily closed head injuries, recovered for 12 weeks and then maintained on a high-salt diet or a normal diet for an additional 12 weeks. Experimental endpoints were haemodynamics, behaviour, microglial gene expression (bulk RNA sequencing), brain inflammation (brain tissue quantitative PCR) and microbiome diversity (16S RNA sequencing). High-salt diet did not affect systemic blood pressure or heart rate in sham or injured mice. High-salt diet increased anxiety-like behaviour in injured mice compared to sham mice fed with high-salt diet and injured mice fed with normal diet. Increased anxiety in injured mice that received a high-salt diet was associated with microgliosis and a proinflammatory microglial transcriptomic signature, including upregulation in interferon-gamma, interferon-beta and oxidative stress-related pathways. Accordingly, we found upregulation of tumour necrosis factor-alpha and interferon-gamma mRNA in the brain tissue of high salt diet-fed injured mice. High-salt diet had a larger effect on the gut microbiome composition than repetitive closed head injury. Increases in gut microbes in the families Lachnospiraceae, Erysipelotrichaceae and Clostridiaceae were positively correlated with anxiety-like behaviours. In contrast, Muribaculaceae, Acholeplasmataceae and Lactobacillaceae were negatively correlated with anxiety in injured mice that received a high-salt diet, a time-dependent effect. The findings suggest that high-salt diet, administered after a recovery period, may affect neurologic outcomes following mild repetitive head injury, including the development of anxiety. This effect was linked to microbiome dysregulation and an exacerbation of microglial inflammation, which may be physiological targets to prevent behavioural sequelae in the chronic period after mild repetitive head injury. The data suggest an important contribution of diet in determining long-term outcomes after mild repetitive head injury.
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Affiliation(s)
- Saef Izzy
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
- The Football Players Health Study at Harvard University, Boston, MA 02138, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Taha Yahya
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Omar Albastaki
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Tian Cao
- Divisions of Stroke, Cerebrovascular, and Critical Care Neurology, Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Luke A Schwerdtfeger
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Hadi Abou-El-Hassan
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Kusha Chopra
- Cancer Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Millicent N Ekwudo
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ugne Kurdeikaite
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Isabelly M Verissimo
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Danielle S LeServe
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Toby B Lanser
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Michael Aronchik
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Marilia G Oliveira
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Thais Moreira
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Rafael Machado Rezende
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Joseph El Khoury
- Harvard Medical School, Boston, MA 02115, USA
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Laura M Cox
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Howard L Weiner
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Ross Zafonte
- Harvard Medical School, Boston, MA 02115, USA
- The Football Players Health Study at Harvard University, Boston, MA 02138, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Boston, MA 02129, USA
| | - Michael J Whalen
- Harvard Medical School, Boston, MA 02115, USA
- The Football Players Health Study at Harvard University, Boston, MA 02138, USA
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114, USA
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Al Attar WSA, Mahmoud H, Alfadel A, Faude O. Does Headgear Prevent Sport-Related Concussion? A Systematic Review and Meta-Analysis of Randomized Controlled Trials Including 6311 Players and 173,383 Exposure Hours. Sports Health 2024; 16:473-480. [PMID: 37204092 PMCID: PMC11025511 DOI: 10.1177/19417381231174461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
CONTEXT A sport-related concussion (SRC) is a traumatic brain injury that is caused by biomechanical stresses and results in a complex pathophysiological process in the brain. Some in the sporting community believe that headgear (HG) can prevent SRC, and several professional Australian sports organizations, including rugby, football, and soccer clubs, recommend its use. OBJECTIVE The purpose of this study is to determine whether HG is effective in lowering the prevalence of SRC in sports. DATA SOURCES A systematic search for related studies published between 1985 and 2023 was conducted using the following databases: Cochrane Library, AMED, PubMed, Web of Science, and Physiotherapy Evidence Database (PEDro). STUDY SELECTION Only randomized controlled trials (RCTs) that investigated the effectiveness of HG in reducing SRC rate were included. STUDY DESIGN Systematic review and meta-analysis of RCTs. LEVEL OF EVIDENCE Level 1a. DATA EXTRACTION Two researchers independently completed the title and abstract search and performed full-text reviews. A third reviewer was consulted to reach a consensus if any discrepancies were noted. The PEDro scale was used to evaluate the quality of the included RCTs. Data recorded from each study included authors, year of publication, type and number of players, study design, duration of the study, injury rate, compliance (%), sports/level, and exposure hours. RESULTS The pooled results of 6311 players and 173,383 exposure hours showed 0% SRC reduction per 1000 hours of exposure in the experimental group compared with the control group, with an injury risk ratio of 1.03 (95% CI, 0.82-1.30; P = 0.79). CONCLUSION This systematic review and meta-analysis demonstrates that HG does not prevent SRC among soccer and rugby players, and therefore the findings from this meta-analysis do not currently support the use of HG to prevent SRC in soccer or rugby.
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Affiliation(s)
- Wesam Saleh A. Al Attar
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
| | - Hayam Mahmoud
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy for Neurology, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Abdulaziz Alfadel
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia
- Department of Physical Therapy, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
| | - Oliver Faude
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
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Konstantinides N, Geraghty E, Harmon K, Whelan BM, Poddar SK, Bohr A. Recovery duration and concussion severity in sport- and non-sport-related concussion among Pac-12 collegiate athletes: a retrospective cohort study. BMJ Open 2024; 14:e079953. [PMID: 38684271 PMCID: PMC11057321 DOI: 10.1136/bmjopen-2023-079953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES To examine non-sport- and sport-related concussion severity, clinical care frequency and delayed reporting in relation to recovery duration among collegiate athletes. DESIGN Retrospective cohort study. SETTING Pac-12 varsity collegiate athletes. PARTICIPANTS 461 collegiate male and female athletes PRIMARY AND SECONDARY OUTCOME MEASURES: The incidence of sport-related concussion (SRC) and non-sport-related concussion (NRC) were collected as well as times to recovery and return-to-play (RTP), symptom score and symptom severity and reported a loss of consciousness (LOC), retrograde amnesia (RGA) and post-traumatic amnesia (PTA) following concussion incidence. RESULTS Among 461 concussions, 388 (84%) occurred within sport and 73 (16%) occurred outside of sport. NRC, on average, required 3.5 more days to become asymptomatic (HR: 0.73, 95%confidence interval: 0.56 to 0.96, p=0.02) and 7 more days to RTP (HR: 0.64, 95% confidence interval: 0.49 to 0.85, p<0.01) compared with SRC. NRC were associated with an increase of 1.83 (p=0.07) symptoms reported at the time of diagnosis, an increase of 6.95 (p=0.06) in symptom severity and a higher prevalence of reported LOC (22% NRC vs. 3% SRC, p<0.001), PTA (15% NRC vs. 5% SRC, p<0.01) and RGA (10% NRC vs. 4% SRC, p=0.06), compared with SRC. There was no significant difference in clinical care (p=0.28) or immediate reporting (p=0.35) between NRC and SRC. CONCLUSION NRC were associated with greater severity and longer recovery duration when compared with SRC in a cohort of collegiate athletes.
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Affiliation(s)
- Niki Konstantinides
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Elisabeth Geraghty
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Kimberly Harmon
- Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Bridget M Whelan
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Sourav K Poddar
- Family Medicine and Orthopedics, University of Colorado Boulder, Boulder, Colorado, USA
| | - Adam Bohr
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
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Hrabarchuk EI, Hannah T, Kalagara R, Li AY, Schupper AJ, McCarthy L, Ali M, Quinones A, Gometz A, Lovell M, Choudhri TF. Baseline ImPACT Composite Scores in Student-Athletes With Attention-Deficit/Hyperactivity Disorder. Arch Clin Neuropsychol 2024; 39:347-354. [PMID: 37824213 DOI: 10.1093/arclin/acad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Athletes who are diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of concussion compared to other athletes. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is a widely used concussion tool, but it relies on pre-injury baseline testing that can be affected by psychiatric conditions. This research aims to determine if there are differences in pre-injury testing composite scores in student-athletes with ADHD compared to those without ADHD diagnosis. METHODS We obtained 11,563 pre-season ImPACT assessments of 7,454 student-athletes (ages: 12-22) from 2009 to 2019. After exclusions, there were 6,920 control and 276 ADHD subjects. Multivariable linear regression analyses compared the independent effect of ADHD on the six ImPACT composite score metrics with Bonferroni correction for multiple comparisons with a = 0.008. RESULTS Univariate analyses indicated ADHD is associated with more symptoms as measured by the Post-Concussion Symptom Scale (PCSS) (β = 2.67, 95% CI: 1.47-3.87, p < .0001) and worse Impulse Control scores (β = 0.93, 95% CI: 0.33-1.53, p = .002). In multivariate analysis, this association was the same for symptom score (β = 2.48, 95% CI: 1.22-3.74, p < .0001), but Impulse Control was not significantly different after multiple comparison adjustment (β = 0.87, 95% CI: 0.22-1.15, p = .009). CONCLUSIONS The ADHD subjects reported worse symptoms at baseline and had worse Impulse Control in univariate analysis, but not multivariate analysis. These results can further guide clinicians in concussion diagnosis and test interpretations for student-athletes with ADHD, considering the symptom burden at baseline.
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Affiliation(s)
- Eugene I Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Theodore Hannah
- Department of Neurosurgery, Lewis Katz School of Medicine Temple University, Philadelphia, PA, USA
| | - Roshini Kalagara
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adam Y Li
- Department of Neurosurgery, University of Rochester School of Medicine, New York, NY, USA
| | - Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Addison Quinones
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Gometz
- Physical Medicine and Rehabilitation, Concussion Management of New York, NY, USA
| | - Mark Lovell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tanvir F Choudhri
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kakavas G, Tsiokanos A, Potoupnis M, Tsaklis PV. Mechanical and Contractile Properties of Knee Joint Muscles after Sports-Related Concussions in Women Footballers. J Funct Morphol Kinesiol 2024; 9:65. [PMID: 38651423 PMCID: PMC11036212 DOI: 10.3390/jfmk9020065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/24/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024] Open
Abstract
The purpose of this study was to determine if women footballers have an increased lack of neuromuscular control of the knee joint after a concussion compared to a healthy cohort tested with tensiomyography (TMG). Forty-one female collegiate footballers were enrolled in this study from which there were 20 with a history of sports-related concussions (SRCs) and 21 control subjects. Results from the SRC group had significantly higher Tc (ms) (z = -5.478, p = 0.000) and significantly lower Dm (mm) (z = -3.835, p = 0.000) than the control group in the case of the rectus femoris muscle. The SRC group had significantly higher Tc (ms) (z = -2.348, p = 0.016) and significantly lower Dm (mm) (z = -4.776, p = 0.000) than the control group in the case of the vastus medialis muscle. The SRC group had significantly higher Tc (ms) (z = -5.400, p = 0.000) and significantly lower Dm (mm) (z = -4.971, p = 0.000) than the control group in the case of the vastus lateralis muscle. The SRC group had significantly higher Tc (ms) (z = -5.349, p = 0.000) than the control group in the case of the biceps femoris muscle response, whereas no significant difference was found in Dm (mm) (z = -0.198, p = 0.853) between the groups. The results of the current study may have implications for current practice standards regarding the evaluation and management of concussions and can add valuable information for knee prevention programs as well.
