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Peterson AB, Waltzman D, Daugherty J, Chen J, Breiding M. Sport and Recreation Related Concussion in Children: National Concussion Surveillance System. Am J Prev Med 2024; 67:370-379. [PMID: 38852098 PMCID: PMC11338698 DOI: 10.1016/j.amepre.2024.05.003] [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: 01/11/2024] [Revised: 05/03/2024] [Accepted: 05/03/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Concussions sustained during sports and recreational activities are a concern for young athletes. The purpose of this study was to estimate past 12-month sport- and recreation-related (SRR) traumatic brain injuries (TBIs) among a sample of children. METHODS Pilot data from the Centers for Disease Control and Prevention's National Concussion Surveillance System were analyzed. National Concussion Surveillance System utilized a cross-sectional random-digit-dial telephone survey using computer-assisted telephone interviewing to collect self/proxy-reported data from 2018 to 2019. Adults with children aged 5-17 in the household were asked about head injuries sustained by their children. Estimates were stratified by sociodemographic and injury circumstance characteristics. Data analysis occurred from April 2022 to July 2023. RESULTS Utilizing a tiered case definition developed by the Centers for Disease Control and Prevention, an estimated 6.9% (95% confidence interval [CI], 6.0%-7.8%) of the sample's 5-17-year-old children sustained at least one probable or possible SRR-TBI in the previous 12 months; 3.3% (95% CI, 2.7%-4.0%) of the children sustained at least one probable SRR-TBI. An estimated 63.6% (95% CI, 58.1%-69.0%) of all reported TBIs were attributed to SRR activities. Of the SRR-TBIs reported, 41.1% (95% CI, 33.0%-49.2%) were experienced while playing contact sports. Symptoms did not resolve for 8 or more days or had not resolved at the time of the interview for 18.1% (95% CI, 13.0%-23.1%) of the children's most recent SRR-TBI. CONCLUSIONS Many proxy-reported TBIs among children aged 5-17 years were due to sports and recreational activities. Athletic trainers and healthcare providers can play a role in the prevention, identification, and management of SRR-TBIs in their respective environments.
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Affiliation(s)
- Alexis B Peterson
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia.
| | - Dana Waltzman
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia
| | - Jill Daugherty
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia
| | - Jufu Chen
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia
| | - Matthew Breiding
- Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC), Division of Injury Prevention, Atlanta, Georgia
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Palusak C, Dart L, Ciccia A, Nagele D, Lundine JP. Caregiver and student perspectives on school services for students with traumatic brain injury during the COVID-19 pandemic. J Pediatr Rehabil Med 2024:PRM230021. [PMID: 39213105 DOI: 10.3233/prm-230021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
PURPOSE This study aimed to identify unique challenges created by COVID-19 school closures for students with traumatic brain injury (TBI) and their families with relation to special education accommodations, therapy services, social support systems, and mental health complications. METHODS Forty-one caregivers and students participated in semi-structured, virtual interviews. Families had students in kindergarten through 12th grade who experienced a TBI prior to spring 2020 and were receiving support services at schools in Pennsylvania (US). Researchers used reflexive thematic analysis to identify themes across interviews. RESULTS Central themes encompassing the student- and caregiver-reported challenges and advantages of COVID-19 school closures were changes in [1] education delivery, special education services, and accommodations for children with TBI, and [2] social relationships for students with TBI and their caregivers. CONCLUSION COVID-19 and the transition to remote learning significantly impacted special education services and education received by students with TBI. Families in this study discussed both perceived obstacles to and advantages of remote learning in this population. As remote and asynchronous learning are now commonly integrated into the curriculum, research should clarify the facilitators and barriers for successful service provision for students with TBI.
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Affiliation(s)
- Cara Palusak
- Heritage College of Osteopathic Medicine, Ohio University Dublin Campus, Columbus, OH, USA
| | - Libby Dart
- Speech-Language Pathology Program, Midwestern University, Downers Grove, IL, USA
- Psychological Sciences Department, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
| | - Angela Ciccia
- Psychological Sciences Department, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
| | - Drew Nagele
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Jennifer P Lundine
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH, USA
- Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH, USA
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Ciancaglini R, Botash AS, Armijo-Garcia V, Hymel KP, Thomas NJ, Hicks SD. A Pilot Study of Saliva MicroRNA Signatures in Children with Moderate-to-Severe Traumatic Brain Injury. J Clin Med 2024; 13:5065. [PMID: 39274278 PMCID: PMC11396305 DOI: 10.3390/jcm13175065] [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: 06/12/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Traumatic brain injury (TBI) is a leading cause of death and disability in children. Currently, no biological test can predict outcomes in pediatric TBI, complicating medical management. This study sought to identify brain-related micro-ribosomal nucleic acids (miRNAs) in saliva associated with moderate-to-severe TBI in children, offering a potential non-invasive, prognostic tool. Methods: A case-control design was used, enrolling participants ≤ 18 years old from three pediatric trauma centers. Participants were divided into moderate-to-severe TBI and non-TBI trauma control groups. Saliva samples were collected within 24 h of injury, with additional samples at 24-48 h and >48 h post-injury from the TBI group. miRNA profiles were visualized with partial least squares discriminant analysis (PLSDA) and hierarchical clustering. Mann-Whitney testing was used to compare miRNAs between groups, and mixed models were used to assess longitudinal expression patterns. DIANA miRPath v3.0 was used to interrogate the physiological functions of miRNAs. Results: Twenty-three participants were enrolled (14 TBI, nine controls). TBI and control groups displayed complete separation of miRNA profiles on PLSDA. Three miRNAs were elevated (adj. p < 0.05) in TBI (miR-1255b-5p, miR-3142, and miR-4320), and two were lower (miR-326 and miR-4646-5p). Three miRNAs (miR-3907, miR-4254, and miR-1273g-5p) showed temporal changes post-injury. Brain-related targets of these miRNAs included the glutamatergic synapse and GRIN2B. Conclusions: This study shows that saliva miRNA profiles in children with moderate-to-severe TBI may differ from those with non-TBI trauma and exhibit temporal changes post-injury. These miRNAs could serve as non-invasive biomarkers for prognosticating pediatric TBI outcomes. Further studies are needed to confirm these findings.
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Affiliation(s)
- Robert Ciancaglini
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA 17033, USA
| | - Ann S Botash
- Department of Pediatrics, SUNY Upstate Golisano Children's Hospital, Syracuse, NY 13210, USA
| | | | - Kent P Hymel
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA 17033, USA
| | - Neal J Thomas
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA 17033, USA
| | - Steven D Hicks
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA 17033, USA
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Kramer A, Foley J, Hansen C, Teramoto M. Parent-Reported Academic Outcomes After a Mild Traumatic Brain Injury in the Pediatric Population. THE JOURNAL OF SCHOOL HEALTH 2024. [PMID: 39103203 DOI: 10.1111/josh.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/29/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Millions of children are diagnosed with a traumatic brain injury (TBI) each year, most being mild TBI (mTBI). The effect of mTBIs on academic performance is of significant importance. We investigate mTBI's impact on parent-reported academic outcomes in school-aged pediatric participants. METHODS This cross-sectional survey study queried parents (N = 285) regarding letter grade performance and the presence or absence of academic accommodations before and after an mTBI, including complicated mTBI (c-mTBI, or mTBI with radiographic abnormality). RESULTS We found a parent-reported decline in letter grades following c-mTBI (p < .001), with no significant change following uncomplicated mTBIs. Degree and length of recovery were also associated with grade changes (p < .05). Those with no academic accommodations prior to the injury showed significant decreases in grades after injury regardless of post-injury accommodation status (p < .05). IMPLICATIONS OF SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY This study underscores the need for an improved framework of support to maximize academic performance of children following mTBI, especially in those with a c-mTBI and still recovering from their injury. CONCLUSION Our study identifies children who are at risk for adverse academic outcomes following mTBI. We encourage efforts to better support school nurses in this effort, including improved communication between health care teams and school teams.
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Ferrazzano PA, Rebsamen S, Field AS, Broman AT, Mayampurath A, Rosario B, Buttram S, Willyerd FA, Rathouz PJ, Bell MJ, Alexander AL. MRI and Clinical Variables for Prediction of Outcomes After Pediatric Severe Traumatic Brain Injury. JAMA Netw Open 2024; 7:e2425765. [PMID: 39102267 DOI: 10.1001/jamanetworkopen.2024.25765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024] Open
Abstract
Importance Traumatic brain injury (TBI) is a leading cause of death and disability in children, and predicting functional outcome after TBI is challenging. Magnetic resonance imaging (MRI) is frequently conducted after severe TBI; however, the predictive value of MRI remains uncertain. Objectives To identify early MRI measures that predict long-term outcome after severe TBI in children and to assess the added predictive value of MRI measures over well-validated clinical predictors. Design, Setting, and Participants This preplanned prognostic study used data from the Approaches and Decisions in Acute Pediatric TBI (ADAPT) prospective observational comparative effectiveness study. The ADAPT study enrolled 1000 consecutive children (aged <18 years) with severe TBI between February 1, 2014, and September 30, 2017. Participants had a Glasgow Coma Scale (GCS) score of 8 or less and received intracranial pressure monitoring. Magnetic resonance imaging scans performed as part of standard clinical care within 30 days of injury were collected at 24 participating sites in the US, UK, and Australia. Summary imaging measures were correlated with the Glasgow Outcome Scale-Extended for Pediatrics (GOSE-Peds), and the predictive value of MRI measures was compared with the International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) core clinical predictors. Data collection, image analysis, and data analyses were completed in July 2023. Exposures Pediatric severe TBI with an MRI scan performed as part of clinical care. Main Outcomes and Measures All measures were selected a priori. Magnetic resonance imaging measures included contusion, ischemia, diffuse axonal injury, intracerebral hemorrhage, and brainstem injury. Clinical predictors included the IMPACT core measures (GCS motor score and pupil reactivity). All models adjusted for age and sex. Outcome measures included the GOSE-Peds score obtained at 3, 6, and 12 months after injury. Results This study included 233 children with severe TBI who were enrolled at participating sites and had an MRI scan and preselected clinical predictors available. Their median age was 6.9 (IQR, 3.0-13.3) years, and more than half of participants (134 [57.5%]) were male. In a multivariable model including MRI measures and IMPACT core clinical variables, contusion volume (odds ratio [OR], 1.13; 95% CI, 1.02-1.26), brain ischemia (OR, 2.11; 95% CI, 1.58-2.81), brainstem lesions (OR, 5.40; 95% CI, 1.90-15.35), and pupil reactivity were each independently associated with GOSE-Peds score. Adding MRI measures to the IMPACT clinical predictors significantly improved model fit and discrimination between favorable and unfavorable outcomes compared with IMPACT predictors alone (area under the receiver operating characteristic curve, 0.77; 95% CI, 0.72-0.85 vs 0.67; 95% CI, 0.61-0.76 for GOSE-Peds score >3 at 6 months after injury). Conclusions and Relevance In this prognostic study of children with severe TBI, the addition of MRI measures significantly improved outcome prediction over well-established and validated clinical predictors. Magnetic resonance imaging should be considered in children with severe TBI to inform prognosis and may also promote stratification of patients in future clinical trials.