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Affiliation(s)
- Georgios Kakavas
- Fysiotek Spine and Sports Lab, 11635 Athens, Greece;
- ErgoMechLab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
| | - Athanasios Tsiokanos
- ErgoMechLab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
| | - Michael Potoupnis
- Medical School, 3rd Academic Orthopedic Clinic, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Panagiotis V. Tsaklis
- ErgoMechLab, Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece;
- Department of Molecular Medicine and Surgery, Growth and Metabolism, Karolinska Institute, 17164 Solna, Sweden
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Meyer CM, Mensch J, Battle N, Yeargin SW. Knowledge and Attitudes of Concussion Reporting Behavior Intentions in Parents of Youth Recreational Football Players. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:218-226. [PMID: 37040134 DOI: 10.1080/02701367.2023.2189444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 02/26/2023] [Indexed: 06/19/2023]
Abstract
Purpose: This study: (1) Described the knowledge, attitudes, and reported behavior intentions of young recreational football players' parents toward concussion. (2) Investigated associations of the previous variables with parent demographics. Materials and Methods: A cross-sectional design utilized an online platform to survey parents of children (8-14 yrs.) in three youth football leagues in the southern United States. Demographics collected included items such as sex or concussion history. Knowledge was assessed via true/false items, with higher scores (0-20) representing greater concussion understanding. 4-point Likert scales were used to describe parents attitudes (1 = not at all, 4 = very much), confidence in intended recognition/reporting (1 = not-confident, 4 = extremely confident), and agreement with intended reporting behaviors (1 = strong- disagreement, 4 = strong-agreement). Descriptive statistics were calculated for demographics. Mann-Whitney U test or Kruskal-Wallis Tests examined survey responses across demographics. Results: Respondents (n = 101) were primarily female (64.4%), white (81.2%), and participated in contact sport (83.2%). Parents averaged 15.9 ± 1.4 on concussion knowledge, with only 34.7% (n = 35) of parents scoring > 17/20. Statements that received the lowest average agreement (3.29/4) regarding reporting intent were related to emotional symptoms. Some parents (n = 42, 41.6%) reported low confidence in recognizing symptoms of a concussion in their child. Parent demographics did not have clinically significant associations with survey responses, with 6/7 demographic variables resulting in no statistical significance (p > .05). Conclusions: Although one-third of parents attained high knowledge scores, several reported low confidence in recognizing concussion symptoms in their children. Parents scored lower in agreement with removing their child from play when concussion symptoms were subjective. Youth sports organizations providing concussion education to parents should consider these results when revising their materials.
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Meyer EJ, Correa ET, Monuteaux MC, Mannix R, Hatoun J, Vernacchio L, Lyons TW. Patterns and Predictors of Health Care Utilization After Pediatric Concussion: A Retrospective Cohort Study. Acad Pediatr 2024; 24:51-58. [PMID: 37148968 DOI: 10.1016/j.acap.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To characterize types, duration, and intensity of health care utilization following pediatric concussion and to identify risk factors for increased post-concussion utilization. METHODS A retrospective cohort study of children 5 to 17 years old diagnosed with acute concussion at a quaternary center pediatric emergency department or network of associated primary care clinics. Index concussion visits were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. We analyzed patterns of health care visits 6 months before and after the index visit using interrupted time-series analyses. The primary outcome was prolonged concussion-related utilization, defined as having ≥1 follow-up visits with a concussion diagnosis more than 28 days after the index visit. We used logistic regressions to identify predictors of prolonged concussion-related utilization. RESULTS Eight hundred nineteen index visits (median [interquartile range] age, 14 [11-16] years; 395 [48.2%] female) were included. There was a spike in utilization during the first 28 days after the index visit compared to the pre-injury period. Premorbid headache/migraine disorder (adjusted odds ratio (aOR) 2.05, 95% confidence interval [CI] 1.09-3.89) and top quartile pre-injury utilization (aOR 1.90, 95% CI 1.02-3.52) predicted prolonged concussion-related utilization. Premorbid depression/anxiety (aOR 1.55, 95% CI 1.31-1.83) and top quartile pre-injury utilization (aOR 2.29, 95% CI 1.95-2.69) predicted increased utilization intensity. CONCLUSIONS Health care utilization is increased during the first 28 days after pediatric concussion. Children with premorbid headache/migraine disorders, premorbid depression/anxiety, and high baseline utilization are more likely to have increased post-injury health care utilization. This study will inform patient-centered treatment but may be limited by incomplete capture of post-injury utilization and generalizability.
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Affiliation(s)
- Erin J Meyer
- Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass.
| | - Emily Trudell Correa
- Pediatric Physicians' Organization at Children's (ET Correa, J Hatoun, and L Vernacchio), Wellesley, Mass
| | - Michael C Monuteaux
- Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass
| | - Rebekah Mannix
- Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass
| | - Jonathan Hatoun
- Pediatric Physicians' Organization at Children's (ET Correa, J Hatoun, and L Vernacchio), Wellesley, Mass; Department of Pediatrics (J Hatoun and L Vernacchio), Boston Children's Hospital and Harvard Medical School, Mass
| | - Louis Vernacchio
- Pediatric Physicians' Organization at Children's (ET Correa, J Hatoun, and L Vernacchio), Wellesley, Mass; Department of Pediatrics (J Hatoun and L Vernacchio), Boston Children's Hospital and Harvard Medical School, Mass
| | - Todd W Lyons
- Division of Emergency Medicine (EJ Meyer, MC Monuteaux, R Mannix, and TW Lyons), Boston Children's Hospital and Harvard Medical School, Mass
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Loftin MC, Zynda AJ, Pollard-McGrandy A, Eke R, Covassin T, Wallace J. Racial differences in concussion diagnosis and mechanism of injury among adults presenting to emergency departments across the United States. Brain Inj 2023; 37:1326-1333. [PMID: 37607067 DOI: 10.1080/02699052.2023.2248581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the association between race and concussion diagnosis as well as the association between race and mechanism of injury (MOI) for concussion diagnoses in adult patients (>19 years old) visiting the emergency department (ED). METHODS A retrospective analysis of patient visits to the ED for concussion between 2010 and 2018, using the National Hospital Ambulatory Medical Care Survey, was conducted. Outcome measures included concussion diagnosis and MOI. Multivariable and multinomial logistic regression analyses were conducted to assess associations between race and outcome variables. The results were weighted to reflect population estimates with a significance set at p < 0.05. RESULTS Overall, 714 patient visits for concussions were identified, representing an estimated 4.3 million visits nationwide. Black adults had lower odds of receiving a concussion diagnosis [p < 0.05, Odds Ratio (OR), 0.54; 95% Confidence Interval (CI), 0.38-0.76] compared to White adults in the ED. There were no significant differences in MOI for a concussion diagnosis by race. CONCLUSION Racial differences were found in the ED for concussion diagnosis. Disparities in concussion diagnosis for Black or other minoritized racial groups could have significant repercussions that may prolong recovery or lead to long-term morbidity.
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Affiliation(s)
- Megan C Loftin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Aaron J Zynda
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | | | - Ransome Eke
- Department of Community Medicine, School of Medicine, Mercer University, Columbus, Georgia
| | - Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Jessica Wallace
- Department of Health Science, The University of Alabama, Tuscaloosa, Alabama, USA
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10
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Walker D, Qureshi AW, Marchant D, Bahrami Balani A. Developing a simple risk metric for the effect of sport-related concussion and physical pain on mental health. PLoS One 2023; 18:e0292751. [PMID: 37831707 PMCID: PMC10575528 DOI: 10.1371/journal.pone.0292751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Risk factors associated with depression in athletes include biological sex, physical pain, and history of sport-related concussion (SRC). Due to the well-documented benefits of sport and physical activity on mental health, athletes and non-athletes were recruited to assess any differences. Beyond this, athletes were also grouped by sport-type (contact/non-contact sports) due to the increased prevalence of pain and SRC in contact sports. To our knowledge, there has been no research on how these factors influence the likelihood of depression. In the current study, 144 participants completed a short survey on the above factors and the Center for Epidemiological Studies Depression Scale. Sixty-two of these reported a history of concussion. Logistic regression revealed all the above predictors to be significantly associated with the depression scale. Individuals that had previously sustained SRC, were experiencing greater physical pain and females were more likely to display poor mental health. However, we provide further evidence for the benefits of engaging in sport and physical activity as those that took part in sport were less likely to report depression. Therefore, this study provides a simple risk metric whereby sportspeople can make a better informed choice of their sporting participation, making their own cost/reward judgement.
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11
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Thomas KD, Lombard ZK, Shadiack AL. Osteopathic manipulative treatment for concussions and postconcussive syndrome in athletes: a literature review. J Osteopath Med 2023; 123:395-403. [PMID: 37283218 DOI: 10.1515/jom-2022-0217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/27/2023] [Indexed: 06/08/2023]
Abstract
CONTEXT Concussions are the most common type of traumatic brain injury (TBI) and can often occur in athletes. These injuries have many deleterious acute symptoms and can lead to the development of postconcussive syndrome (PCS). Osteopathic manipulative treatment (OMT) is a treatment option that may benefit patients with concussions and PCS. OBJECTIVES The objective of this review is to determine whether OMT can improve symptoms associated with concussions and PCS in athletes. METHODS A comprehensive literature review was conducted between August 2021 and March 2022 by two authors (Z.K.L. and K.D.T.) who searched the literature utilizing PubMed, Google Scholar, and Cochrane Library. Articles reviewed included case reports, case studies, randomized control trials, meta-analyses, and peer-reviewed journal articles. Search terms included concussion, postconcussive symptoms, osteopathic manipulative medicine, and manipulation. To be included into this study, articles must have included OMT from an osteopathic physician or manipulative techniques by nonosteopathic providers for patients with a concussion or PCS, and the insulting injury must have occurred in an athletic setting. No disagreements occurred between authors about what studies to include. However, we were prepared to come to a unanimous decision through discussion among the authors. A narrative synthesis was performed. No other data analyses were conducted in this study. RESULTS Included in this review were nine articles including randomized control trials, retrospective review, case series, longitudinal, retrospective studies, and case reports. The literature shows the positive effects of OMT and manipulative techniques on symptom resolution after a concussion. However, most of the literature is qualitative rather than quantitative in nature, lacking in randomized control trials. CONCLUSIONS There is a scarcity of high-quality studies evaluating the effectiveness of OMT on concussions and PCS. More research is needed to understand the degree of benefit for this treatment option.
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Affiliation(s)
- Kevin D Thomas
- HCA Healthcare/Mercer University School of Medicine/Grand Strand Medical Center Family Medicine Residency Program, Myrtle Beach, SC, USA
| | - Zoe K Lombard
- Edward Via College of Osteopathic Medicine-Carolinas, Spartanburg, SC, USA
| | - Anthony L Shadiack
- HCA Healthcare/Mercer University School of Medicine/Grand Strand Medical Center Family Medicine Residency Program, Myrtle Beach, SC, USA
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12
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Rose SC, Levine DA, Shi J, Wheeler K, Aungst T, Stanley RM, Beauchamp MH. Emergency department visits for mild traumatic brain injury in early childhood. Am J Emerg Med 2023; 65:36-42. [PMID: 36580699 DOI: 10.1016/j.ajem.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Brain injury during early childhood may disrupt key periods of neurodevelopment. Most research regarding mild traumatic brain injury (mTBI) has focused on school-age children. We sought to characterize the incidence and healthcare utilization for mTBI in young children presenting to U.S. emergency departments (ED). METHODS The Nationwide Emergency Department Sample was queried for children age 0-6 years with mTBI from 2016 to 2019. Patients were excluded for focal or diffuse TBI, drowning or abuse mechanism, death in the ED or hospital, Injury Severity Score > 15, neurosurgical intervention, intubation, or blood product transfusion. RESULTS National estimates included 1,372,291 patient visits: 63.5% were two years or younger, 57.5% were male, and 69.4% were injured in falls. The most common head injury diagnosis was "unspecified injury of head" (83%); this diagnosis decreased in frequency as age increased, in favor of a concussion diagnosis. Most patients were seen at low pediatric volume EDs (64.5%) and non-children's hospital EDs (86.2%), and 64.9% were seen at a non-teaching hospital. Over 98% were treated in the ED and discharged home. Computed tomography of the head and cervical spine were performed in 18.7% and 1.6% of patients, respectively, less often at children's hospitals (OR = 0.55, 95%CI = 0.41-0.76 for head and OR = 0.19, 95%CI = 0.11-0.34 for cervical spine). ED charges resulted in $540-681 million annually, and more than half of patients utilized Medicaid. CONCLUSIONS Early childhood mTBI is prevalent and results in high financial burden in the U.S. There is wide variation in diagnostic coding and computed tomography scanning amongst EDs. More focused research is needed to identify optimal diagnostic tools and management strategies.