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Affiliation(s)
- Peter A Ferrazzano
- Department of Pediatrics, University of Wisconsin-Madison
- Waisman Center, University of Wisconsin-Madison
| | - Susan Rebsamen
- Department of Radiology, University of Wisconsin-Madison
| | - Aaron S Field
- Department of Radiology, University of Wisconsin-Madison
| | - Aimee T Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison
| | - Anoop Mayampurath
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison
| | - Bedda Rosario
- Department of Epidemiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sandra Buttram
- Department of Child Health, Phoenix Children's Hospital, Phoenix, Arizona
| | - F Anthony Willyerd
- Department of Child Health, Phoenix Children's Hospital, Phoenix, Arizona
- Barrow Neurological Institute, Phoenix, Arizona
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin
| | - Michael J Bell
- Department of Pediatrics, Children's National Medical Center, Washington, DC
| | - Andrew L Alexander
- Waisman Center, University of Wisconsin-Madison
- Department of Medical Physics, University of Wisconsin-Madison
- Department of Psychiatry, University of Wisconsin-Madison
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Tian E, O'Guinn ML, Chen SY, Ourshalimian S, Chaudhari PP, Spurrier RG. Primary caregiver employment status is associated with traumatic brain injury in children in the USA. Inj Prev 2024:ip-2023-045151. [PMID: 39043570 DOI: 10.1136/ip-2023-045151] [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: 10/19/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a common injury in children. Previous literature has demonstrated that TBI may be associated with supervision level. We hypothesised that primary caregiver employment would be associated with child TBI. METHODS A retrospective cross-sectional study was performed for children aged 0-17 using the National Survey of Children's Health (NSCH) 2018-2019. The NSCH contains survey data on children's health completed by adult caregivers from randomly selected households across the USA. We compared current TBI prevalence between children from households of different employment statuses. Current TBI was defined by survey responses indicating a healthcare provider diagnosed TBI or concussion for the child and the condition was present at the time of survey completion. Household employment status was categorised as two caregivers employed, two caregivers unemployed, one of two caregivers unemployed, single caregiver employed and single caregiver unemployed. Multivariable logistic regression was performed, controlling for sociodemographic factors. RESULTS Of 56 865 children, median age was 10 years (IQR: 5-14), and 0.6% (n=332) had a current TBI. Children with TBI were older than children without TBI (median 12 years vs 10 years, p<0.001). On multivariable regression, children with at least one caregiver unemployed had increased odds of current TBI compared with children with both caregivers employed. CONCLUSIONS Children with at least one caregiver unemployed had increased TBI odds compared with children with both caregivers employed. These findings highlight a population of families that may benefit from injury prevention education and intervention.
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Affiliation(s)
- Emma Tian
- Children's Hospital Los Angeles, Los Angeles, California, USA
- USC Keck School of Medicine, Los Angeles, California, USA
| | | | | | | | - Pradip P Chaudhari
- Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California, USA
| | - Ryan G Spurrier
- Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Surgery, USC Keck School of Medicine, Los Angeles, California, USA
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Reuter-Rice K, Fitterer AN, Duquette P, Yang Q, Palipana AK, Laskowitz D, Garrett ME, Fletcher M, Smith J, Makor L, Grant G, Ramsey K, Bloom OJ, Ashley-Koch AE. A study protocol for risk stratification in children with concussion (RSiCC): Theoretical framework, design, and methods. PLoS One 2024; 19:e0306399. [PMID: 39024215 PMCID: PMC11257289 DOI: 10.1371/journal.pone.0306399] [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] [Received: 06/10/2024] [Accepted: 06/14/2024] [Indexed: 07/20/2024] Open
Abstract
Research shows that one in five children will experience a concussion by age 16. Compared to adults, children experience longer and more severe postconcussive symptoms (PCS), with severity and duration varying considerably among children and complicating management of these patients. Persistent PCS can result in increased school absenteeism, social isolation, and psychological distress. Although early PCS diagnosis and access to evidence-based interventions are strongly linked to positive health and academic outcomes, symptom severity and duration are not fully explained by acute post-injury symptoms. Prior research has focused on the role of neuroinflammation in mediating PCS and associated fatigue; however relationship between inflammatory biomarkers and PCS severity, has not examined longitudinally. To identify which children are at high risk for persistent PCS and poor health, academic, and social outcomes, research tracking PCS trajectories and describing school-based impacts across the entire first year postinjury is critically needed. This study will 1) define novel PCS trajectory typologies in a racially/ethnically diverse population of 500 children with concussion (11-17 years, near equal distribution by sex), 2) identify associations between these typologies and patterns of inflammatory biomarkers and genetic variants, 3) develop a risk stratification model to identify children at risk for persistent PCS; and 4) gain unique insights and describe PCS impact, including fatigue, on longer-term academic and social outcomes. We will be the first to use NIH's symptom science model and patient-reported outcomes to explore the patterns of fatigue and other physical, cognitive, psychological, emotional and academic responses to concussion in children over a full year. Our model will enable clinicians and educators to identify children most at risk for poor long-term health, social, and academic outcomes after concussion. This work is critical to meeting our long-term goal of developing personalized concussion symptom-management strategies to improve outcomes and reduce disparities in the health and quality of life of children.
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Affiliation(s)
- Karin Reuter-Rice
- Duke University School of Nursing, Durham, North Carolina, United States of America
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States of America
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Amanda N. Fitterer
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Peter Duquette
- Department of Physical Medicine & Rehabilitation, Univeristy of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Qing Yang
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Anushka K. Palipana
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Daniel Laskowitz
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Melanie E. Garrett
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
| | - Margaret Fletcher
- Duke University School of Nursing, Durham, North Carolina, United States of America
| | - Julia Smith
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
| | - Lynn Makor
- Department of Public Instruction, State of North Carolina, Office of Exceptional Children, Raleigh, North Carolina, United States of America
| | - Gerald Grant
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Kristen Ramsey
- Duke University Health System, Carolina Family Practice and Sports Medicine, Carolina Sports Concussion Clinic, Cary, North Carolina, United States of America
| | - O. Josh Bloom
- Duke University Health System, Carolina Family Practice and Sports Medicine, Carolina Sports Concussion Clinic, Cary, North Carolina, United States of America
| | - Allison E. Ashley-Koch
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina, United States of America
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Ewing-Cobbs L, Clark A, Keenan H. Long-term Participation and Functional Status in Children Who Experience Traumatic Brain Injury. J Head Trauma Rehabil 2024; 39:E162-E171. [PMID: 38032836 DOI: 10.1097/htr.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To evaluate the effect of child and family factors on children's participation outcomes 2 to 3 years following traumatic brain injury (TBI). SETTING Two level 1 pediatric trauma centers. PARTICIPANTS Children aged 0 to 15 years with TBI at all severity levels or an orthopedic injury. DESIGN Prospective cohort. MAIN MEASURES Caregivers completed the Child and Adolescent Scale of Participation (CASP) at 2- and 3-year follow-ups. The CASP was categorized as more than 90 or 90 or less on a 100-point scale, with 90 or less representing the 10th percentile and below in this sample. Modified Poisson regression models were used to describe relative risk of the CASP at 90 or less at 2 to 3 years postinjury, adjusting for preinjury family environment variables and injury group. A secondary analysis only included children who were 31 months or older at injury ( n = 441) to determine whether changes in functional outcome (Pediatric Injury Functional Outcome Scale, PIFOS) and executive functions (Behavior Rating Inventory of Executive Function, BRIEF) from preinjury to 1 year after injury predicted CASP scores at the 2- or 3-year follow-up. RESULTS Seventy-eight percent (596/769) of children who had a completed preinjury survey had a completed CASP. In the adjusted model, children with severe TBI had a nearly 3 times higher risk (RR = 2.90; 95% CI, 1.43-5.87) of reduced participation than children with an orthopedic injury. In the secondary analysis, lower functional skills (5-point increase in 1-year postinjury PIFOS score) (RR = 1.36; 95% CI, 1.18-1.57) and less favorable family function (RR = 1.46; 95% CI, 1.02-2.10) were associated with reduced participation in both girls and boys. CONCLUSION Participation in home, school, and community activities after TBI is related to multiple biopsychosocial factors. Participation-focused interventions are needed to reduce barriers to involvement and assist children and families to close the participation gap across settings.
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Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics and Children's Learning Institute, McGovern Medical School, University of Texas Health Science Center at Houston (Dr Ewing-Cobbs); and Division of Critical Care, Department of Pediatrics, University of Utah (Ms Clark and Dr Keenan)
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Crook L, Riccardi JS, Lundine JP, Ciccia A. The Influence of the Family Functioning and Social Relationships on Child Participation After Traumatic Brain Injury. Dev Neurorehabil 2023; 26:462-470. [PMID: 38555502 DOI: 10.1080/17518423.2024.2331446] [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: 02/23/2022] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To describe the relationship amongst child and family characteristics (e.g. social relationships, family functioning) and child participation after traumatic brain injury (TBI) an average of 2.65 years post-TBI (SD = 2.12). METHOD Cross-sectional, secondary analysis of data collected as part of a larger research project. RESULTS N = 44 children with TBI. Analysis revealed statistically significant correlations between child participation, family functioning, and child characteristics. CONCLUSIONS School-aged children with TBI might experience chronic participation restrictions, associated with challenges in family functioning. Professionals can support children with TBI and their families through follow-up services that include a focus on family-based interventions to better support long-term outcomes for this population.