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Affiliation(s)
- Sean C Rose
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Division of Pediatric Neurology, Columbus, OH 43205, United States.
| | - Deborah A Levine
- New York Presbyterian Hospital and Weill Cornell Medicine, Department of Emergency Medicine, New York, NY 10021, United States
| | - Junxin Shi
- Nationwide Children's Hospital, Division of Emergency Medicine, Columbus, OH 43205, United States
| | - Krista Wheeler
- Nationwide Children's Hospital, Division of Emergency Medicine, Columbus, OH 43205, United States
| | - Taylour Aungst
- Nationwide Children's Hospital, Division of Neurology, Columbus, OH 43205, United States
| | - Rachel M Stanley
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Division of Emergency Medicine, Columbus, OH 43205, United States
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
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13
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Schaffer O, Xie F, Cheng D, Grossman SN, Galetta SL, Balcer LJ, Balcer LJ. Trends in concussion mechanism of injury during the COVID-19 pandemic. J Neurol Sci 2023; 445:120538. [PMID: 36608628 PMCID: PMC9797225 DOI: 10.1016/j.jns.2022.120538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The primary objective was to determine the effect of the COVID-19 pandemic on volume, demographics, and mechanisms of injury (MOI) for patients seen at an urban multidisciplinary concussion center. During the first phase of the pandemic in the United States, stay-at-home orders led to decreased group activities and required cancellation of outpatient appointments or initiation of telemedicine visits. METHODS This study was a retrospective chart review of 3500 patient electronic medical records (EMR). Patients aged 1-99 years were eligible if they had been seen at New York University Langone Health Concussion Center during March 1-December 31, 2019 (control/pre-pandemic period) or during the same period in 2020 (pandemic period). Injury date, appointment date, age, sex, and MOI were captured; statistical analyses were performed using Stata17 (StataCorp, College Station, TX). RESULTS There were 48% fewer visits during the COVID-19 pandemic period compared to the 2019 control period. There was a decreased proportion of pediatric patients (15% control, 6% pandemic; p = 0.007, chi-square test). Fewer concussions were related to team sports (21% control, 5% pandemic; p < 0.001), and a greater proportion were caused by bicycle accidents (4% control, 8% pandemic; p = 0.037) and assault/domestic violence (3% control, 9% pandemic; p < 0.001). CONCLUSION The relative proportions of concussion MOI, age distributions, and visit volumes were significantly associated with pre-pandemic vs. pandemic periods, suggesting that COVID-19 changed concussion epidemiology during the pandemic period. This study demonstrates how epidemiologic data may inform future resource allocation during public health emergencies.
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Affiliation(s)
- Olivia Schaffer
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Frank Xie
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Debby Cheng
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Scott N Grossman
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States of America; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Steven L Galetta
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States of America; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Laura J Balcer
- Department of Neurology, NYU Grossman School of Medicine, New York, NY, United States of America; Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States of America; Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, United States of America.
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14
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Trbovich AM, Preszler J, Emami K, Cohen P, Eagle S, Collins MW, Kontos AP. Is Overparenting Associated with Adolescent/Young Adult Emotional Functioning and Clinical Outcomes Following Concussion? Child Psychiatry Hum Dev 2022; 53:1231-1239. [PMID: 34136979 DOI: 10.1007/s10578-021-01204-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Overparenting (O-P), or "helicopter" parenting, has warranted increased attention across the past decade. It is characterized as being overly involved, protective, and low on granting autonomy, and is associated with deleterious psychosocial outcomes outside of the concussion literature. This study examined the association of overparenting and patient emotional distress and clinical outcomes (i.e., symptoms, neurocognitive test scores, recovery time) post-concussion. Adolescents/young adult concussion patients (injury < 30 days) and parents (N = 101 child-parent dyads) participated. Patient participants completed measures of depression, anxiety, stress, and concussion clinical outcomes while parents concurrently completed an overparenting measure. Results of a general linear model found that overparenting was associated with higher anxiety and stress report of the child. Overparenting had a significant positive correlation with concussion recovery, although of a small magnitude. Emotional distress level, but not overparenting, was moderately associated with worse performance on clinical outcomes, including neurocognitive testing, vestibular/ocular motor dysfunction, and concussion symptom severity.
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Affiliation(s)
- Alicia M Trbovich
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA.
| | - Jonathan Preszler
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Kouros Emami
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Paul Cohen
- WakeMed Concussion Program, WakeMed Health and Hospitals, 3000 New Bern Ave, Raleigh, NC, 27610, USA
| | - Shawn Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Michael W Collins
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, University of Pittsburgh, 3200 S. Water St. Pittsburgh, Pittsburgh, PA, 15203, USA
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Hannah TC, Kalagara R, Ali M, Schupper AJ, Li AY, Spiera Z, Marayati NF, Quinones A, Asfaw ZK, Vasan V, Hrabarchuk EI, McCarthy L, Gometz A, Lovell M, Choudhri T. Evaluation of differences across age groups in the incidence, severity, and recovery of concussion in adolescent student-athletes from 2009 to 2019. J Neurosurg Pediatr 2022; 30:369-377. [PMID: 35907188 DOI: 10.3171/2022.6.peds22127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Concussion incidence is known to be highest in children and adolescents; however, there is conflicting evidence about the effect of age on concussion risk and recovery within the adolescent age range. The heterogeneity of results may be partially due to the use of age groupings based on convenience, making comparisons across studies difficult. This study evaluated the independent effect of age on concussion incidence, severity, and recovery in student-athletes aged 12-18 years using cluster analysis to define groupings. METHODS Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores of 11,403 baseline tests and 4922 postinjury tests were used to calculate the incidence rates for adolescent student-athletes grouped into 3 age bands (12-13, 14-15, and 16-18 years of age) on the basis of clustering analysis. The recently created Severity Index was used to compare concussion severity between groups. Follow-up tests for subjects who sustained a concussion were used to evaluate recovery time. The chi-square test and 1-way ANOVA were used to compare differences in demographic characteristics and concussion incidence, severity, and recovery. Multivariable logistic and linear regressions were used to evaluate the independent effects of age on concussion incidence and severity, respectively. Multivariable Cox hazard regression was used to evaluate differences in recovery time. Further analyses were conducted to directly compare findings across studies on the basis of the age groupings used in prior studies. RESULTS Multivariable regression analyses demonstrated that the 14- to 15-year-old age group had a significantly higher concussion incidence than both the 12- to 13-year-old (14- to 15-year-old group vs 12- to 13-year-old group, OR 1.57, 95% CI 1.16-2.17, p = 0.005) and 16- to 18-year-old (16- to 18-year-old group vs 14- to 15-year-old group, OR 0.79, 95% CI 0.69-0.91, p = 0.0008) age groups. There was no difference in incidence between the 12- to 13-year-old and 16- to 18-year-old groups (16- to 18-year group vs 12- to 13-year group, OR 1.26, 95% CI 0.93-1.72, p = 0.15). There were also no differences in concussion severity or recovery between any groups. CONCLUSIONS This study found that concussion incidence was higher during mid-adolescence than early and late adolescence, suggesting a U-shaped relationship between age and concussion risk over the course of adolescence. Age had no independent effect on concussion severity or recovery in the 12- to 13-, 14- to 15-, and 16- to 18-year-old groups. Further analysis of the various age groups revealed that results may vary significantly with minor changes to groupings, which may explain the divergent results in the current literature on this topic. Thus, caution should be taken when interpreting the results of this and all similar studies, especially when groupings are based on convenience.
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Affiliation(s)
- Theodore C Hannah
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Roshini Kalagara
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Muhammad Ali
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | | | - Adam Y Li
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Zachary Spiera
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | | | - Addison Quinones
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Zerubabbel K Asfaw
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Vikram Vasan
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Eugene I Hrabarchuk
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Lily McCarthy
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
| | - Alex Gometz
- 2Physical Medicine and Rehabilitation, Concussion Management of New York, New York, New York; and
| | - Mark Lovell
- 3Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Tanvir Choudhri
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York
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16
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Mooney J, Pate J, Cummins I, McLeod MC, Gould S. Effects of prior concussion on symptom severity and recovery time in acute youth concussion. J Neurosurg Pediatr 2022; 30:263-271. [PMID: 35901756 DOI: 10.3171/2022.5.peds2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many studies have identified factors associated with increased symptom burden and prolonged recovery after pediatric and adolescent concussion. Few have systematically examined the effects of prior concussion on these outcomes in patients with concussion due to any mechanism. An improved understanding of the short- and long-term effects of a multiple concussion history will improve counseling and management of this subgroup of patients. METHODS A retrospective review of adolescent and young adult acute concussion patients presenting to the multidisciplinary concussion clinic between 2018 and 2019 was conducted at a single center. Patient demographic data, medical history including prior concussion, initial symptom severity score (SSS), injury mechanisms, and recovery times were collected. Univariate and multivariable analyses were conducted to identify associations of history of prior concussion and patient and injury characteristics with symptom score and recovery time. RESULTS A total of 266 patients with an average age of 15.4 years (age range 13-27 years) were included. Prior concussion was reported in 35% of patients. The number of prior concussions per patient was not significantly associated with presenting symptom severity, recovery time, or recovery within 28 days. Male sex and sports-related concussion (SRC) were associated with lower presenting SSS and shorter recovery time on univariate but not multivariable analysis. However, compared to non-sport concussion mechanisms, SRC was associated with 2.3 times higher odds of recovery within 28 days (p = 0.04). A history of psychiatric disorders was associated with higher SSS in univariate analysis and longer recovery time in univariate and multivariable analyses. Multivariable log-linear regression also demonstrated 5 times lower odds of recovery within 28 days for those with a psychiatric history. CONCLUSIONS The results of this study demonstrated that an increasing number of prior concussions was associated with a trend toward higher presenting SSS after youth acute concussion but did not show a significant association with recovery time or delayed (> 28 days) recovery. Presence of psychiatric history was found to be significantly associated with longer recovery and lower odds of early (≤ 28 days) recovery. Future prospective, long-term, and systematic study is necessary to determine the optimal counseling and management of adolescent and young adult patients with a history of multiple concussions.
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Affiliation(s)
| | | | | | | | - Sara Gould
- 4Department of Orthopedic Surgery, University of Alabama at Birmingham, Alabama
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17
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Little CE, Dukelow SP, Schneider KJ, Emery CA. Using a Prism Paradigm to Identify Sensorimotor Impairment in Youth Following Concussion. J Head Trauma Rehabil 2022; 37:189-198. [PMID: 34145153 DOI: 10.1097/htr.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The study assesses the intrarater reliability and utility of a prism paradigm to identify sensorimotor impairment following sports-related concussion in youth, (recent and history of concussion) compared with youth with no concussion. SETTING University of Calgary. PARTICIPANTS Three groups of 40 ice hockey players ranging in age from 11 to 17 years were included: (1) no concussion; (2) recent concussion, mean number of days since last concussion 5 (95% CI, 4-6); and (3) history of concussion, mean number of days since last concussion 631 (95% CI, 505-730). DESIGN Cross-sectional study. MAIN MEASURES The vestibulo-ocular reflex is a fundamental reflex of the central nervous system that stabilizes the position of the eyes during head movement and adapts when sensory input is altered (the bend of the light on the retina by prism glasses). The prism adaptation measure was the number of throws taken to adapt to wearing prism glasses while throwing balls at a central target. RESULTS The intraclass correlation coefficient (0.73; 95% CI, 0.55-0.84) and the Bland-Altman 95% levels of agreement (lower limit -18.5; 95% CI, -22.4 to -14.6); and upper limit 16.6; 95% CI, 12.7-20.5) reflected good intrarater reliability. Prism adaptation measures were significantly different across groups ( F2,119 = 51.9, P < .001, r = 0.52, power of 90%), with the mean number of throws for youth (aged 11-17 years) in each group as follows: 10 (95% CI, 8-12) no concussion history; 25 (95% CI, 23-27) recent concussion (1-11 days); and 17 (95% CI, 15-20) history of concussion (90-1560 days). CONCLUSION Use of a prism paradigm as a clinical measurement tool has the potential to alter concussion management in youth. The prism paradigm is objective, is readily translatable to the clinical arena, has minimal associated costs, and is easily administered, reliable, and portable.