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Affiliation(s)
- Libby Crook
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Jennifer P Lundine
- The Ohio State University, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
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Crook L, Riccardi JS, Eagan-Johnson B, Vaccaro M, Ciccia AH. Factors impacting educational outcomes for students with traumatic brain injury in BrainSTEPS. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:677-687. [PMID: 36255122 DOI: 10.1080/17549507.2022.2127899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Purpose: To describe child pre-injury and injury factors impacting post-injury educational outcomes for students with traumatic brain injury (TBI) participating in a state-wide, school-based, school re-entry consultation program, BrainSTEPS in Pennsylvania.Method: Retrospective analysis of a BrainSTEPS annual follow-up survey.Result: A total of 296 parent surveys were completed. Analysis revealed a significant difference between levels of severity of TBI and current educational placement (p < 0.001), receipt of current therapy (p < 0.05) and need for additional consult (p < 0.05). Severity of TBI was not related to other examined educational outcome variables (i.e. school performance, current symptoms). History of TBI, symptoms and treatment were not found to be associated with educational outcomes.Conclusion: These results both support findings from previous studies, and extend previous work by highlighting ongoing needs, including continued, individualised support, of children who sustain a moderate-severe TBI during childhood, and are currently in the chronic stages of injury, with consideration of pre- and post- injury factors. Programs such as BrainSTEPS provide identification of educational needs and provide needed services and supports for children with TBI. Sensitive, validated measures are needed to further understand the role of pre-injury and injury factors on educational outcomes, particularly in programs like BrainSTEPS.
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Affiliation(s)
- Libby Crook
- Communication Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jessica S Riccardi
- Communication Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Monica Vaccaro
- Brain Injury Association of Pennsylvania, Pittsburgh, PA, USA, and
| | - Angela H Ciccia
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
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11
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McCart M, Todis B, Gomez D, Glang A. School experiences following traumatic brain injury: A longitudinal qualitative study. NeuroRehabilitation 2023:NRE220209. [PMID: 37125570 DOI: 10.3233/nre-220209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND This longitudinal qualitative study tracked students with traumatic brain injury (TBI) from hospital discharge through their return to school and then for an average of four years of school. OBJECTIVE To better understand the experiences of students and parents in the education system following TBI. METHODS Participants were parents and educators of 21 students with TBI. Interviews were conducted using open-ended questions and students were observed in the classroom. RESULTS From these data, three themes were identified: lack of student tracking year to year, lack of educator training, and conflicting views between educators and parents about students' needs. These factors ultimately led to parent frustration and eventually conflict and deteriorating relationships between parents and educators. CONCLUSION The results suggest that improving educator training could positively affect the factors identified and possibly mitigate parent frustration.
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Affiliation(s)
- Melissa McCart
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Bonnie Todis
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Douglas Gomez
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Ann Glang
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
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12
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Bickart KC, Olsen A, Dennis EL, Babikian T, Hoffman AN, Snyder A, Sheridan CA, Fischer JT, Giza CC, Choe MC, Asarnow RF. Frontoamygdala hyperconnectivity predicts affective dysregulation in adolescent moderate-severe TBI. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:1064215. [PMID: 36684686 PMCID: PMC9845889 DOI: 10.3389/fresc.2022.1064215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023]
Abstract
In survivors of moderate to severe traumatic brain injury (msTBI), affective disruptions often remain underdetected and undertreated, in part due to poor understanding of the underlying neural mechanisms. We hypothesized that limbic circuits are integral to affective dysregulation in msTBI. To test this, we studied 19 adolescents with msTBI 17 months post-injury (TBI: M age 15.6, 5 females) as well as 44 matched healthy controls (HC: M age 16.4, 21 females). We leveraged two previously identified, large-scale resting-state (rsfMRI) networks of the amygdala to determine whether connectivity strength correlated with affective problems in the adolescents with msTBI. We found that distinct amygdala networks differentially predicted externalizing and internalizing behavioral problems in patients with msTBI. Specifically, patients with the highest medial amygdala connectivity were rated by parents as having greater externalizing behavioral problems measured on the BRIEF and CBCL, but not cognitive problems. The most correlated voxels in that network localize to the rostral anterior cingulate (rACC) and posterior cingulate (PCC) cortices, predicting 48% of the variance in externalizing problems. Alternatively, patients with the highest ventrolateral amygdala connectivity were rated by parents as having greater internalizing behavioral problems measured on the CBCL, but not cognitive problems. The most correlated voxels in that network localize to the ventromedial prefrontal cortex (vmPFC), predicting 57% of the variance in internalizing problems. Both findings were independent of potential confounds including ratings of TBI severity, time since injury, lesion burden based on acute imaging, demographic variables, and other non-amygdalar rsfMRI metrics (e.g., rACC to PCC connectivity), as well as macro- and microstructural measures of limbic circuitry (e.g., amygdala volume and uncinate fasciculus fractional anisotropy). Supporting the clinical significance of these findings, patients with msTBI had significantly greater externalizing problem ratings than healthy control participants and all the brain-behavior findings were specific to the msTBI group in that no similar correlations were found in the healthy control participants. Taken together, frontoamygdala pathways may underlie chronic dysregulation of behavior and mood in patients with msTBI. Future work will focus on neuromodulation techniques to directly affect frontoamygdala pathways with the aim to mitigate such dysregulation problems.
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Affiliation(s)
- Kevin C. Bickart
- BrainSPORT, Department of Neurosurgery, UCLA, Los Angeles, CA, United States,Department of Neurology, UCLA, Los Angeles, CA, United States,Correspondence: Kevin C. Bickart
| | - Alexander Olsen
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, University Hospital, Trondheim, Norway
| | - Emily L. Dennis
- TBI and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Talin Babikian
- BrainSPORT, Department of Neurosurgery, UCLA, Los Angeles, CA, United States,Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States
| | - Ann N. Hoffman
- BrainSPORT, Department of Neurosurgery, UCLA, Los Angeles, CA, United States
| | - Aliyah Snyder
- BrainSPORT, Department of Neurosurgery, UCLA, Los Angeles, CA, United States,Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States
| | - Christopher A. Sheridan
- Wake Forest School of Medicine, Radiology Informatics and Image Processing Laboratory, Winston-Salem, NC, United States,Wake Forest School of Medicine, Department of Radiology, Section of Neuroradiology, Winston-Salem, NC, United States
| | - Jesse T. Fischer
- BrainSPORT, Department of Neurosurgery, UCLA, Los Angeles, CA, United States,Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States
| | - Christopher C. Giza
- BrainSPORT, Department of Neurosurgery, UCLA, Los Angeles, CA, United States,UCLA Mattel Children's Hospital, Department of Pediatrics, Division of Neurology, Los Angeles, CA, United States
| | - Meeryo C. Choe
- BrainSPORT, Department of Neurosurgery, UCLA, Los Angeles, CA, United States,UCLA Mattel Children's Hospital, Department of Pediatrics, Division of Neurology, Los Angeles, CA, United States
| | - Robert F. Asarnow
- BrainSPORT, Department of Neurosurgery, UCLA, Los Angeles, CA, United States,Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, United States
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13
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Gomez D, Glang A, Haarbauer-Krupa J, Bull R, Tucker P, Ratcliffe J, Hall A, Gioia GA, Jain S, Sathian U, Simon HK, Wright D. Stakeholder perspectives on navigating the pediatric concussion experience: Exploring the needs for improved communication across the care continuum. NeuroRehabilitation 2023; 52:605-612. [PMID: 37125574 PMCID: PMC10481243 DOI: 10.3233/nre-220220] [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: 05/02/2023]
Abstract
BACKGROUND For children, the post-concussion return to school process is a critical step towards achieving positive health outcomes. The process requires integration between healthcare professionals, parents, and school personnel. OBJECTIVE This research team conducted focus groups with stakeholders including parents, education personnel, school nurses, external healthcare providers (nurses) and athletic trainers to identify communication patterns between healthcare providers outside of the school setting and school personnel. METHODS Data from focus groups were analyzed using a Thematic Analysis approach. Researchers used an inductive (bottom-up) coding process to describe semantic themes and utilized a critical realist epistemology. RESULTS We identified four key themes within focus group data: (1) lack of effective communication between hospital and outpatient healthcare providers to school personnel; (2) parents who were strong advocates had improved communication with healthcare professionals and garnered more accommodations for their children; (3) non-school professionals and families were often confused about who the point of contact was at a given school; and (4) differing experiences for athletes vs. non-athletes. CONCLUSION This study suggests gaps in communication between healthcare and school professionals when children return to school following a concussion. Improving communication between healthcare providers and school staff will require a multi-faceted approach.
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Affiliation(s)
- Douglas Gomez
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Ann Glang
- Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Juliet Haarbauer-Krupa
- Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC) Atlanta, GA, USA
| | - Rachel Bull
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Paula Tucker
- Department of Emergency Medicine, Nell Hodgson Woodruff School of Nursing, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan Ratcliffe
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Alex Hall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gerard A. Gioia
- Division of Pediatric Neuropsychology, Children’s National Hospital, George Washington University School of Medicine Washington, DC, USA
| | - Shabnam Jain
- Pediatric Emergency Medicine, Children’s Healthcare of Atlanta, Emory University Atlanta, GA, USA
| | - Usha Sathian
- Pediatric Urgent Care, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Harold K. Simon
- Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - David Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
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14
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Thamjamrassri T, Watanitanon A, Moore A, Chesnut RM, Vavilala MS, Lele AV. A Pilot Prospective Observational Study of Cerebral Autoregulation and 12-Month Outcomes in Children With Complex Mild Traumatic Brain Injury: The Argument for Sufficiency Conditions Affecting TBI Outcomes. J Neurosurg Anesthesiol 2022; 34:384-391. [PMID: 34009858 PMCID: PMC8563492 DOI: 10.1097/ana.0000000000000775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The relationship between cerebral autoregulation and outcomes in pediatric complex mild traumatic brain injury (TBI) is unknown, and explored in this study. METHODS We conducted a prospective observational study of patients aged 0 to 18 years hospitalized with complex mild TBI (admission Glasgow Coma Scale score 13 to 15 with either abnormal computerized tomogram of the head or history of loss of consciousness). Cerebral autoregulation was tested using transcranial Doppler ultrasonography, and impaired autoregulation defined as autoregulation index<0.4. We collected Glasgow Outcome Scale Extended-Pediatrics score and health-related quality of life data at 3, 6, and 12 months after discharge. RESULTS Twenty-four patients aged 1.8 to 16.6 years (58.3% male) with complete 12-month outcome data were included in the analysis. Median admission Glasgow Coma Scale score was 15 (range: 13 to 15), median injury severity score was 12 (range: 4 to 29) and 23 patients (96%) had isolated TBI. Overall, 10 (41.7%) patients had impaired cerebral autoregulation. Complete recovery was observed in 6 of 21 (28.6%) children at 3 months, in 4 of 16 (25%) children at 6 months, and in 8 of 24 (33.3%) children at 12 months. There was no difference in median (interquartile range) Glasgow Outcome Scale Extended-Pediatrics score (2 [2.3] vs. 2 [interquartile range 1.3]) or health-related quality of life scores (91.5 [21.1] vs. 90.8 [21.6]) at 12 months between those with intact and impaired autoregulation, respectively. Age-adjusted hypotension occurred in 2/24 (8.3%) patients. CONCLUSION Two-thirds of children with complex mild TBI experienced incomplete functional recovery at 1 year. The co-occurrence of hypotension and cerebral autoregulation may be a sufficiency condition needed to affect TBI outcomes.
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Affiliation(s)
| | | | - Anne Moore
- Department of Neurological Surgery, University of Washington, Harborview Medical Center
| | - Randall M. Chesnut
- Department of Neurological Surgery, University of Washington, Harborview Medical Center
- Orthopedics and Sport Medicine, Seattle, WA
| | - Monica S. Vavilala
- Harborview Injury Prevention and Research Center
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Abhijit V. Lele
- Harborview Injury Prevention and Research Center
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
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15
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Gao S, Treble-Barna A, Fabio A, Kelly MK, Beers SR, Rosario BL, Bell MJ, Wisniewski SR. Effects of inpatient rehabilitation after acute care on functional and quality-of-life outcomes in children with severe traumatic brain injury. Brain Inj 2022; 36:1280-1287. [PMID: 36101488 PMCID: PMC9890641 DOI: 10.1080/02699052.2022.2120211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 04/02/2022] [Accepted: 08/28/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Few studies have assessed the effectiveness of the rehabilitation process in children surviving severe traumatic brain injury (TBI). We evaluated whether receiving inpatient rehabilitation after acute hospitalization was associated with better functional outcomes compared to receiving only non-inpatient rehabilitation in children with severe TBI and explored an effect modification for Glasgow Coma Scale (GCS) score at hospital discharge. METHODS We included 254 children who received rehabilitation following severe TBI from a multinational observational study. The Pediatric Glasgow Outcome Scale - Extended (GOS-E Peds), parent/guardian-reported and child-reported Pediatric Quality of Life Inventory (PedsQL) at 12 months post-injury were assessed and described using summary statistics. Unadjusted and propensity score-weighted linear/ordinal logistic regression modeling were also performed. RESULTS 180 children received inpatient rehabilitation and 74 children received only non-inpatient rehabilitation after acute hospitalization. Among children with a GCS<13 at discharge, those receiving inpatient rehabilitation had a more favorable GOS-E Peds score (OR = 0.12, p = 0.045). However, no such association was observed in children with a higher GCS. We found no differences in PedsQL scores between rehabilitation groups. CONCLUSIONS Future studies are warranted to confirm the benefits of inpatient rehabilitation for children with more severely impaired consciousness when medically stable.
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Affiliation(s)
- Shiyao Gao
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, USA
| | - Amery Treble-Barna
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, USA
| | - Anthony Fabio
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, USA
| | - M. Kathleen Kelly
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, USA
| | - Sue R. Beers
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Bedda L. Rosario
- Epidemiology Data Center, University of Pittsburgh, Pittsburgh, USA
| | - Michael J. Bell
- Department of Pediatrics, Division of Critical Care Medicine, Children’s National Hospital, Washington, D.C., USA
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16
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Crumlish L, Wallace SJ, Copley A, Rose TA. Exploring the measurement of pediatric cognitive-communication disorders in traumatic brain injury research: A scoping review. Brain Inj 2022; 36:1207-1227. [PMID: 36303459 DOI: 10.1080/02699052.2022.2111026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To synthesize information about the constructs measured, measurement instruments used, and the timing of assessment of cognitive-communication disorders (CCDs) in pediatric traumatic brain injury (TBI) research. METHODS AND PROCEDURES Scoping review conducted in alignment with Arksey and O'Malley's five-stage methodological framework and reported per the PRISMA extension for Scoping Reviews. Inclusion criteria: (a) cohort description, case-control, and treatment studies; (b) participants with TBI aged 5-18 years; (c) communication or psychosocial outcomes; and (d) English full-text journal articles. The first author reviewed all titles, abstracts, and full-text articles; 10% were independently reviewed. OUTCOMES AND RESULTS Following screening, a total of 687 articles were included and 919 measurement instruments, measuring 2134 unique constructs, were extracted. The Child Behavior Checklist was the most used measurement instrument and 'Global Outcomes/Recovery' was the construct most frequently measured. The length of longitudinal monitoring ranged between ≤3 months and 16 years. CONCLUSIONS AND IMPLICATIONS We found considerable heterogeneity in the constructs measured, the measurement instruments used, and the timing of CCD assessment in pediatric TBI research. A consistent approach to measurement may support clinical decision-making and the efficient use of data beyond individual studies in systematic reviews and meta-analyses.
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Affiliation(s)
- Lauren Crumlish
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sarah J Wallace
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Queensland Aphasia Research Centre, Australia
| | - Anna Copley
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Tanya A Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Queensland Aphasia Research Centre, Australia
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17
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Lopez DA, Christensen ZP, Foxe JJ, Ziemer LR, Nicklas PR, Freedman EG. Association between mild traumatic brain injury, brain structure, and mental health outcomes in the Adolescent Brain Cognitive Development Study. Neuroimage 2022; 263:119626. [PMID: 36103956 DOI: 10.1016/j.neuroimage.2022.119626] [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: 06/01/2022] [Revised: 07/20/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Children that experience a mild traumatic brain injury (mTBI) are at an increased risk of neural alterations that can deteriorate mental health. We test the hypothesis that mTBI is associated with psychopathology and that structural brain metrics (e.g., volume, area) meaningfully mediate the relation in an adolescent population. METHODS We analyzed behavioral and brain MRI data from 11,876 children who participated in the Adolescent Brain Cognitive Development (ABCD) Study. Mixed-effects models were used to examine the longitudinal association between mTBI and mental health outcomes. Bayesian methods were used to investigate brain regions that are intermediate between mTBI and symptoms of poor mental health. RESULTS There were 199 children with mTBI and 527 with possible mTBI across the three ABCD Study visits. There was a 7% (IRR = 1.07, 95% CI: 1.01, 1.13) and 15% (IRR = 1.16, 95% CI: 1.05, 1.26) increased risk of emotional or behavioral problems in children that experienced possible mTBI or mTBI, respectively. Possible mTBI was associated with a 17% (IRR: 1.17, 95% CI: 0.99, 1.40) increased risk of experiencing distress following a psychotic-like experience. We did not find any brain regions that meaningfully mediated the relationship between mTBI and mental health outcomes. Analysis of volumetric measures found that approximately 2% to 5% of the total effect of mTBI on mental health outcomes operated through total cortical volume. Image intensity measure analyses determined that approximately 2% to 5% of the total effect was mediated through the left-hemisphere of the dorsolateral prefrontal cortex. CONCLUSION Results indicate an increased risk of emotional and behavioral problems in children that experienced possible mTBI or mTBI. Mediation analyses did not elucidate the mechanisms underlying the association between mTBI and mental health outcomes.
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Affiliation(s)
- Daniel A Lopez
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA; Department of Public Health Sciences, Division of Epidemiology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Zachary P Christensen
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - John J Foxe
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Laura R Ziemer
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Paige R Nicklas
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Edward G Freedman
- Department of Neuroscience, The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monte Institute for Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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18
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Visualizing the Knowledge Base and Research Hotspot of Public Health Emergency Management: A Science Mapping Analysis-Based Study. SUSTAINABILITY 2022. [DOI: 10.3390/su14127389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Public health emergency management has been one of the main challenges of social sustainable development since the beginning of the 21st century. Research on public health emergency management is becoming a common focus of scholars. In recent years, the literature associated with public health emergency management has grown rapidly, but few studies have used a bibliometric analysis and visualization approach to conduct deep mining and explore the characteristics of the public health emergency management research field. To better understand the present status and development of public health emergency management research, and to explore the knowledge base and research hotspots, the bibliometric method and science mapping technology were adopted to visually evaluate the knowledge structure and research trends in the field of public health emergency management studies. From 2000 to 2020, a total of 3723 papers related to public health emergency management research were collected from the Web of Science Core Collection as research data. The five main research directions formed are child prevention, mortality from public health events, public health emergency preparedness, public health emergency management, and coronavirus disease 2019 (COVID-19). The current research hotspots and frontiers are climate change, COVID-19 and related coronaviruses. Further research is needed to focus on the COVID-19 and related coronaviruses. This study intends to contribute inclusive support to related academia and industry in the aspects of public health emergency management and public safety research, as well as research hotspots and future research directions.
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Schmidt M, Babcock L, Kurowski BG, Cassedy A, Sidol C, Wade SL. Usage Patterns of an mHealth Symptom Monitoring App Among Adolescents With Acute Mild Traumatic Brain Injuries. J Head Trauma Rehabil 2022; 37:134-143. [PMID: 35125434 PMCID: PMC9203862 DOI: 10.1097/htr.0000000000000768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To understand usage patterns of SMART (Self-Monitoring Activity Regulation and Relaxation Treatment) mHealth app among adolescents with acute mild traumatic brain injuries (mTBIs) and to identify individual characteristics that influenced app usage. METHODS SETTING Emergency departments of tertiary care children's medical center. PARTICIPANTS Children aged 11 to 18 years with mTBI in the past 2 weeks, English-speaking, no evidence of severe TBI, and no preexisting neurological impairment. DESIGN Nested cohort of the intervention arm of a randomized clinical trial (n = 34). MHEALTH APP INTERVENTION SMART was a month-long educational program on mTBI designed to promote self-monitoring and management of recovery. SMART included digital symptom and activity self-monitoring surveys, feedback on symptom changes, and 8 modules providing psychoeducation, strategies for symptom management, and training in active problem solving. MAIN MEASURES App usage time, navigation, and interaction data were automatically collected. Usage involved inputting symptom ratings/activities and reviewing modules. Patterns of symptom/activity reporting and completion of learning modules data were analyzed. Predictors of app utilization, including individual characteristics, resilience (Connor-Davidson Resilience Scale), and coping (Coping Strategies Inventory-Short Form), were analyzed using Spearman correlations. RESULTS Participants completed symptom monitoring an average of 9 days over the month. Participants completed an average of 1.87 learning modules out of 7. Parent income and education, comorbid attention-deficit/hyperactivity disorder (ADHD), and emotional engagement coping style predicted symptom monitoring. Parental income, comorbid ADHD, and greater reliance on emotional engagement coping predicted module completion. SIGNIFICANT ADVERSE EVENTS None. CONCLUSION Adolescents of higher socioeconomic status and those who manage their emotions using active engagement spent more time on both components of the SMART program.