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Affiliation(s)
- C Elaine Little
- Faculty of Kinesiology (Drs Little, Schneider, and Emery), Department of Clinical Neurosciences (Dr Dukelow), and Cumming School of Medicine (Drs Dukelow and Emery), University of Calgary, Calgary, Alberta, Canada
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Male Youth Ice Hockey Concussion Incidence in a USA Hockey Membership-Adjusted Population: A Peak in 2011 and the Impact of Major Rule Changes. Clin J Sport Med 2022; 32:122-127. [PMID: 34009791 DOI: 10.1097/jsm.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the incidence of youth ice hockey-related concussions preceding and following the implementation of new body-checking and head contact rules by USA hockey in 2011. We hypothesized a decrease in concussions after the rule change. DESIGN Retrospective analysis. SETTING United States emergency department (ED) data queried in the National Electronic InjurySurveillance System (NEISS). PATIENTS National Electronic Injury Surveillance System reported male youth (≤18 years) ice hockey concussion cases from January 1, 2002, to December 31, 2016. In total, 848 players were diagnosed with concussion, representing a national estimate of 17 374 cases. INDEPENDENT VARIABLES Time, specifically years. MAIN OUTCOME MEASURES Incidences and incidence rates (measured per 10 000 person-years) of male youth ice hockey concussions. Annual trends were analyzed using descriptive and linear or polynomial regression analysis. RESULTS The national estimate of youth ice hockey-related concussions seen in US emergency departments (EDs) increased significantly from 656 in 2007 to 2042 in 2011 (P < 0.01). During the same period, their respective incidence increased significantly from 21.8 to 66.8 per 10 000, before dropping through 2016 (P < 0.05). After 2011, concussions decreased from 1965 in 2012 to 1292 in 2016 (P = 0.055). The gap in concussion incidence between the 11 to 12 and 13 to 14 divisions widened after 2011 (before 2011: 41 vs 49 per 10 000 person-years [P = 0.80]; after 2011: 45 and 89, respectively [P < 0.01]). CONCLUSIONS US EDs experienced a significant increase in youth ice hockey concussion visits from 2007 to 2011. After the 2011 rule changes, concussion visits decreased significantly from 2012 to 2016.
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Berz K, Rhine T, Pomerantz WJ, Zhang Y, Loftus K, Lyons S, Logan K. An intervention to improve knowledge and increase comfort of concussion management among school medical staff. NURSE EDUCATION TODAY 2022; 109:105247. [PMID: 34968933 DOI: 10.1016/j.nedt.2021.105247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 11/03/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Concussion can negatively impact a child's ability to learn. School-based health professional staff have a unique opportunity to monitor students during recovery and mitigate the potential negative impact. Little is known about school health professional staff's knowledge and comfort with concussion diagnosis and management. OBJECTIVES We aimed to evaluate whether a tailored concussion education session could improve school health professional staff's knowledge about pediatric concussions. A secondary aim was to determine their knowledge retention and comfort with concussion management over the following year, including the impact of periodic follow-up education. We hypothesized that there would be sustained improvement in concussion knowledge and self-reported comfort in concussion management. STUDY DESIGN This study was a pre/post-intervention assessment with longitudinal follow-up. The study investigators provided a three-hour educational presentation about concussions in school-aged children. A survey on knowledge and management of pediatric concussions was administered immediately before and after this educational intervention. Knowledge retention and comfort with management was assessed at six months and at one year post-intervention. PARTICIPANTS AND SETTING Participants included Cincinnati Health Department school health professional staff in attendance at their Back to School in-service, prior to the start of the 2017-2018 school year. RESULTS Sixty school health professional staff from thirty-three schools completed the baseline knowledge survey, and forty completed all four assessments. Among the 40 participants with complete data, on average, the correct response rate (mean number correct, SD) was 82.3% (18.1/22, 11.0) pre-education, 91.8% (20.2/22, 10.3) immediate post-education, 86.4% (19.0/22, 10.8) 6-month follow-up, and 87.3% (19.2/22, 10.9) one-year follow-up. CONCLUSIONS A brief didactic educational intervention improved pediatric concussion knowledge and management skills among school health care providers. Periodic and in-person education is likely necessary to optimize knowledge retention.
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Affiliation(s)
- Kate Berz
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America.
| | - Tara Rhine
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America
| | - Wendy J Pomerantz
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America
| | - Yin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, United States of America
| | - Kirsten Loftus
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, United States of America; Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, United States of America
| | - Stephanie Lyons
- Comprehensive Children's Injury Center, Division of Trauma Services, Cincinnati Children's Hospital Medical Center, United States of America
| | - Kelsey Logan
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, United States of America; Department of Internal Medicine, University of Cincinnati College of Medicine, United States of America
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20
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Miller MR, Robinson M, Fischer L, DiBattista A, Patel MA, Daley M, Bartha R, Dekaban GA, Menon RS, Shoemaker JK, Diamandis EP, Prassas I, Fraser DD. Putative Concussion Biomarkers Identified in Adolescent Male Athletes Using Targeted Plasma Proteomics. Front Neurol 2022; 12:787480. [PMID: 34987469 PMCID: PMC8721148 DOI: 10.3389/fneur.2021.787480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Sport concussions can be difficult to diagnose and if missed, they can expose athletes to greater injury risk and long-lasting neurological disabilities. Discovery of objective biomarkers to aid concussion diagnosis is critical to protecting athlete brain health. To this end, we performed targeted proteomics on plasma obtained from adolescent athletes suffering a sports concussion. A total of 11 concussed male athletes were enrolled at our academic Sport Medicine Concussion Clinic, as well as 24 sex-, age- and activity-matched healthy control subjects. Clinical evaluation was performed and blood was drawn within 72 h of injury. Proximity extension assays were performed for 1,472 plasma proteins; a total of six proteins were considered significantly different between cohorts (P < 0.01; five proteins decreased and one protein increased). Receiver operating characteristic curves on the six individual protein biomarkers identified had areas-under-the-curves (AUCs) for concussion diagnosis ≥0.78; antioxidant 1 copper chaperone (ATOX1; AUC 0.81, P = 0.003), secreted protein acidic and rich in cysteine (SPARC; AUC 0.81, P = 0.004), cluster of differentiation 34 (CD34; AUC 0.79, P = 0.006), polyglutamine binding protein 1 (PQBP1; AUC 0.78, P = 0.008), insulin-like growth factor-binding protein-like 1 (IGFBPL1; AUC 0.78, P = 0.008) and cytosolic 5'-nucleotidase 3A (NT5C3A; AUC 0.78, P = 0.009). Combining three of the protein biomarkers (ATOX1, SPARC and NT5C3A), produced an AUC of 0.98 for concussion diagnoses (P < 0.001; 95% CI: 0.95, 1.00). Despite a paucity of studies on these three identified proteins, the available evidence points to their roles in modulating tissue inflammation and regulating integrity of the cerebral microvasculature. Taken together, our exploratory data suggest that three or less novel proteins, which are amenable to a point-of-care immunoassay, may be future candidate biomarkers for screening adolescent sport concussion. Validation with protein assays is required in larger cohorts.
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Affiliation(s)
- Michael R Miller
- Department of Pediatrics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada
| | - Michael Robinson
- School of Health Studies, Western University, London, ON, Canada.,School of Kinesiology, Western University, London, ON, Canada.,Department of Family Medicine, Western University, London, ON, Canada
| | - Lisa Fischer
- Department of Family Medicine, Western University, London, ON, Canada
| | - Alicia DiBattista
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Neurolytixs Inc., Toronto, ON, Canada
| | - Maitray A Patel
- Department of Epidemiology, Western University, London, ON, Canada
| | - Mark Daley
- Department of Epidemiology, Western University, London, ON, Canada.,Department of Computer Science, Western University, London, ON, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Western University, London, ON, Canada.,Robarts Research Institute, London, ON, Canada
| | - Gregory A Dekaban
- Robarts Research Institute, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - Ravi S Menon
- Department of Medical Biophysics, Western University, London, ON, Canada.,Robarts Research Institute, London, ON, Canada
| | | | | | - Ioannis Prassas
- Department of Pathology and Laboratory Medicine, University of Toronto, Toronto, ON, Canada
| | - Douglas D Fraser
- Department of Pediatrics, Western University, London, ON, Canada.,Children's Health Research Institute, London, ON, Canada.,Neurolytixs Inc., Toronto, ON, Canada.,Department of Physiology and Pharmacology, Western University, London, ON, Canada.,Depatment of Clinical Neurological Sciences, Western University, London, ON, Canada
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21
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McQuivey KS, Moore ML, Pollock JR, Hassebrock JD, Patel KA, Chhabra A. Top-100 Most-Cited Sports-Related Concussion Articles Focus on Symptomatology, Epidemiology, and Demographics. Arthrosc Sports Med Rehabil 2021; 3:e1585-e1597. [PMID: 34977610 PMCID: PMC8689224 DOI: 10.1016/j.asmr.2021.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose To analyze the top-100 cited articles on sports-related concussions together with a bibliometric analysis to determine citations by year, level of evidence, study design, and several other factors related to the top referenced articles in sports concussions. Methods The Clarivate Analytics Web of Knowledge database was used to gather data using Boolean queries to capture all possible iterations of sports-related concussion research. Articles were organized in descending order based on the number of citations and included or excluded based on relevance to concussion. Collected information included author name, publication year, country of origin, journal name, article type, study focus, and the level of evidence. Results The top-100 articles were cited 31,197 times with an average of 312.0 citations per publication. More than one half were published in 2006 or later (52). Cohort studies and descriptive articles were the most prevalent study types (22 each). Studies with Level V evidence were the most common (33). The most common areas of study were symptomatology (short term, long term) with 17 articles, followed by epidemiology/demographics with 16 articles. The least common area of study was concussion prevention (2 articles), followed by management/treatment, diagnostics (labs, imaging) with 4 articles each. Conclusions We identified the most influential studies in sports-related concussion based on number of citations and citation density. A majority of these articles were published in the United States after 2006 and are most commonly cohort studies (Level IV evidence) and descriptive articles (Level V evidence). Current research focuses most heavily on the symptomatology and epidemiology/demographics of sports concussion. Clinical Relevance This study serves to identify the most influential articles in sports-related concussion and identify research topics with general deficiencies within the field of sports-related concussion research.
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Affiliation(s)
| | - M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona, U.S.A
| | | | | | - Karan A Patel
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix
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22
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Reporting of Concussion Symptoms by a Nationwide Survey of United States Parents of Middle School Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212070. [PMID: 34831822 PMCID: PMC8622026 DOI: 10.3390/ijerph182212070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/12/2021] [Accepted: 11/14/2021] [Indexed: 11/16/2022]
Abstract
This cross-sectional study assessed concussion symptom knowledge of parents of middle school (MS) children (aged 10-15 years) through a free-response item that solicited concussion symptoms and compared findings to a pre-validated scale-based measure. A self-administered online questionnaire was sent to a panel of randomly selected United States residents who were recruited by a third-party company, aged ≥ 18 years, and identified as parents of MS children. Via a free-response item, parents listed what they believed were concussion symptoms. Multiple sections later, parents identified potential concussion symptoms via a scale measure, which featured 25 items (22 actual symptoms, three distractor symptoms) with three response options: yes, no, maybe. Free-response item responses were coded into specific symptoms. The 1062 eligible parents that provided complete data commonly identified the symptoms of dizziness (90.2%), blurred vision (87.4%), and balance problems (86.4%) on the scale-based measure. However, these and other symptoms were less commonly identified via the free-response item (dizziness: 44.4%; blurred vision: 16.5%; balance problems: 3.5%). Concussion symptoms commonly reported via the scale-based measure were reported less frequently within the free-response item. Future research must explore strategies to help clinicians working with parents and their children to measure and assess concussion symptom reporting and knowledge.
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23
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Babl FE, Rausa VC, Borland ML, Kochar A, Lyttle MD, Phillips N, Gilhotra Y, Dalton S, Cheek JA, Furyk J, Neutze J, Bressan S, Davis GA, Anderson V, Williams A, Oakley E, Dalziel SR, Crowe LM, Hearps SJC. Characteristics of concussion based on patient age and sex: a multicenter prospective observational study. J Neurosurg Pediatr 2021:1-10. [PMID: 34598158 DOI: 10.3171/2021.6.peds20953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Children with concussion frequently present to emergency departments (EDs). There is limited understanding of the differences in signs, symptoms, and epidemiology of concussion based on patient age. Here, the authors set out to assess the association between age and acute concussion presentations. METHODS The authors conducted a multicenter prospective observational study of head injuries at 10 EDs in Australia and New Zealand. They identified children aged 5 to < 18 years, presenting with a Glasgow Coma Scale score of 13-15, presenting < 24 hours postinjury, with no abnormalities on CT if performed, and one or more signs or symptoms of concussion. They extracted demographic, injury-related, and signs and symptoms information and stratified it by age group (5-8, 9-12, 13 to < 18 years). RESULTS Of 8857 children aged 5 to < 18 years, 4709 patients met the defined concussion criteria (5-8 years, n = 1546; 9-12 years, n = 1617; 13 to < 18 years, n = 1546). The mean age of the cohort was 10.9 years, and approximately 70% of the patients were male. Sport-related concussion accounted for 43.7% of concussions overall, increasing from 19.1% to 48.9% to 63.0% in the 5-8, 9-12, and 13 to < 18 years age groups. The most common acute symptoms postinjury were headache (64.6%), disorientation (36.2%), amnesia (30.0%), and vomiting (27.2%). Vomiting decreased with increasing age and was observed in 41.7% of the 5-8 years group, 24.7% of the 9-12 years group, and 15.4% of the 13 to < 18 years group, whereas reported loss of consciousness (LOC) increased with increasing age, occurring in 9.6% in the 5-8 years group, 21.0% in the 9-12 years group, 36.7% in the 13 to < 18 years group, and 22.4% in the entire study cohort. Headache, amnesia, and disorientation followed the latter trajectory. Symptom profiles were broadly similar between males and females. CONCLUSIONS Concussions presenting to EDs were more sports-related as age increased. Signs and symptoms differed markedly across age groups, with vomiting decreasing and headache, LOC, amnesia, and disorientation increasing with increasing age.
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Affiliation(s)
- Franz E Babl
- 1Emergency Department, Royal Children's Hospital, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Vanessa C Rausa
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
| | - Meredith L Borland
- 20Emergency Department, Perth Children's Hospital, Perth, Australia; and.,21School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Australia
| | - Amit Kochar
- 7Emergency Department, Women's & Children's Hospital, Adelaide, Australia
| | - Mark D Lyttle
- 8Faculty of Health & Life Sciences, University of the West of England, Bristol, United Kingdom
| | - Natalie Phillips
- 9Emergency Department, Queensland Children's Hospital, Brisbane.,10Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane
| | - Yuri Gilhotra
- 9Emergency Department, Queensland Children's Hospital, Brisbane
| | - Sarah Dalton
- 11Emergency Department, The Children's Hospital at Westmead, Sydney
| | - John A Cheek
- 1Emergency Department, Royal Children's Hospital, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne.,12Emergency Department, Monash Medical Centre, Melbourne, Australia
| | - Jeremy Furyk
- 13Emergency Department, The Townsville Hospital, Townsville, Queensland.,15School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Jocelyn Neutze
- 16Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Silvia Bressan
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,17Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gavin A Davis
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,4Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne
| | - Vicki Anderson
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,5School of Psychological Sciences, University of Melbourne, Melbourne.,6Psychology Service, Royal Children's Hospital, Melbourne
| | - Amanda Williams
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
| | - Ed Oakley
- 1Emergency Department, Royal Children's Hospital, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Stuart R Dalziel
- 18Emergency Department, Starship Children's Health, Auckland.,19Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Louise M Crowe
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne.,5School of Psychological Sciences, University of Melbourne, Melbourne.,6Psychology Service, Royal Children's Hospital, Melbourne
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24
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Grool AM, DeMatteo C, Reed N, Newhook D, Zemek R. Patient, parent and educator perspectives on paediatric concussion. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/2059700220969535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Past research on paediatric concussion awareness, management, impact and outcome priorities has focused on health care professionals and sports organizations, yet little is known about patient, parent and educator perspectives. Methods To address this knowledge gap, we conducted a qualitative descriptive study using semi-structured interviews with three participant groups: patient-participants including children with acute or chronic concussion; parent-participants including caregivers of children at risk for or with history of concussion; and educator-participants including teachers and athletic coaches from three Ontario secondary schools. We designed our interview guide to elicit participants’ perspectives across four domains: concussion awareness, concussion experience, support and resources, and outcome priorities. We analyzed our resultant data using a qualitative content analysis approach. Results Nine paediatric patient-participants, 17 parent-participants, and 14 educator-participants completed the study. Participants described concussion as a serious health concern and attributed greater concussion awareness to increased media attention and concussion protocol implementation within schools/sports. While most educator-participants regarded concussion protocols positively, some feared student manipulation. Parent- and educator-participants desired consistent information and resources from reliable sources. The impact of concussion ranged from a few days to prolonged absences (from school, sports, and socializing) and necessitated accommodations in both academic and sport settings. Short-term problems (e.g., decreased peer-contact) primarily troubled patient-participants, whereas long-term problems (e.g., impaired academics, psychological stress) concerned parent and educator groups. Conclusion Patients, parents and educators worry about the consequences of paediatric concussion. Initial concussion recovery in youth should focus on a timely return to academics and on minimizing social isolation by ensuring peer-contact during recovery.
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Affiliation(s)
- Anne M Grool
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Carol DeMatteo
- CanChild Centre for Disability Research, McMaster University, Hamilton, Canada
| | - Nick Reed
- Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Canada
| | - Dennis Newhook
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Roger Zemek
- Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
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25
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Rose SC, Anderson W, Feinberg D, Ganesh A, Green L, Jaffee M, Kaplen M, Lorincz M, De Luigi A, Patel D, Tsao JW, Lee E, Webb A. Quality Improvement in Neurology: Concussion Quality Measurement Set. Neurology 2021; 97:537-542. [PMID: 34321361 DOI: 10.1212/wnl.0000000000012537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/10/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sean C Rose
- Nationwide Childrens Hospital and The Ohio State University, Columbus, OH
| | | | | | | | - Lauren Green
- University of Southern California, Los Angeles, CA
| | | | | | | | | | | | | | - Erin Lee
- American Academy of Neurology, Minneapolis, MN
| | - Adam Webb
- Emory University School of Medicine, Decatur, GA
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26
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Makovec Knight J, Nguyen JVK, Mitra B, Willmott C. Soft-shell headgear, concussion and injury prevention in youth team collision sports: a systematic review. BMJ Open 2021; 11:e044320. [PMID: 34083330 PMCID: PMC8183293 DOI: 10.1136/bmjopen-2020-044320] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 05/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess the association between soft-shell headgear (HG) use and sports-related concussion (SRC). Secondary objectives were to assess the association between HG and superficial head injury and investigate potential increase in injury risk among HG users. DESIGN A systematic search in Ovid MEDLINE, Cochrane Library, Scopus, PsycINFO and SPORTDiscus was conducted in April 2020. Inclusion criteria were youth <18, English language, in vivo studies published after 1980 that evaluated SRC and other injury incidence in HG users compared with non-users. OUTCOME MEASURES Incidence rates of SRC, superficial head injury or other injuries. RESULTS Eight studies were eligible. The majority (n=5) reported no difference in the rate of SRC among HG users versus non-users. One rugby study identified significantly lower risk of SRC for non-HG users (risk ratio (RR) 0.63; 95% CI 0.41 to 0.98) compared with HG users, whereas a cross-sectional survey of soccer players indicated higher risk of SRC for non-HG users (RR 2.65; 95% CI 1.23 to 3.12) compared with HG users. Three of the four studies investigating superficial head injury found no significant differences with HG use, though the soccer survey reported reduced risk among HG users (RR 1.86; 95% CI 0.09 to 0.11). Increased incidence of injuries to all body regions for rugby HG users was reported in two studies with adjusted RRs of 1.16 (95% CI 1.04 to 1.29) and 1.23 (95% CI 1.00 to 1.50). CONCLUSIONS HG use was not associated with reduced rates of SRC or superficial head injury in youth soccer and rugby. The possibility of increased injury risk to all body regions for rugby HG users was raised. The need for research specific to youth and female athletes was highlighted. PROSPERO REGISTRATION NUMBER CRD42018115310.
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Affiliation(s)
- Jennifer Makovec Knight
- Turner Institute for Brain and Mental Health, School of Psychological Sciences Monash University, Melbourne, Victoria, Australia
| | - Jack V K Nguyen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences Monash University, Melbourne, Victoria, Australia
| | - Biswadev Mitra
- Department of Epidemiology and Preventive Medicine, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Catherine Willmott
- Turner Institute for Brain and Mental Health, School of Psychological Sciences Monash University, Melbourne, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Victoria, Australia
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27
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Wallace JS, Mannix RC. Racial Disparities in Diagnosis of Concussion and Minor Head Trauma and Mechanism of Injury in Pediatric Patients Visiting the Emergency Department. J Pediatr 2021; 233:249-254.e1. [PMID: 33524386 DOI: 10.1016/j.jpeds.2021.01.057] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if racial/ethnic differences exist in the diagnosis and mechanism of injury among children and adolescents visiting the emergency department (ED) for concussion and minor head trauma (MHT). STUDY DESIGN A retrospective, cross-sectional study of patient (age ≤19 years) visits to the ED for concussion between 2010-2015, using the National Hospital Ambulatory Medical Care Survey, was completed. The primary study exposure was race/ethnicity. Outcome measures included ED visits that resulted in a concussion/MHT diagnosis and mechanism of injury. Mechanism categories included sport, motor vehicle collision, fall, assault, and other mechanism. A multivariable logistic regression and multinomial logistic regression were conducted to assess relationships between race/ethnicity and outcomes. Findings were weighted to reflect population estimates. RESULTS In total, 1263 child/adolescent visits for concussion/MHT were identified, representing an estimated 6.6 million child/adolescent visits nationwide. Compared with non-Hispanic White pediatric patients, non-Hispanic Black patients were least likely to have an ED visit for a concussion/MHT (P < .001; OR, 0.66; 95% CI, 0.52-0.83) The odds of non-Hispanic Black children/adolescents (OR, 3.80; 95% CI, 1.68-8.55) and children/adolescents of other race/ethnicity (OR, 4.93; 95% CI, 1.09-22.23) sustaining a concussion/MHT resulting from assault vs sport was higher. CONCLUSIONS Amid the emerging focus on sport-related concussion, these ethnic/racial differences in ED diagnosis of concussion/MHT demonstrate sociodemographic differences that warrant further attention. Assault may be a more common mechanism of concussion among children/adolescents of a racial minority.
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Affiliation(s)
- Jessica S Wallace
- Department of Epidemiology, Harvard T.H Chan School of Public Health, Boston, MA; Department of Health Science, University of Alabama, Tuscaloosa, AL.
| | - Rebekah C Mannix
- Departments of Pediatrics & Emergency Medicine, Harvard Medical School, Boston, MA; Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
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28
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Wright B, Wilmoth K, Juengst SB, Didehbani N, Maize R, Cullum CM. Perceived Recovery and Self-Reported Functioning in Adolescents with Mild Traumatic Brain Injury: The Role of Sleep, Mood, and Physical Symptoms. Dev Neurorehabil 2021; 24:237-243. [PMID: 33356738 DOI: 10.1080/17518423.2020.1858456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To determine the contributions of anxiety, depressive, and concussion symptoms and sleep quality to self-perceived recovery in adolescents with concussion.Method: Adolescents aged 12-20 (n = 298) completed anxiety, depression, concussion symptoms, and sleep measures at an initial concussion clinic visit and three-month follow-up. At follow-up, they reported self-perceived recovery as percent back to normal.Results: Injury-related factors alone did not predict self-perceived recovery (R2Adj =.017, p =.074). More concurrent physical, mental health, and sleep symptoms explained 18.8% additional variance in poorer self-perceived recovery (R2Adj Change =.188, p <.05). Physical symptoms (Bstand = -.292) and anxiety (Bstand = -.260) accounted for the most variance in self-perceived recovery.Conclusion: Post-concussive symptoms, in particular anxiety and self-reported physical symptoms, seem to characterize protracted recovery. Self-perceived recovery as an outcome measure may provide a more holistic understanding of adolescents' experiences after concussion.