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Affiliation(s)
- Matthew Schmidt
- Educational Technology, College of Education, University of Florida, Gainesville (Dr Schmidt); Cincinnati Children's Hospital Medical Center (Drs Babcock, Kurowski, Cassedy, Sidol, and Wade), Division of Pediatric Rehabilitation Medicine (Drs Kurowski and Wade), and Departments of Pediatrics and Neurology and Rehabilitation Medicine (Dr Kurowski), University of Cincinnati College of Medicine, Cincinnati, Ohio
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20
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Ryan E, Kelly L, Stacey C, Duff E, Huggard D, Leonard A, Boran G, McCollum D, Doherty D, Bolger T, Molloy EJ. Traumatic Brain Injury in Children: Glial fibrillary Acidic Protein and Clinical Outcomes. Pediatr Emerg Care 2022; 38:e1139-e1142. [PMID: 34469402 DOI: 10.1097/pec.0000000000002527] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Glial fibrillary acidic protein (GFAP) is a neuronal protein released after traumatic brain injury (TBI) and detectable in serum samples. GFAP correlates with symptom severity in adults and may be a marker of brain injury in children with milder symptoms or preverbal children. METHODS GFAP was examined in children with severe TBI (initial Glasgow Coma Scale score <8), with mild TBI (Glasgow Coma Scale score 14/15), and at 0 to 4 and at 10 to 14 days after TBI and was compared with healthy age-matched controls. Mechanism, time points from injury, and symptoms were recorded. RESULTS The study enrolled 208 children including 110 with TBI (n = 104 mild, 6 severe) and controls (n = 98). GFAP was higher in mild TBI than in controls and highest in the severe TBI cohort, with a maximum value at 6 hours from injury. Vomiting was significantly associated with higher GFAP levels, but no association was found with amnesia, loss of consciousness, and the Sports Concussion Assessment Tool. Children reporting >1-point changes from their preinjury functioning on the Post-Concussive Symptom Inventory had higher initial GFAP but not total Post-Concussive Symptom Inventory score changes. CONCLUSIONS GFAP identifies children with TBI, even at the milder end of the spectrum, and is strongly associated with postinjury vomiting. It may be a useful marker of pediatric TBI; however, sampling is time critical.
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Affiliation(s)
| | | | | | | | | | - Ann Leonard
- Department of Biochemistry, Tallaght Universtiy Hospital
| | - Gerard Boran
- Department of Biochemistry, Tallaght Universtiy Hospital
| | | | - Dermot Doherty
- Department of Intensive Care, Children's Hospital Ireland (CHI) at Temple Street
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21
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Kesavan C, Rundle C, Mohan S. Repeated mild traumatic brain injury impairs fracture healing in male mice. BMC Res Notes 2022; 15:25. [PMID: 35093144 PMCID: PMC8801079 DOI: 10.1186/s13104-022-05906-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/11/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives The goal of this study was to evaluate the long-term impact of repeated (r) mild traumatic brain injury (mTBI) on the healing of fractures in a mouse model. Ten week-old male mice were subjected to r-mTBI once per day for 4 days followed by closed femoral fracture using a three-point bending technique, 1 week post impact and fracture healing phenotype evaluated at 20 weeks of age. Results Micro-CT analysis of the fracture callus region at nine weeks post fracture revealed reduced bone volume (30%, p < 0.05) in the r-mTBI fracture group compared to the control-fracture group. The connectivity density of the fracture callus bone was reduced by 40% (p < 0.01) in the r-mTBI fracture group. Finite element analysis of the fracture callus region showed reduced failure load (p = 0.08) in the r-mTBI group compared to control group. There was no residual cartilage in the fracture callus region of either the r-mTBI or control fracture group. The reduced fracture callus bone volume and mechanical strength of fracture callus in r-mTBI mice 9 weeks post fracture are consistent with negative effects of r-mTBI on fracture healing over a long-term resulting in decreased mechanical strength of the fracture callus.
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Affiliation(s)
- Chandrasekhar Kesavan
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, 11201 Benton Street, Loma Linda, CA, 92357, USA.,Departments of Medicine, Loma Linda University, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Charles Rundle
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, 11201 Benton Street, Loma Linda, CA, 92357, USA.,Departments of Medicine, Loma Linda University, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Subburaman Mohan
- Musculoskeletal Disease Center, VA Loma Linda Healthcare System, 11201 Benton Street, Loma Linda, CA, 92357, USA. .,Departments of Medicine, Loma Linda University, 11234 Anderson St, Loma Linda, CA, 92354, USA. .,Orthopedic Surgery, Loma Linda University, 11234 Anderson St, Loma Linda, CA, 92354, USA.
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22
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Palusak C, Shook B, Davies SC, Lundine JP. A scoping review to inform care coordination strategies for youth with traumatic brain injuries: Care coordination personnel. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345211070647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction & Importance: Effective, patient-centered care coordination has been shown to improve outcomes for children with special healthcare needs (CSHCN), who often have complex, long-term involvement with multiple service providers. Traumatic brain injury (TBI) can result in long-term physical, intellectual, social, and emotional disabilities that persist long after acute treatment. Yet, even though it is a chronic condition, TBI remains an area with scarce standardization and research surrounding the complex, long-term care coordination need in this population. The purpose of this scoping review is to summarize current research on outcomes in CSHCN after implementation of care coordinators, whether individual or teams, to inform future research for youth with TBI. Methods: OVID/Medline, CINAHL, PsycINFO, EMBASE, and ERIC databases were searched for articles relevant to care coordination and CSHCN. Results: 31 articles met inclusion criteria. Outcomes for children and families were grouped into 5 major categories: healthcare utilization, cost of care, disease status, parent and child quality of life, and healthcare satisfaction and perception of care. Discussion: Implementation of care coordinators, whether in the form of individuals, dyads, or teams, resulted in overall positive outcomes for CSHCN and their families across all 5 major outcome domains. Future research should be focused on the efficacy of care coordinators differing in profession, qualifications, and educational attainment specifically for the unique needs of children with TBI. Additionally, the application of care coordination within medical homes should be further investigated to increase proactive, preventative care of children with TBI and further reduce reactive, need-based treatment only.
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Affiliation(s)
- Cara Palusak
- Heritage College of Osteopathic Medicine, Ohio University Dublin Campus, Columbus, OH
| | - Brandy Shook
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH
| | - Susan C. Davies
- Department of Counselor Education and Human Services, University of Dayton, Dayton, OH
| | - Jennifer P. Lundine
- Department of Speech & Hearing Science, The Ohio State University, Columbus, OH
- Division of Clinical Therapies & Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
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Keys ME, Delaplain P, Kirby KA, Boudreau KI, Rosenbaum K, Inaba K, Lekawa M, Nahmias J. Early cognitive impairment is common in pediatric patients following mild traumatic brain injury. J Trauma Acute Care Surg 2021; 91:861-866. [PMID: 34695063 PMCID: PMC10112330 DOI: 10.1097/ta.0000000000003266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The incidence and factors related to early cognitive impairment (ECI) after mild traumatic brain injury (mTBI) in pediatric trauma patients (PTPs) are unknown. Prior data in the adult population demonstrated an ECI incidence of 51% after mTBI and strong correlation with initial Glasgow Coma Scale (GCS) and Brain Injury Guidelines (BIG) category. Therefore, we hypothesized that ECI is common after mTBI in PTPs and associated with initial GCS and BIG category. METHODS A single-center, retrospective review of PTPs (age, 8-17 years) from 2015 to 2019 with intracranial hemorrhage and mTBI (GCS score, 13-15) was performed. Primary outcome was ECI, defined as Ranchos Los Amigos score less than 8. Comparisons between ECI and non-ECI groups regarding Injury Severity Score (ISS), demographics, and cognitive and clinical outcomes were evaluated using χ2 statistics and Wilcoxon rank sum tests. Odds of ECI were evaluated using multivariable logistic regression. RESULTS From 47 PTPs with mTBI, 18 (38.3%) had ECI. Early cognitive impairment patients had a higher ISS than non-ECI patients (19.7 vs. 12.6, p = 0.003). Injuries involving motor vehicles were more often related to ECI than non-auto-involved mechanisms (55% vs. 15%, p = 0.005). Lower GCS score (odds ratio [OR], 6.60; 95% confidence interval [CI], 1.34-32.51, p = 0.02), higher ISS (OR, 1.12; 95% CI, 1.01-1.24; p = 0.030), and auto-involved injuries (OR, 6.06; 95% CI, 1.15-31.94; p = 0.030) were all associated with increased risk of ECI. There was no association between BIG category and risk of ECI (p > 0.05). CONCLUSION Nearly 40% of PTPs with mTBI suffer from ECI. Lower initial GCS score, higher ISS, and autoinvolved mechanism of injury were associated with increased risk of ECI. Brain Injury Guidelines category was not associated with ECI in pediatric patients. LEVEL OF EVIDENCE Prognostic study, Level III.
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Affiliation(s)
- Megan Elizabeth Keys
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA USA
| | - Patrick Delaplain
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA USA
| | | | - Kate Irene Boudreau
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA USA
| | - Kathryn Rosenbaum
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA USA
| | - Kenji Inaba
- University of Southern California, Department of Surgery, Los Angeles, CA USA
| | - Michael Lekawa
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA USA
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Soccer-related injuries utilization of U.S. emergency departments for concussions, intracranial injuries, and other-injuries in a national representative probability sample: Nationwide Emergency Department Sample, 2010 to 2013. PLoS One 2021; 16:e0258345. [PMID: 34637479 PMCID: PMC8509888 DOI: 10.1371/journal.pone.0258345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022] Open
Abstract
Soccer participation in the United States (U.S.) has increased over time, and injuries as well as interest to prevent injuries has become more common. This study described Emergency Department (ED) visits related to concussions, intracranial injuries (ICI), and all-other injuries attributed to soccer play; described healthcare cost and length of hospital stay of soccer-related injuries; and determined independent predictors of concussions, ICI, and all-other soccer injuries leading to ED visits. The study examined soccer-related weighted discharge data from the Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Weighted tabular analysis of univariate and bivariate analyses and weighted and adjusted logistic regression models were conducted. A total of 480,580 of U.S. ED visits related to soccer injuries were available for analysis between 2010 to 2013. Generally, 98% of soccer-related ED visits resulted in routine (treat-and-release) visits. However, the odds of transfer to a short-term hospital following ED evaluation and treatment was more than 37-fold higher for soccer-injured youth and adults diagnosed with ICI when compared to all-other soccer injuries; additionally, these patients showed 28-fold higher odds of being admitted for inpatient care at the ED-affiliated hospital. For concussion, soccer-injured patients with concussion showed nearly 1.5-fold higher odds of being transferred to a short-term hospital than did those with any other soccer injury. Soccer-related ED visits cost more than 700 million in U.S. dollars from 2010 to 2013. Notable differences were noted between concussions, ICI, and all-other soccer injuries presenting to U.S. ED. Albeit underestimated given that this study excludes other forms of health care and treatment for injuries, such as outpatient clinics, over the counter medications and treatment, and rehabilitation, healthcare cost associated with soccer-related injuries presenting to ED is high, and remarkably costly in those with an ICI diagnosis.
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Gao S, Fabio A, Rosario BL, Kelly MK, Beers SR, Bell MJ, Wisniewski SR. Characteristics Associated with the Use of an Inpatient Rehabilitation or Skilled Nursing Facility after Acute Care in Children with Severe Traumatic Brain Injury. Dev Neurorehabil 2021; 24:466-477. [PMID: 33872126 PMCID: PMC8429094 DOI: 10.1080/17518423.2021.1908441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
To characterize inpatient rehabilitation services for children with severe traumatic brain injury (TBI), we included 254 children, whose parents/guardians reported receipt of rehabilitation within a 12-month follow-up period, from a multinational observational study. Children discharged to an inpatient rehabilitation or skilled nursing facility after acute care were classified into the "inpatient rehabilitation" group, and children discharged home after acute care were classified into the "non-inpatient rehabilitation" group. Multivariable regression analyses determined the associations of sociodemographic and clinical characteristics with rehabilitation groups. Children receiving inpatient rehabilitation had a shorter length of acute hospitalization. Children from the UK were less likely to receive inpatient rehabilitation compared to children from the US. Future studies are warranted to extend current findings by identifying the reasons behind differential access to inpatient rehabilitation among children with severe TBI.
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Affiliation(s)
- Shiyao Gao
- Epidemiology Data Center, University of Pittsburgh
| | | | | | | | - Sue R. Beers
- Department of Psychiatry, University of Pittsburgh
| | - Michael J. Bell
- Department of Pediatrics, Division of Critical Care Medicine, Children’s National Hospital
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Radlicz C, Jackson K, Hautmann A, Shi J, Yang J. Influence of insurance type on rate and type of initial concussion-related medical visits among youth. BMC Public Health 2021; 21:1565. [PMID: 34407798 PMCID: PMC8375144 DOI: 10.1186/s12889-021-11586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background A growing number of studies report increased concussion-related health care utilization in recent years, but factors impacting care-seeking behaviors among youth following a concussion are not well described. This study aimed to evaluate the influence of insurance type on the rate and type of initial concussion visits and the time from injury to the initial visit in youth. Methods We extracted and analyzed initial concussion-related medical visits for youth ages 10 to 17 from electronic health records. Patients must have visited Nationwide Children’s Hospital’s (NCH) concussion clinic at least once between 7/1/2012 and 12/31/2017. We evaluated the trends and patterns of initial concussion visits across the study period using regression analyses. Results Of 4955 unique concussion visits included, 60.1% were males, 80.5% were white, and 69.5% were paid by private insurance. Patients’ average age was 13.9 years (SD = 3.7). The rate of the initial concussion visits per 10,000 NCH visits was consistently higher in privately insured than publicly insured youth throughout the study period (P < .0001). Privately insured youth had greater odds of initial concussion visits to sports medicine clinics (AOR = 1.45, 95% CI = 1.20, 1.76) but lower odds of initial concussion visits to the ED/urgent care (AOR = 0.74, 95% CI = 0.60, 0.90) than publicly insured youth. Days from injury to initial concussion visit significantly decreased among both insurance types throughout the study (P < .0001), with a greater decrease observed in publicly insured than privately insured youth (P = .011). Conclusions Results on the differences in the rate, type, and time of initial concussion-related visits may help inform more efficient care of concussion among youth with different types of insurance.
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Affiliation(s)
- Chris Radlicz
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA
| | - Kenneth Jackson
- Biostatistics Resource, Nationwide Children's Hospital, Columbus, OH, USA.,Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Amanda Hautmann
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA
| | - Junxin Shi
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, Nationwide Children's Hospital, 700 Children's Drive, RBIII-WB5403, Columbus, OH, 43205, USA. .,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA.
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Traumatic brain injury biomarkers in pediatric patients: a systematic review. Neurosurg Rev 2021; 45:167-197. [PMID: 34170424 DOI: 10.1007/s10143-021-01588-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/23/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
Traumatic brain injury (TBI) is the main cause of pediatric trauma death and disability worldwide. Recent studies have sought to identify biomarkers of TBI for the purpose of assessing functional outcomes. The aim of this systematic review was to evaluate the utility of TBI biomarkers in the pediatric population by summarizing recent findings in the medical literature. A total of 303 articles were retrieved from our search. An initial screening to remove duplicate studies yielded 162 articles. After excluding all articles that did not meet the inclusion criteria, 56 studies were gathered. Among the 56 studies, 36 analyzed serum biomarkers; 11, neuroimaging biomarkers; and 9, cerebrospinal fluid (CSF) biomarkers. Most studies assessed biomarkers in the serum, reflecting the feasibility of obtaining blood samples compared to obtaining CSF or performing neuroimaging. S100B was the most studied serum biomarker in TBI, followed by SNE and UCH-L1, whereas in CSF analysis, there was no unanimity. Among the different neuroimaging techniques employed, diffusion tensor imaging (DTI) was the most common, seemingly holding diagnostic power in the pediatric TBI clinical setting. The number of cross-sectional studies was similar to the number of longitudinal studies. Our data suggest that S100B measurement has high sensitivity and great promise in diagnosing pediatric TBI, ideally when associated with head CT examination and clinical decision protocols. Further large-scale longitudinal studies addressing TBI biomarkers in children are required to establish more accurate diagnostic protocols and prognostic tools.
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Ferrazzano P, Yeske B, Mumford J, Kirk G, Bigler ED, Bowen K, O'Brien N, Rosario B, Beers SR, Rathouz P, Bell MJ, Alexander AL. Brain Magnetic Resonance Imaging Volumetric Measures of Functional Outcome after Severe Traumatic Brain Injury in Adolescents. J Neurotrauma 2021; 38:1799-1808. [PMID: 33487126 PMCID: PMC8219192 DOI: 10.1089/neu.2019.6918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Adolescent traumatic brain injury (TBI) is a major public health concern, resulting in >35,000 hospitalizations in the United States each year. Although neuroimaging is a primary diagnostic tool in the clinical assessment of TBI, our understanding of how specific neuroimaging findings relate to outcome remains limited. Our study aims to identify imaging biomarkers of long-term neurocognitive outcome after severe adolescent TBI. Twenty-four adolescents with severe TBI (Glasgow Coma Scale ≤8) enrolled in the ADAPT (Approaches and Decisions after Pediatric TBI) study were recruited for magnetic resonance imaging (MRI) scanning 1-2 years post-injury at 13 participating sites. Subjects underwent outcome assessments ∼1-year post-injury, including the Wechsler Abbreviated Scale of Intelligence (IQ) and the Pediatric Glasgow Outcome Scale-Extended (GOSE-Peds). A typically developing control cohort of 38 age-matched adolescents also underwent scanning and neurocognitive assessment. Brain-image segmentation was performed on T1-weighted images using Freesurfer. Brain and ventricular cerebrospinal fluid volumes were used to compute a ventricle-to-brain ratio (VBR) for each subject, and the corpus callosum cross-sectional area was determined in the midline for each subject. The TBI group demonstrated higher VBR and lower corpus callosum area compared to the control cohort. After adjusting for age and sex, VBR was significantly related with GOSE-Peds score in the TBI group (n = 24, p = 0.01, cumulative odds ratio = 2.18). After adjusting for age, sex, intracranial volume, and brain volume, corpus callosum cross-sectional area correlated significantly with IQ score in the TBI group (partial cor = 0.68, n = 18, p = 0.007) and with PSI (partial cor = 0.33, p = 0.02). No association was found between VBR and IQ or between corpus callosum and GOSE-Peds. After severe adolescent TBI, quantitative MRI measures of VBR and corpus callosum cross-sectional area are associated with global functional outcome and neurocognitive outcomes, respectively.
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Affiliation(s)
- Peter Ferrazzano
- Waisman Center, University of Wisconsin, Madison, Wisconsin, USA
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin, USA
| | - Benjamin Yeske
- Waisman Center, University of Wisconsin, Madison, Wisconsin, USA
| | - Jeanette Mumford
- Center for Healthy Minds, University of Wisconsin, Madison, Wisconsin, USA
| | - Gregory Kirk
- Waisman Center, University of Wisconsin, Madison, Wisconsin, USA
| | - Erin D. Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
- Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA
| | | | - Nicole O'Brien
- Department of Pediatrics, Division of Critical Care Medicine Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Bedda Rosario
- Department of Epidemiology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sue R. Beers
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Paul Rathouz
- Department of Population Health, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Michael J. Bell
- Department of Pediatrics, Children's National Medical Center, Washington, DC, USA
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin, Madison, Wisconsin, USA
- Waisman Center Brain Imaging Laboratory, University of Wisconsin, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin, USA
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Salley J, Crook L, Iske T, Ciccia A, Lundine JP. Acute and Long-Term Services for Elementary and Middle School Children With Early Childhood Brain Injury. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:908-919. [PMID: 33556249 DOI: 10.1044/2020_ajslp-20-00045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The purpose of this study was to investigate the rates of referral to and receipt of acute and long-term services and identify factors that could impact these rates for children who experienced an acquired brain injury (ABI) during early childhood who are now in elementary and middle school. Method This was a retrospective chart review and prospective phone survey of 29 caregivers of children with ABIs. Results Acutely, two thirds of this sample received hospital-based rehabilitation services, but only 44.8% of families reported receiving ABI-specific education or a referral to educational or rehabilitation services at the time of discharge. At an average of 8.5 years postinjury, children in this sample were largely reported to be performing positively in school. While special education rates did not change significantly over time, 20.7% of the sample reported having unmet educational needs. Additionally, service receipt decreased over time. Various injury and educational factors influenced rates of long-term special education and service receipt. Conclusions This study contributes to the emerging literature focusing on long-term outcomes of children with ABI. The results reinforce that children who experience an ABI in early childhood are unlikely to receive ABI-specific education or referrals to educational and rehabilitation services during their acute-care stay and, in the chronic stages of recovery, present with educational and therapy needs that can go unmet. To improve long-term service access for children who experience an early ABI, pathways need to be established within the acute-care setting for education and referrals that connect the child and family to treatment within early intervention and educational systems. Maintaining these pathways long term, particularly for potential social-behavioral and cognitive-communication concerns, could increase access to appropriate services and, thus, decrease unmet needs for children with ABI.