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Affiliation(s)
- Brittany Wright
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - K Wilmoth
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - S B Juengst
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Medical College of Wisconsin, Milwaukee, WI, USA
| | - N Didehbani
- The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - R Maize
- Carlow University, Pittsburgh, PA, USA
| | - C M Cullum
- The University of Texas Southwestern Medical Center, Dallas, TX, USA.,Carlow University, Pittsburgh, PA, USA
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29
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Lugo GJ, Beletanga M, Goldstein L, Rana M, Jonas R, Torres AR. Assessment and Treatment of Concussion in the Pediatric Population. Semin Neurol 2021; 41:132-146. [PMID: 33657625 DOI: 10.1055/s-0041-1725135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Traumatic brain injury (TBI) is common in children. The evaluation and management of children with TBI is based on the research performed in adults. There is a relative paucity of research in the literature involving children and many of the practice recommendations for this age are based on expert opinion in the absence of good research studies in both sports and non-sports-related injuries. The pediatric population is heterogeneous and the approach might be specific for infants, preschoolers, school age children, and adolescents. Children may also suffer from neurodevelopmental disabilities, making their evaluation even more challenging. Adult neurologists are often asked to see children due to increasing demands. This review will focus on specific issues related to TBI in children that might be useful to adult neurologists. Science, however, is evolving rapidly and physicians should make sure to remain up to date to offer evidence-based services to their patients.
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Affiliation(s)
- Giancarlo J Lugo
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Maria Beletanga
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Laura Goldstein
- Division of Child Psychiatry, Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
| | - Mandeep Rana
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Rinat Jonas
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Alcy R Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.,Pediatric Brain Injury Program, Boston University School of Medicine, Boston, Massachusetts
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Kerr ZY, Nedimyer AK, Kay MC, Chandran A, Gildner P, Byrd KH, Haarbauer-Krupa JK, Register-Mihalik JK. Factors associated with concussion-symptom knowledge and attitudes toward concussion care seeking in a national survey of parents of middle-school children in the US. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:113-121. [PMID: 32919064 PMCID: PMC7987565 DOI: 10.1016/j.jshs.2020.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/18/2020] [Accepted: 08/04/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Developing appropriate concussion prevention and management paradigms in middle school (MS) settings requires understanding parents' general levels of concussion-related knowledge and attitudes. This study examined factors associated with concussion-symptom knowledge and care-seeking attitudes among parents of MS children (aged 10-15 years). METHODS A panel of 1224 randomly selected U.S. residents, aged ≥ 18 years and identifying as parents of MS children, completed an online questionnaire capturing parental and child characteristics. The parents' concussion-symptom knowledge was measured using 25 questions, with possible answers being "yes", "maybe", and "no". Correct answers earned 2 points, "maybe" answers earned 1 point, and incorrect answers earned 0 point (range: 0-50; higher scores = better knowledge). Concussion care-seeking attitudes were also collected using five 7-point scale items (range: 5-35; higher scores = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher scores. Models met proportional odds assumptions. Adjusted odds ratios (aORs) with 95% confidence intervals (95%CIs) (excluding 1.00) were deemed statistically significant. RESULTS Median scores were 39 (interquartile range: 32-44) for symptom knowledge and 32 (interquartile range: 28-35) for care-seeking attitude. In multivariable models, odds of better symptom knowledge were higher in women vs. men (aOR = 2.28; 95%CI: 1.71-3.05), white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.88; 95%CI: 1.42-2.49), higher parental age (10-year-increase aOR = 1.47; 95%CI: 1.26-1.71), and greater competitiveness (10%-scale-increase aOR = 1.24; 95%CI: 1.13-1.36). Odds of more positive care-seeking attitudes were higher in white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.45; 95%CI: 1.06-1.99) and in older parental age (10-year-increase aOR = 1.24; 95%CI: 1.05-1.47). CONCLUSION Characteristics of middle school children's parents (e.g., sex, race or ethnicity, age) are associated with their concussion-symptom knowledge and care-seeking attitudes. Parents' variations in concussion knowledge and attitudes warrant tailored concussion education and prevention.
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Affiliation(s)
- Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA.
| | - Aliza K Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC 27599-8700, USA
| | - Melissa C Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN 46202, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - K Hunter Byrd
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Juliet K Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-8700, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina, Chapel Hill, NC 27599-8700, USA; Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC 27510, USA
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Zendler JM, Jadischke R, Frantz J, Hall S, Goulet GC. Emergency Department Visits From 2014 to 2018 for Head Injuries in Youth Non-Tackle Football Compared With Other Sports. Orthop J Sports Med 2021; 9:2325967120975402. [PMID: 33614796 PMCID: PMC7869161 DOI: 10.1177/2325967120975402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Non-tackle football (ie, flag, touch, 7v7) is purported to be a lower-risk alternative to tackle football, particularly in terms of head injuries. However, data on head injuries in non-tackle football are sparse, particularly among youth participants. Purpose To describe the epidemiology of emergency department visits for head injuries due to non-tackle football among youth players in the United States and compare the data with basketball, soccer, and tackle football. Study Design Descriptive epidemiology study. Methods Injury data from 2014 to 2018 were obtained from the National Electronic Injury Surveillance System database. Injury reports coded for patients aged 6 to 18 years and associated with basketball, football, or soccer were extracted. Data were filtered to include only injuries to the head region, specifically, the head, ear, eyeball, mouth, or face. Football injuries were manually assigned to "non-tackle" or "tackle" based on the injury narratives. Sports & Fitness Industry Association data were used to estimate annual sport participation and calculate annual injury rates per 100,000 participant-years. Results A total of 26,770 incident reports from 2014 to 2018 were analyzed. For head region injuries in non-tackle football, the head was the most commonly injured body part, followed by the face; the most common diagnosis was a laceration, followed by concussion and internal injury (defined as an unspecified head injury or internal head injury [eg, subdural hematoma or cerebral contusion]). The most common contacting object was another player. The projected national rate of head region injuries was lowest for non-tackle football across the 4 sports. In particular, the projected rate of injuries to the head for non-tackle football (78.0 per 100,000 participant-years) was less than one-fourth the rates for basketball (323.5 per 100,000 participant-years) and soccer (318.2 per 100,000 participant-years) and less than one-tenth the rate for tackle football (1478.6 per 100,000 participant-years). Conclusion Among youth in the United States aged 6 to 18 years who were treated in the emergency department for injuries related to playing non-tackle football, the most common diagnosis for injuries to the head region was a laceration, followed by a concussion. Head region injuries associated with non-tackle football occurred at a notably lower rate than basketball, soccer, or tackle football.
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Affiliation(s)
- Jessica M Zendler
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA.,Xenith, Detroit, Michigan, USA
| | | | - Jared Frantz
- Applied Safety and Ergonomics, Ann Arbor, Michigan, USA
| | - Steve Hall
- Applied Safety and Ergonomics, Ann Arbor, Michigan, USA
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Repetitive Traumatic Brain Injury Causes Neuroinflammation before Tau Pathology in Adolescent P301S Mice. Int J Mol Sci 2021; 22:ijms22020907. [PMID: 33477535 PMCID: PMC7831108 DOI: 10.3390/ijms22020907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 01/22/2023] Open
Abstract
Repetitive closed head injury (rCHI) is commonly encountered in young athletes engaged in contact and collision sports. Traumatic brain injury (TBI) including rCHI has been reported to be an important risk factor for several tauopathies in studies of adult humans and animals. However, the link between rCHI and the progression of tau pathology in adolescents remains to be elucidated. We evaluated whether rCHI can trigger the initial acceleration of pathological tau in adolescent mice and impact the long-term outcomes post-injury. To this end, we subjected adolescent transgenic mice expressing the P301S tau mutation to mild rCHI and assessed tau hyperphosphorylation, tangle formation, markers of neuroinflammation, and behavioral deficits at 40 days post rCHI. We report that rCHI did not accelerate tau pathology and did not worsen behavioral outcomes compared to control mice. However, rCHI induced cortical and hippocampal microgliosis and corpus callosum astrocytosis in P301S mice by 40 days post-injury. In contrast, we did not find significant microgliosis or astrocytosis after rCHI in age-matched WT mice or sham-injured P301S mice. Our data suggest that neuroinflammation precedes the development of Tau pathology in this rCHI model of adolescent repetitive mild TBI.
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Miller MR, Robinson M, Bartha R, Charyk Stewart T, Fischer L, Dekaban GA, Menon RS, Shoemaker JK, Fraser DD. Concussion Acutely Decreases Plasma Glycerophospholipids in Adolescent Male Athletes. J Neurotrauma 2021; 38:1608-1614. [PMID: 33176582 DOI: 10.1089/neu.2020.7125] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Concussions are frequent in sports and can contribute to significant and long-lasting neurological disability. Adolescents are particularly susceptible to concussions, with accurate determination of the injury challenging. Our previous study demonstrated that concussion diagnoses could be aided by metabolomics profiling and machine learning, with particular weighting on changes in plasma glycerophospholipids (PCs). Here, our aim was to report directional change of PCs after concussion and develop a diagnostic concussion panel utilizing a minimum number of plasma PCs. To this end, we enrolled 12 concussed male athletes at our academic Sport Medicine Concussion Clinic, as well as 17 sex-, age-, and activity-matched healthy controls. Blood was drawn and 71 plasma PCs were measured for statistically significant changes within 72 h of injury, and individual PCs were further analyzed with receiver operating characteristic (ROC) curves. Our data demonstrated that 26 of 71 PCs measured were significantly decreased after sports-related concussion (p < 0.01). None of the PCs increased in plasma after concussion. ROC curve analyses identified the top four PCs with areas under the curve (AUCs) ≥0.86 for concussion diagnosis: PCaeC36:0 (0.92; p < 0.001); PCaaC42:6 (0.90; p < 0.001); PCaeC36:2 (0.86; p = 0.001), and PCaaC32:0 (0.86; p = 0.001). Cut-off values in μM were ≤0.31, 0.22, 5.07, and 4.63, respectively. Importantly, combining these four PCs produced an AUC of 0.96 for concussion diagnoses (p < 0.001; 95% confidence interval, 0.89, 1.00). Our data suggest that as few as four circulating PCs may provide excellent diagnostic potential for adolescent concussion. External validation is required in larger cohorts.
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Affiliation(s)
- Michael R Miller
- Pediatrics, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada
| | | | - Robert Bartha
- Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, London, Ontario, Canada
| | | | - Lisa Fischer
- Family Medicine, Western University, London, Ontario, Canada
| | - Gregory A Dekaban
- Microbiology and Immunology, Western University, London, Ontario, Canada.,Robarts Research Institute, London, Ontario, Canada
| | - Ravi S Menon
- Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, London, Ontario, Canada
| | | | - Douglas D Fraser
- Pediatrics, Western University, London, Ontario, Canada.,Physiology and Pharmacology, Western University, London, Ontario, Canada.,Clinical Neurological Sciences, Western University, London, Ontario, Canada.,Children's Health Research Institute, London, Ontario, Canada.,Neurolytixs, Inc., Toronto, Ontario, Canada
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Doyle-Baker PK, Emery CA. Self-Reported Physical Activity, Injury, and Illness in Canadian Adolescent Ski Racers. Front Sports Act Living 2020; 2:32. [PMID: 33345024 PMCID: PMC7739776 DOI: 10.3389/fspor.2020.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Youth ski racers spend a considerable amount of time on snow and this may detract from other activities known to influence fundamental movement skills and overall health related outcomes. Parents of racers (n = 52 F; n = 44 M; age range 9–14 years) registered in the Canadian club system completed a baseline medical questionnaire during preseason testing in 2017. We describe physical activity volume and sport participation outside of physical education classes over the previous 12 months and report on injuries, medication use and health care utilization. The mean number of activities participated was five (range 1–14) with cycling, hiking, and swimming as the preferred choice and a cumulative mean of just under 400 h of activity was reported (range F 27–1,015; M 62–869 h/year) in the past year. During the past 12 months 16% of the athletes reported being injured and injury severity impacted return to sport with range of reported days missed from 1 to 365 days. Thirteen non-concussive injuries were reported in alpine skiing and females (12%, 6/52) reported more lower limb injuries than males (7%, 3/44). More males were concussed over their lifetime, with alpine skiing accounting for 46% and mountain biking 15%. Most athletes (85%) did not take medication on a regular basis and those that did had a medical diagnosis. The frequency of respiratory conditions was 13% (12/96) with males reporting slightly more cases than females. No difference in emergency visits occurred (25%) between males and females in the past 12 months, however females reported more (n = 102) allied health care, sport medicine and x-rays appointments when compared to males (n = 65). In summary, a high volume of physical activity (an hour plus per day) over the previous 12 months was reported with racers participating in several activities outside of skiing, likely honing their fundamental movement skills. Close proximity to the mountains may have influenced their choices of activity outside of ski racing, and their injuries and a variety of health conditions were typical of their age group. Future research employing wearable technology to objectively quantify the volume and intensity of physical activity participation is recommended.