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Affiliation(s)
- Jessica Salley
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleaveland, OH
| | - Libby Crook
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleaveland, OH
| | - Taylor Iske
- Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
| | - Angela Ciccia
- Communication Sciences Program, Department of Psychological Sciences, Case Western Reserve University, Cleaveland, OH
| | - Jennifer P Lundine
- Division of Clinical Therapies and Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH
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Lundine JP, Todis B, Gau JM, McCart M, Wade SL, Yeates KO, Glang A. Return to School Following TBI: Educational Services Received 1 Year After Injury. J Head Trauma Rehabil 2021; 36:E89-E96. [PMID: 32769832 DOI: 10.1097/htr.0000000000000591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many children who experience a traumatic brain injury (TBI) return to school without receiving needed support services. OBJECTIVE To identify services received and predictors of formal special education services (ie, Individualized Education Plan [IEP]) for students with TBI 1 year after returning to school. SETTING AND PARTICIPANTS A total of 74 students with TBI recruited from children's hospitals in Colorado, Ohio, and Oregon. DESIGN Secondary analysis of previously reported randomized control trials with surveys completed by caregivers when students returned to school (T1) and 1 year later (T2). This study reports data collected at T2. RESULTS While 45% of students with TBI reported an IEP 1 year after returning to school, nearly 50% of students received informal or no services. Male students, those who sustained a severe TBI, and students whose parents reported domain-specific concerns were more likely to receive special education services at 1 year. In a multivariate model, sex remained the only significant predictor of IEP services at T2. CONCLUSIONS Females and students with less severe or less visible deficits were less likely to receive special education services. While transition services may help students obtain special education for the first year after TBI, identifying students with TBI who have subtle or later-developing deficits remains a challenge.
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Affiliation(s)
- Jennifer P Lundine
- Department of Speech and Hearing Science, The Ohio State University, and Division of Clinical Therapies and Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, Ohio (Dr Lundine); Center on Brain Injury Research and Training, Department of Psychology, University of Oregon, Eugene (Drs Todis, McCart, and Glang); Center on Human Development, University of Oregon, Eugene (Mr Gau); Department of Pediatrics, University of Cincinnati College of Medicine, and Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Ohio (Dr Wade); and Department of Psychology, University of Calgary, and Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (Dr Yeates)
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Anderson D, Gau JM, Beck L, Unruh D, Gioia G, McCart M, Davies SC, Slocumb J, Gomez D, Glang AE. Management of Return to School Following Brain Injury: An Evaluation Model. INTERNATIONAL JOURNAL OF EDUCATIONAL RESEARCH 2021; 108:10.1016/j.ijer.2021.101773. [PMID: 33927471 PMCID: PMC8076871 DOI: 10.1016/j.ijer.2021.101773] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Traumatic brain injury (TBI) affects children's ability to succeed at school. Few educators have the necessary training and knowledge needed to adequately monitor and treat students with a TBI, despite schools regularly serving as the long-term service provider. In this article, we describe a return to school model used in Oregon that implements best practices indicated by the extant literature, as well as our research protocol for evaluating this model. We discuss project aims and our planned procedures, including the measures used, our quasi-experimental design using matched controls, statistical power, and impact analyses. This project will provide the evidential base for implementation of a return to school model at scale.
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Affiliation(s)
| | - Jeff M. Gau
- University of Oregon, Eugene, 97403-5252, USA
| | - Laura Beck
- University of Oregon, Eugene, 97403-5252, USA
| | | | - Gerard Gioia
- Children’s National Health System, 111 Michigan
Avenue NW, Washington, DC, 20010
| | | | - Susan C Davies
- University of Dayton, University of Dayton, 300 College
Park Dayton, Ohio 45469, USA
| | | | - Doug Gomez
- University of Oregon, Eugene, 97403-5252, USA
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Obikane E, Yamana H, Yasunaga H, Kawakami N. Cumulative visits for care of minor injuries are associated with traumatic brain injury in young children. Acta Paediatr 2020; 109:2775-2782. [PMID: 32304586 DOI: 10.1111/apa.15315] [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: 01/15/2020] [Revised: 03/13/2020] [Accepted: 04/15/2020] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the association between cumulative visits for care of minor injuries and risk of traumatic brain injuries in children aged ≤36 months. METHODS We conducted a retrospective analysis of children born from 2009 to 2012, using a health insurance claims database in Japan. We investigated the total number of visits where children aged 0-36 months presented for treatment of minor injuries such as superficial injuries, fractures, burns and foreign body ingestions. Logistic regression analysis was used to evaluate the association between the cumulative number of visits for treatment of minor injuries and traumatic brain injuries in children aged ≤36 months. RESULTS A total of 91 011 children were included in the analysis, 51% of whom were boys. Traumatic brain injuries were identified in 0.7% of these children. Cumulative visits for care of minor injuries among children aged 0-36 months were significantly associated with traumatic brain injuries by 36 months of age, with an odds ratio of 2.12 (95% confidence interval: 1.68-2.68) for multiple visits. CONCLUSION Cumulative visits for treatment of minor injuries during the first 36 months of life were associated with increased risk of traumatic brain injuries by 36 months of age.
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Affiliation(s)
- Erika Obikane
- Department of Mental Health Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hayato Yamana
- Department of Health Services Research Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Norito Kawakami
- Department of Mental Health Graduate School of Medicine The University of Tokyo Tokyo Japan
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Preliminary Efficacy of Online Traumatic Brain Injury Professional Development for Educators: An Exploratory Randomized Clinical Trial. J Head Trauma Rehabil 2020; 34:77-86. [PMID: 30499929 DOI: 10.1097/htr.0000000000000447] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the efficacy of an online traumatic brain injury (TBI) professional development intervention, In the Classroom After Concussion: Best Practices for Student Success. DESIGN A randomized controlled trial with a sample of 100 general educators, who were randomly assigned to the In the Classroom Web site (treatment group) or the LEARNet Web site (control group). Participants completed the pretest, accessed the In the Classroom or LEARNet site and the posttest and completed follow-up assessments 60 days after posttest. MEASURES (1) Knowledge of effective strategies for working with students with TBI; (2) knowledge application; (3) self-efficacy in handling situations presented in text and video scenarios, and (4) a standardized self-efficacy measure. RESULTS On the posttest assessment, In the Classroom educators showed significantly greater gains in knowledge (P < .0001, d = 1.36 [large effect]), TBI knowledge application (P = .0261, d = 0.46), and general self-efficacy (P = .0106, d = 0.39) than the LEARNet controls. In the Classroom educators maintained significant gains in knowledge (P = .001, d = 0.82) and general self-efficacy (P = .018, d = 0.38) but not in TBI knowledge application (P = .921, d = 0.02). CONCLUSION Given the prevalence of TBI, it is important to develop evidence-based, cost-effective approaches to knowledge transfer and exchange in TBI professional development. In the Classroom is one such approach.
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Sarmiento K, Daugherty J, DePadilla L, Breiding MJ. Examination of sports and recreation-related concussion among youth ages 12-17: results from the 2018 YouthStyles survey. Brain Inj 2020; 34:357-362. [PMID: 32013618 DOI: 10.1080/02699052.2020.1723165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: This paper sought to examine the frequency of self-reported sports- and recreation-related (SRR) concussion, as well as care-seeking behaviors and potential activity restrictions after concussions, in a sample of youth.Methods: A sample of 845 youth ages 12-17 years responded to the web-based YouthStyles survey in 2018. The survey measured the frequency of self-reported lifetime SRR concussion, the setting of their most recent SRR concussion, whether a doctor or nurse evaluated them, and the types of activity restrictions they experienced.Results: Forty-three percent of youth surveyed sustained their most recent concussion while playing on a sports team, 21.1% while playing on a community-based team, and 36.0% while engaged in a sport or recreational activity. Nearly half (45.3%) reported having to miss playing sports or participating in physical activity for at least one day; about two in ten (19.7%) reported having to miss time on their phone or computer for at least one day.Conclusion: Despite wide-spread efforts to promote protocols for SRR concussion among youth, a third of participants in this study did not seek medical care and more than half did not miss at least one day of sports or physical activity participation following a concussion.
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Affiliation(s)
- Kelly Sarmiento
- Division of Injury Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Jill Daugherty
- Division of Injury Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Lara DePadilla
- Division of Injury Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | - Matthew J Breiding
- Division of Injury Prevention, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia, USA
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Abstract
Abstract
Social robots have shown some efficacy in assisting children with autism and are now being considered as assistive tools for therapy. The physical proximity of a small companion social robot could become a source of harm to children with autism during aggressive physical interactions. A child exhibiting challenging behaviors could throw a small robot that could harm another child’s head upon impact. In this paper, we investigate the effects of the mass and shape of objects thrown on impact at different velocities on the linear acceleration of a developed dummy head. This dummy head could be the head of another child or a caregiver in the room. A total of 27 main experiments were conducted based on Taguchi’s orthogonal array design. The data were then analyzed using ANOVA and then optimized based on the signal-to-noise ratio. Our results revealed that the two design factors considered (i.e. mass and shape) and the noise factor (i.e. impact velocities) affected the response. Finally, confirmation runs at the optimal identified shape and mass (i.e. mass of 0.3 kg and shape of either cube or wedge) showed an overall reduction in the resultant peak linear acceleration of the dummy head as compared to the other conditions. These results have implications on the design and manufacturing of small social robots whereby minimizing the mass of the robots can aid in mitigating the potential harm to the head due to impacts.
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Ali B, Lawrence BA, Miller T, Allison J. Products and activities associated with non-fatal traumatic brain injuries in children and adolescents - United States 2010-2013. Brain Inj 2019; 33:1425-1429. [PMID: 31355679 DOI: 10.1080/02699052.2019.1631483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Traumatic brain injury (TBI) is prevalent in children and adolescents ages <1-19 years, yet we have limited understanding of consumer products that are associated with TBIs in children and adolescents of varying ages. To address this gap, we combined two data sources to investigate leading products and activities associated with TBIs in children and adolescents in different developmental age groups (i.e. <1, 1-4, 5-9, 10-14, and 15-19 years). Methods: We analysed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), augmented with product information from the National Electronic Injury Surveillance System (NEISS), for the years 2010 through 2013. Results: From 2010 to 2013, children and adolescents aged <1-19 years accounted for 4.1 million non-fatal TBI-related emergency department visits. TBIs from home furnishings and fixtures, primarily beds, were highest among infants aged <1 year and children aged 1-4 years. TBIs from sports/recreation, especially bicycles and football, were highest among those aged 5-9 years, 10-14 years, and 15-19 years. Conclusions: The combined NEISS and NEISS-AIP data allow us to comprehensively examine products and activities that contribute to emergency department visits for TBIs in children and adolescents. Our findings indicate priority areas for TBI prevention and intervention.