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Affiliation(s)
- Patricia K Doyle-Baker
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.,School of Architecture, Planning and Landscape, University of Calgary, Calgary, AB, Canada.,The Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Emery
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.,The Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Billeck J, Peeler J. The influence of fatiguing exercise on Sport Concussion Assessment Tool (SCAT) scoring in a female pediatric population. PHYSICIAN SPORTSMED 2020; 48:458-462. [PMID: 32223686 DOI: 10.1080/00913847.2020.1746979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
There is currently a lack of information available about the effect that exercise fatigue may have on Child Sport Concussion Assessment Tool (SCAT) scoring in a pediatric population. Objective: The goal of this study was to examine the influence of a fatiguing bout of aerobic exercise on Child Sport Concussion Assessment Tool (SCAT) scoring in an adolescent female sporting population. Methods: A prospective, observational-based, test-retest study design was used to collect Child SCAT data from thirty healthy 9-12 year old physically active females during two testing sessions that occurred a minimum of 7 days apart. Within each testing session, each child completed a fatiguing bout of aerobic exercise, and the Child SCAT was administered: (1). Pre-exercise and (2). Post-exercise. Parametric and non-parametric testing was used to compare aerobic exercise test results and pre- vs. post-exercise Child SCAT data. Test-retest reliability was evaluated using intra-class correlation coefficient (ICC 3,1) analysis. Results: No significantly differences were noted between pre- and post-exercise Child SCAT data during either test day. ICC values suggested that a majority of the individual components of the Child SCAT demonstrated poor test-retest reliability. Conclusion: Clinicians using the Child SCAT as a sideline assessment tool during youth sport should have confidence that individual component scores are uninfluenced by aerobic exercise completed immediately prior to assessment. But, clinicians should also be cautioned against using Child SCAT data from consecutive testing days when making decisions about patient recovery and return-to-sport timelines.
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Affiliation(s)
- Jeffrey Billeck
- Faculty of Kinesiology and Applied Health, University of Winnipeg , Winnipeg, MB, Canada
| | - Jason Peeler
- David & Ruth Asper Research Centre, Pan Am Clinic , Winnipeg, MB, Canada.,College of Rehabilitation Sciences, University of Manitoba , Winnipeg, MB, Canada.,Max Rady College of Medicine, University of Manitoba , Winnipeg, MB, Canada
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The Association of Saliva Cytokines and Pediatric Sports-Related Concussion Outcomes. J Head Trauma Rehabil 2020; 35:354-362. [PMID: 32881769 DOI: 10.1097/htr.0000000000000605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This study aimed to explore cytokine alterations following pediatric sports-related concussion (SRC) and whether a specific cytokine profile could predict symptom burden and time to return to sports (RTS). SETTING Sports Medicine Clinic. PARTICIPANTS Youth ice hockey participants (aged 12-17 years) were recruited prior to the 2013-2016 hockey season. DESIGN Prospective exploratory cohort study. MAIN MEASURE Following SRC, saliva samples were collected and a Sport Concussion Assessment Tool version 3 (SCAT3) was administered within 72 hours of injury and analyzed for cytokines. Additive regression of decision stumps was used to model symptom burden and length to RTS based on cytokine and clinical features. RRelieFF feature selection was used to determine the predictive value of each cytokine and clinical feature, as well as to identify the optimal cytokine profile for the symptom burden and RTS. RESULTS Thirty-six participants provided samples post-SRC (81% male; age 14.4 ± 1.3 years). Of these, 10 features, sex, number of previous concussions, and 8 cytokines, were identified to lead to the best prediction of symptom severity (r = 0.505, P = .002), while 12 cytokines, age, and history of previous concussions predicted the number of symptoms best (r = 0.637, P < .001). The prediction of RTS led to the worst results, requiring 21 cytokines, age, sex, and number of previous concussions as features (r = -0.320, P = .076). CONCLUSIONS In pediatric ice hockey participants following SRC, there is evidence of saliva cytokine profiles that are associated with increased symptom burden. However, further studies are needed.
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Gillie BL, Fazio-Sumrok V, Eagle SR, Kegel N, Trbovich AM, Collins MW, Kontos AP. Clinical predictors of post-injury anxiety in adolescent patients following concussion. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:253-259. [PMID: 32723100 DOI: 10.1080/21622965.2020.1799790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of the current study was to examine predictors (e.g., pre-injury anxiety and sub-types, concussion symptom severity, neurocognitive performance, and vestibular/ocular-motor impairment) of post-injury anxiety scores following concussion among youth aged 10-18 years. This observational cohort study enrolled patients (n = 129) within 30 days of a diagnosed concussion. Patients completed Screening for Child Anxiety Related Disorders-Child Reports (SCARED-C), Generalized Anxiety Disorder-7 (GAD-7), Post-concussion Symptom Scale, neurocognitive testing, and Vestibular-Ocular Motor Screening. Logistic regression analyses were conducted to evaluate the role of risk factors and clinical outcomes as predictors of mild (GAD-7 > 5) and moderate levels (GAD-7 > 10) of post-injury anxiety. Twenty-two percent (n = 28) of patients reported clinical levels of pre-injury anxiety, and 13% (n = 17) reported clinical levels of post-injury anxiety. The logistic regression model predicting mild or greater anxiety was significant (R2 = 31.7%; p < 0.001) and supported pre-injury panic symptoms (OR = 1.38) and total symptom severity (OR = 1.04) as the most robust predictors. The logistic regression model predicting clinical anxiety was significant (R2 = 47.2%; p < 0.001) and supported non-SRC injury type (OR = 9.48), vestibular dysfunction (OR = 1.74) and pre-injury panic symptoms (OR = 1.57) as the most robust predictors. Results suggest that clinicians should employ measures of pre-injury and post-injury emotional functioning when evaluating and treating concussion among adolescents. Moreover, these results highlight the importance of assessing different types of pre-injury and post-injury anxiety in the context of concussion management.
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Affiliation(s)
- Brandon L Gillie
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Vanessa Fazio-Sumrok
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn R Eagle
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nathan Kegel
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alicia M Trbovich
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael W Collins
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony P Kontos
- University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Didehbani N, Silver CH, Hicks C, Bunt S, Tarkenton T, Rossetti H, Cullum CM. Concussion Symptoms by Mechanism of Injury in Elementary School–Aged Children. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2020. [DOI: 10.1007/s40817-020-00087-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gilis-Januszewska A, Kluczyński Ł, Hubalewska-Dydejczyk A. Traumatic brain injuries induced pituitary dysfunction: a call for algorithms. Endocr Connect 2020; 9:R112-R123. [PMID: 32412425 PMCID: PMC7274553 DOI: 10.1530/ec-20-0117] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
Abstract
Traumatic brain injury affects many people each year, resulting in a serious burden of devastating health consequences. Motor-vehicle and work-related accidents, falls, assaults, as well as sport activities are the most common causes of traumatic brain injuries. Consequently, they may lead to permanent or transient pituitary insufficiency that causes adverse changes in body composition, worrisome metabolic function, reduced bone density, and a significant decrease in one's quality of life. The prevalence of post-traumatic hypopituitarism is difficult to determine, and the exact mechanisms lying behind it remain unclear. Several probable hypotheses have been suggested. The diagnosis of pituitary dysfunction is very challenging both due to the common occurrence of brain injuries, the subtle character of clinical manifestations, the variable course of the disease, as well as the lack of proper diagnostic algorithms. Insufficiency of somatotropic axis is the most common abnormality, followed by presence of hypogonadism, hypothyroidism, hypocortisolism, and diabetes insipidus. The purpose of this review is to summarize the current state of knowledge about post-traumatic hypopituitarism. Moreover, based on available data and on our own clinical experience, we suggest an algorithm for the evaluation of post-traumatic hypopituitarism. In addition, well-designed studies are needed to further investigate the pathophysiology, epidemiology, and timing of pituitary dysfunction after a traumatic brain injury with the purpose of establishing appropriate standards of care.
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Affiliation(s)
- Aleksandra Gilis-Januszewska
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland
| | - Łukasz Kluczyński
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland
- Correspondence should be addressed to Ł Kluczyński:
| | - Alicja Hubalewska-Dydejczyk
- Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
- Endocrinology Department, University Hospital in Krakow, Krakow, Poland
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Gornall A, Takagi M, Clarke C, Babl FE, Davis GA, Dunne K, Anderson N, Hearps SJ, Demaneuf T, Rausa V, Anderson V. Behavioral and Emotional Difficulties after Pediatric Concussion. J Neurotrauma 2020; 37:163-169. [DOI: 10.1089/neu.2018.6235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alice Gornall
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E. Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Gavin A. Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Thibaut Demaneuf
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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An Evaluation of Heart Rate Variability in Female Youth Soccer Players Following Soccer Heading: A Pilot Study. Sports (Basel) 2019; 7:sports7110229. [PMID: 31689916 PMCID: PMC6915463 DOI: 10.3390/sports7110229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022] Open
Abstract
Most head impacts in soccer occur from purposeful heading; however, the link between heading and neurological impairment is unknown. Previous work suggests concussion may result in an uncoupling between the autonomic nervous system and cardiovascular system. Accordingly, heart rate variability (HRV) may be a sensitive measure to provide meaningful information regarding repetitive heading in soccer. The purpose of this pilot study assesses the feasibility of measuring HRV to evaluate autonomic function following soccer heading. Sixteen youth female participants underwent heart rate monitoring during a heading and footing condition. Participants completed a five minute resting supine trial at the start and end of each testing session. Standard 450 g soccer balls were projected at 6 m/s towards participants. Participants performed five headers, for the header condition, and five footers for the footer condition. The HRV for resting supine trials, pre- and post-header and footer conditions were assessed for both time and frequency domains. HRV effect sizes were small when comparing conditions, except absolute low frequency (d = 0.61) and standard deviation of the normal-normal (NN) intervals (d = 0.63). Participant retention and adherence were high, without adverse events. Findings suggest HRV is a feasible measure for evaluating the effects of heading on autonomic function.
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The Epidemiology of Sport-Related Concussion: What the Rehabilitation Clinician Needs to Know. J Orthop Sports Phys Ther 2019; 49:768-778. [PMID: 31672116 DOI: 10.2519/jospt.2019.9105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sport-related concussion is common in full-contact and collision sports. Epidemiology studies use different types of surveillance systems and concussion definitions. Concussion incidence rates vary across age, sex, sport, and level of competition. Incidence rates are increasing, likely due to higher rates of reporting following improved knowledge and increased regulations. In this review, we summarize 7 key concepts related to concussion epidemiology: concussion definition, changes in concussion knowledge, reliability and accuracy of injury surveillance systems, conservative management and return to play, reliability of self-report, incidence of concussion across levels of play, and understanding the behaviors of players, coaches, and medical personnel from a multidisciplinary management perspective. J Orthop Sports Phys Ther 2019;49(11):768-778. doi:10.2519/jospt.2019.9105.
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Storey EP, Wiebe DJ, DʼAlonzo BA, Nixon-Cave K, Jackson-Coty J, Goodman AM, Grady MF, Master CL. Vestibular Rehabilitation Is Associated With Visuovestibular Improvement in Pediatric Concussion. J Neurol Phys Ther 2019; 42:134-141. [PMID: 29912034 DOI: 10.1097/npt.0000000000000228] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Vision and vestibular-related deficits are common after concussion and are associated with prolonged recovery times, substantially impacting the quality of life for children. The utility of targeted vestibular rehabilitation for these deficits in children after concussion is unknown. The purpose of this study was to determine whether active vestibular rehabilitation is associated with an improvement in visuovestibular signs and symptoms in children with concussion. METHODS A retrospective cohort study of children diagnosed with concussion and referred to vestibular rehabilitation between 2012 and 2014 was conducted. Patient-reported symptoms and visuovestibular performance measures were assessed in the medical practice and physical therapy settings. RESULTS One hundred nine children were included in the study with a mean age of 11.8 (3.4) years. Among this group, 59 (54%) were male and 48 (44%) had a sports-related concussion. Children presented to a pediatric sports medicine office and physical therapy a median of 24 (interquartile range [IQR], 14-42) and 55 (IQR, 39-94) days after injury, respectively. Concussion symptoms decreased from a median of 9 (IQR, 5-13) symptoms at initial evaluation to a median of 0 (IQR, 0-2) symptoms at final assessment. Performance on all visuovestibular tasks improved significantly over the course of therapy except for near point of convergence. For the 45 children who completed the Balance Error Scoring System at both initial and final therapy visits, there was a significant improvement in mean level of performance (P < 0.0001). Characteristics between those who completed a full versus partial course of physical therapy were similar. DISCUSSION AND CONCLUSIONS Vestibular rehabilitation in children with concussion is associated with improvement in symptoms as well as visuovestibular performance. This active intervention may benefit children with persistent symptoms after concussion. Future prospective studies are needed to determine the efficacy and optimal postinjury timing of vestibular rehabilitation.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A208).
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Affiliation(s)
- Eileen P Storey
- The Children's Hospital of Philadelphia, Division of Orthopaedics, Sports Medicine and Performance Center, Philadelphia, Pennsylvania (E.P.S., K.N-C., J.J-C., M.F.G., C.L.M.); Perelman School of Medicine, University of Pennsylvania, Philadelphia (M.F.G., C.L.M.); Saint Peter's Sports Medicine Institute, Somerset, New Jersey (A.M.G.); and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (D.J.W., B.D.)
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Abstract
OBJECTIVE To examine and describe normative values for an objective, mobile measure of postural stability commonly used in concussion assessments, SWAY Balance (SWAY Medical, Tulsa, Oklahoma). DESIGN Retrospective analysis of baseline balance assessments in a healthy pediatric population. SETTING Baseline assessments completed by certified athletic trainers at an outpatient concussion center or sports medicine offices in Philadelphia, PA and surrounding suburban Pennsylvania and New Jersey or during an athletic trainer's baseline assessment of collegiate athletes at a National Collegiate Athletic Association (NCAA) Division-II University in Fort Lauderdale, FL. PARTICIPANTS Test results of a sample of 466 athletes aged 5 to 18 years were included. INTERVENTIONS The SWAY Balance test was administered using a mobile device on all participants as part of a standard preseason, baseline evaluation, following the standard evaluation protocol. MAIN OUTCOME MEASURES Baseline SWAY Balance mobile assessment balance and reaction time scores, age and sex effects, were examined. RESULTS Normative scores are described, with results stratified into 4 age groups (5-9, 10-12, 13-17, and 18 years old). Balance scores, overall and within each individual stance score, improved with the age of the participants. Sex effects on balance were only seen in single-leg stances, with females outperforming males. Reaction time was found to be faster in males and improved with age, peaking at 13 to 17 years old and slowing in 18-year-olds. CONCLUSIONS Normative, age-specific SWAY Balance test results provided are of clinical use as references in the concussion assessments of pediatric athletes.
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Caccese JB, Johns KE, Langdon JL, Shaver GW, Buckley TA. Does baseline concussion testing aid in identifying future concussion risk? Res Sports Med 2019; 28:594-599. [PMID: 31287331 DOI: 10.1080/15438627.2019.1641500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose was to determine differences in pre-season baseline performance between student-athletes who suffered a future sport-related concussion (fSRC) and those who did not. Collegiate student-athletes (82 fSRC, 82 matched control, age = 18.4 ± 0.8years, height = 172.7 ± 10.3 cm, mass = 80.1 ± 20.9 kg) completed baseline Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Balance Error Scoring System (BESS), and Standardized Assessment of Concussion (SAC). Results of the independent t-tests suggested there were no differences between the fSRC and the control groups for ImPACT composite scores (95% confidence intervals, Visual Memory: fSRC 70.4-75.9, Control 73.4-78.5, p = 0.134; Verbal Memory: fSRC 83.8-87.7, Control 85.7-89.9, p = 0.155; Reaction Time: fSRC 0.562-0.591, Control 0.580-0.614, p = 0.071; Visual Motor Speed: fSRC 38.5-41.1, Control 38.2-40.9, p = 0.757), BESS total errors (fSRC 11.3-13.7, Control 11.8-14.4, p = 0.483), or SAC (fSRC 26.6-27.4, Control 26.9-27.6, p = 0.394). Receiver operating characteristic (ROC) areas-under-the-curve were 0.417-0.515. Our findings suggest that baseline concussion assessments cannot be used to predict individuals who may sustain a fSRC.
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Affiliation(s)
- Jaclyn B Caccese
- Department of Kinesiology and Applied Physiology, University of Delaware , Newark, NJ, USA
| | - Kassandra E Johns
- School of Health and Kinesiology, Georgia Southern University , Statesboro, GA, USA
| | - Jody L Langdon
- School of Health and Kinesiology, Georgia Southern University , Statesboro, GA, USA
| | - George W Shaver
- Regents Center for Learning Disorders, Georgia Southern University , Statesboro, GA, USA
| | - Thomas A Buckley
- Department of Kinesiology and Applied Physiology and Interdisciplinary Biomechanics and Movement Science Program, University of Delaware , Newark, GA, USA
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Lyons TW, Miller KA, Miller AF, Mannix R. Racial and Ethnic Differences in Emergency Department Utilization and Diagnosis for Sports-Related Head Injuries. Front Neurol 2019; 10:690. [PMID: 31312172 PMCID: PMC6614199 DOI: 10.3389/fneur.2019.00690] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/13/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Prior studies have shown racial differences in concussion awareness and outcome. Objective: To assess if racial or ethnic differences exist in Emergency Department (ED) utilization and diagnosis for children with sports-related head injuries. Methods: We performed a retrospective, cross-sectional analysis of ED visits from 2008 to 2017 using National Electronic Injury Surveillance System (NEISS) data. Population-weighted ED visits for children age 7–18 years with a sport-related injury were included. We compared the probability of an ED visit being for an injury to the head or diagnosed as a concussion between children of different races/ethnicities. Analyses were adjusted for age, gender, sport, year, and location where the injury occurred. Results: We identified 11,529,994 population-weighted ED visits for pediatric sports-related injuries, of which 1,497,717 (13.0%) were injuries to the head and 619,714 (5.4%) received a diagnosis of concussion. Black children were significantly less likely than non-Hispanic white children to have their ED visit be for an injury to the head [Odds Ratio (OR) 0.72, 95%CI 0.65–0.79] or concussion (OR 0.58, 95%CI 0.50–0.68). Black children presenting to the ED with an injury to their head were less likely than non-Hispanic white children to be diagnosed with a concussion (OR = 0.71, 95%CI 0.59–0.85). Conclusions: Racial differences exist in both ED utilization for pediatric sports-related head injuries and in the diagnosis of concussion. Further work is needed to understand these differences to ensure all brain injured athletes receive optimal care, regardless of race.
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Affiliation(s)
- Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Kelsey A Miller
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Andrew F Miller
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
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Lambrinakos-Raymond K, Ali S, Dubrovsky AS, Burstein B. Low Usage of Analgesics for Pediatric Concussion-Related Pain in US Emergency Departments Between 2007 and 2015. J Pediatr 2019; 210:20-25.e2. [PMID: 30955787 DOI: 10.1016/j.jpeds.2019.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To estimate the proportion of pediatric patients with a concussion who received analgesia when presenting with pain to US emergency departments, and to describe the analgesics used. STUDY DESIGN This was a repeated cross-sectional analysis study using the National Hospital Ambulatory Medical Care Survey database of nationally representative emergency department visits from 2007 to 2015. We included children under 18 years old with isolated concussions. Survey weighting procedures were applied to generate population-level estimates and to perform multivariable logistic regression to identify factors associated with analgesic administration. RESULTS There were an estimated 1.54 million isolated concussion visits during the 9-year study period. Pain at presentation was reported frequently (78%), with the majority rated as moderate (36%) or severe (27%). Among all children reporting pain, 42% received no analgesics, including 40% with moderate-to-severe pain intensity. Multivariable analysis found younger age, male sex, and treatment in a nonacademic hospital were all negatively associated with analgesic administration. The medications most frequently administered were acetaminophen (54%), nonsteroidal anti-inflammatories (44%), and opioids (13%). CONCLUSIONS Analgesic medications seem to be underused in the treatment of pediatric concussion-related pain. Following acetaminophen and nonsteroidal anti-inflammatories, opioids, which are not recommended for this condition, were the most frequently prescribed analgesics. Further research should establish optimal, consistent, and responsible pain management strategies for pediatric concussions.
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Affiliation(s)
- Kristen Lambrinakos-Raymond
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute, Edmonton, Alberta, Canada
| | - Alexander Sasha Dubrovsky
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett Burstein
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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48
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Mannix R, Bachur R. Diagnosis of Concussion in the Pediatric Emergency Department. Semin Pediatr Neurol 2019; 30:35-39. [PMID: 31235018 DOI: 10.1016/j.spen.2019.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Pediatric visits to the Emergency Department (ED) for concussion are common and increasing. ED clinicians evaluating children with concussion should first ensure the absence of more serious injuries requiring immediate intervention, such as intracranial hemorrhage or cervical spine injury. In the ED setting, signs and symptoms of concussion are sometime subtle and often overlooked. A thorough physical exam is warranted but may be normal. Imaging and laboratory studies have no role in concussion diagnosis and should be reserved for cases where an injury requiring immediate intervention is suspected. Symptom management may include avoiding symptom-triggers (such as bright lights triggering headaches) and/or specific treatments such as nonsteroidal anti-inflammatories or antiemetics. Discharge instructions should include a recommendation for a brief period of rest, followed by outpatient management for return-to-activity decisions in conjunction with a primary care provider.
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Affiliation(s)
- Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Richard Bachur
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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49
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Abstract
The term "concussion" is often ambiguous for patients and caregivers, and likewise for many practitioners the definition remains imprecise. Our understanding of concussion over the last several years has grown and evolved due to the extensive data that is now being collected, and similarly, our definition of the term should too. While there is now more data and literature becoming available regarding pediatric concussion, it seems that there remains a lack of clarity and agreement about the definition and classification of concussion. This article aims to provide a brief review of the available literature on pediatric concussion definition and classifications, and hopefully present the most recent precise and accepted definition and classification system. Surely the definition of concussion will continue to evolve as new knowledge develops.
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Affiliation(s)
- Cassandra Kazl
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, MA.
| | - Alcy Torres
- Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston, MA
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50
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Kerrigan JM, Giza CC. The Rise of the Concussion Clinic for Diagnosis of Pediatric Mild Traumatic Brain Injury. Semin Pediatr Neurol 2019; 30:45-53. [PMID: 31235020 DOI: 10.1016/j.spen.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It was not too long ago that being struck violently in the head or "getting your bell rung" was often brushed off as nothing to worry about. These days the pendulum has swung and there is growing appreciation that this mild traumatic brain injury (mTBI), often called concussion, must be taken seriously and is now on the forefront of public health concerns. As a growing body of research continues to expand our understanding of concussion, the paradigm of diagnosis and treatment is transforming rapidly. The recent rise of specialty concussion clinics across the country has grown out of a need for safe, effective, and efficient evaluation of these injuries by healthcare professionals qualified to implement diagnostic and management strategies that align with the latest evidence-based practice guidelines. Due to the complex nature of each injury, a comprehensive multidisciplinary team can provide a valuable individualized approach to concussion care.
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Affiliation(s)
- Julia Morrow Kerrigan
- Department of Neurosurgery, UCLA Steve Tisch BrainSPORT Program, The University of California, Los Angeles, CA.
| | - Christopher C Giza
- Departments of Neurosurgery and Pediatrics, UCLA Steve Tisch BrainSPORT Program, The University of California, Los Angeles, CA
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