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Affiliation(s)
- Bina Ali
- a Pacific Institute for Research and Evaluation , Calverton , MD , USA
| | - Bruce A Lawrence
- a Pacific Institute for Research and Evaluation , Calverton , MD , USA
| | - Ted Miller
- a Pacific Institute for Research and Evaluation , Calverton , MD , USA
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Incidence and mortality of moderate and severe traumatic brain injury in children: A ten year population-based cohort study in Norway. Eur J Paediatr Neurol 2019; 23:500-506. [PMID: 30879962 DOI: 10.1016/j.ejpn.2019.01.009] [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] [Received: 09/03/2018] [Revised: 12/17/2018] [Accepted: 01/31/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In this study we wanted to estimate population-based rates of incidence and mortality of moderate and severe traumatic brain injury (TBI) in children in one specific region in Norway. METHODS In the region there are seven acute care hospitals (ACHs) in addition to a Level 1 trauma centre. Of 702 869 inhabitants (2014), 145 395 were children aged 0-16 years. Data were collected during ten years (2004-2014). All children aged 0-16 years with moderate (Glasgow Coma Scale [GCS] score 9-13) or severe (GCS score ≤ 8) TBI admitted to the Level 1 trauma centre were prospectively included. Children treated outside the Level 1 trauma centre were retrospectively included from the ACHs. Children who died from TBI prehospitally were included from the National Cause of Death Registry. Poisson regression was used to estimate incidence rate ratios (with a 95% confidence interval) comparing age, sex, and time periods. RESULTS A total of 71 children with moderate or severe TBI were identified. Crude incidence rates were 2·4 (95% CI 1·7-3·3) for moderate and 2·5 (95% CI 1·8-3·4) for severe TBI per 100 000 person-years (py). Mortality rate from TBI was 1·2 (95% CI 0·7-1·9) per 100 000 py, and 88% were prehospital deaths. CONCLUSION The incidence rates and mortality of moderate and severe TBI were low compared to international reports. Most likely explained by successful national prevention of TBI.
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Ferrazzano PA, Rosario BL, Wisniewski SR, Shafi NI, Siefkes HM, Miles DK, Alexander AL, Bell MJ. Use of magnetic resonance imaging in severe pediatric traumatic brain injury: assessment of current practice. J Neurosurg Pediatr 2019; 23:471-479. [PMID: 30738383 PMCID: PMC6687576 DOI: 10.3171/2018.10.peds18374] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE There is no consensus on the optimal timing and specific brain MRI sequences in the evaluation and management of severe pediatric traumatic brain injury (TBI), and information on current practices is lacking. The authors performed a survey of MRI practices among sites participating in a multicenter study of severe pediatric TBI to provide information for designing future clinical trials using MRI to assess brain injury after severe pediatric TBI. METHODS Information on current imaging practices and resources was collected from 27 institutions participating in the Approaches and Decisions after Pediatric TBI Trial. Multiple-choice questions addressed the percentage of patients with TBI who have MRI studies, timing of MRI, MRI sequences used to investigate TBI, as well as the magnetic field strength of MR scanners used at the participating institutions and use of standardized MRI protocols for imaging after severe pediatric TBI. RESULTS Overall, the reported use of MRI in pediatric patients with severe TBI at participating sites was high, with 40% of sites indicating that they obtain MRI studies in > 95% of this patient population. Differences were observed in the frequency of MRI use between US and international sites, with the US sites obtaining MRI in a higher proportion of their pediatric patients with severe TBI (94% of US vs 44% of international sites reported MRI in at least 70% of patients with severe TBI). The reported timing and composition of MRI studies was highly variable across sites. Sixty percent of sites reported typically obtaining an MRI study within the first 7 days postinjury, with the remainder of responses distributed throughout the first 30-day postinjury period. Responses indicated that MRI sequences sensitive for diffuse axonal injury and ischemia are frequently obtained in patients with TBI, whereas perfusion imaging and spectroscopy techniques are less common. CONCLUSIONS Results from this survey suggest that despite the lack of consensus or guidelines, MRI is commonly obtained during the acute clinical setting after severe pediatric TBI. The variation in MRI practices highlights the need for additional studies to determine the utility, optimal timing, and composition of clinical MRI studies after TBI. The information in this survey describes current clinical MRI practices in children with severe TBI and identifies important challenges and objectives that should be considered when designing future studies.
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Affiliation(s)
| | - Bedda L Rosario
- 4Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nadeem I Shafi
- 5Pediatrics, University of Tennessee, Memphis, Tennessee
| | | | - Darryl K Miles
- 7Pediatrics, University of Texas-Southwestern, Dallas, Texas; and
| | - Andrew L Alexander
- 2Medical Physics, and
- 3Psychiatry, University of Wisconsin, Madison, Wisconsin
| | - Michael J Bell
- 8Pediatrics, Children's National Medical Center, Washington, DC
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Cohen ML, Tulsky DS, Boulton AJ, Kisala PA, Bertisch H, Yeates KO, Zonfrillo MR, Durbin DR, Jaffe KM, Temkin N, Wang J, Rivara FP. Reliability and Construct Validity of the TBI-QOL Communication Short Form as a Parent-Proxy Report Instrument for Children With Traumatic Brain Injury. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:84-92. [PMID: 30950756 DOI: 10.1044/2018_jslhr-l-18-0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to evaluate the internal consistency and construct validity of the Traumatic Brain Injury Quality of Life Communication Item Bank (TBI-QOL COM) short form as a parent-proxy report measure. The TBI-QOL COM is a patient-reported outcome measure of functional communication originally developed as a self-report measure for adults with traumatic brain injury (TBI), but it may also be valid as a parent-proxy report measure for children who have sustained TBI. Method One hundred twenty-nine parent-proxy raters completed the TBI-QOL COM short form 6 months postinjury as a secondary aim of a multisite study of pediatric TBI outcomes. The respondents' children with TBI were between 8 and 18 years old ( M age = 13.2 years old) at the time of injury, and the proportion of TBI severity mirrored national trends (73% complicated-mild; 27% moderate or severe). Results The parent-proxy report version of the TBI-QOL COM displayed strong internal consistency (ordinal α = .93). It also displayed evidence of known-groups validity by virtue of more severe injuries associated with more abnormal scores. The instrument also showed evidence of convergent and discriminant validity by displaying a pattern of correlations with other constructs according to their conceptual relatedness to functional communication. Conclusions This preliminary psychometric investigation of the TBI-QOL COM supports the further development of a parent report version of the instrument. Future development of the TBI-QOL COM with this population may include expanding the content of the item bank and developing calibrations specifically for parent-proxy raters. Supplemental Material https://doi.org/10.23641/asha.7616534.
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Affiliation(s)
- Matthew L Cohen
- Department of Communication Sciences and Disorders, University of Delaware, Newark
- Center for Health Assessment Research and Translation, University of Delaware, Newark
- Department of Psychological and Brain Sciences, University of Delaware, Newark
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark
- Department of Physical Therapy, University of Delaware, Newark
- Department of Psychological and Brain Sciences, University of Delaware, Newark
| | - Aaron J Boulton
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark
| | - Hilary Bertisch
- Rusk Rehabilitation, New York University Langone Medical Center, New York
| | - Keith Owen Yeates
- Department of Psychology, Hotchkiss Brain Institute, and Alberta Children's Hospital Research Institute, University of Calgary, Canada
| | | | - Dennis R Durbin
- Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus
| | - Kenneth M Jaffe
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle
| | - Nancy Temkin
- Departments of Biostatistics and Neurological Surgery, University of Washington, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle
| | - Frederick P Rivara
- Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle
- Department of Pediatrics and Department of Epidemiology, University of Washington, Seattle
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Torres AR, Shaikh ZI, Chavez W, Maldonado JE. Brain MRI in Children with Mild Traumatic Brain Injury and Persistent Symptoms in Both Sports- and Non-sports-related Concussion. Cureus 2019; 11:e3937. [PMID: 30937235 PMCID: PMC6433090 DOI: 10.7759/cureus.3937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: To evaluate the utility of magnetic resonance imaging (MRI) in children with mild traumatic brain injury (mTBI), persistent post-concussive syndrome (PPCS), and normal neurologic examination. Materials and methods: This was a retrospective review of pediatric patients, who were evaluated in a Pediatric Concussion Clinic between August 2013 and November 2018, with documented persistent post-concussive symptoms, normal neurological examination, and available brain MRI. Results: In our analysis of 86 cases we found seven MRI studies with abnormal findings, but none were clinically significant. Conclusion: We conclude that MRI has a low diagnostic yield in this population, and based on these results we recommend that clinicians should avoid ordering MRI studies in this group. Further research is necessary to validate these results in larger and prospective studies.
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Affiliation(s)
- Alcy R Torres
- Pediatrics, Boston University School of Medicine, Boston, USA
| | - Zakir I Shaikh
- Pediatrics, Surat Municipal Institute of Medical Education and Research, Surat, IND
| | | | - John E Maldonado
- Pediatrics, Pontifical Catholic University of Ecuador, Quito, ECU
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Lundine JP, Utz M, Jacob V, Ciccia AH. Putting the person in person-centered care: Stakeholder experiences in pediatric traumatic brain injury. J Pediatr Rehabil Med 2019; 12:21-35. [PMID: 30883376 DOI: 10.3233/prm-180568] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This pilot study sought to describe the perspectives and experiences of survivors of pediatric traumatic brain injury (pTBI), their caregivers, and the medical professionals who serve them. METHODS Thirteen people participated in semi-structured interviews: five survivors of pTBI, their primary caregivers, and three medical professionals who work with persons who have sustained pTBI. The study involved a prospective, qualitative, participatory action research model with convenience sampling. All interviews were transcribed and thematic analysis identified central concepts within and between groups. Additionally, the Consolidated Criteria for Reporting Qualitative Research (COREG) were applied. RESULTS This study found that survivors of pTBI and their caregivers commonly noted later developing issues, social challenges, and difficulty in post-rehabilitation transitions. In addition, both caregivers and medical professionals reported the need for improved follow-up with survivors, evidence-based research, and medical and therapy providers with specific training on pTBI. CONCLUSIONS The perspectives provided by key stakeholders in this pilot study identify common themes that should be central to driving innovation in rehabilitation research and clinical care.
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Affiliation(s)
- Jennifer P Lundine
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA.,Division of Clinical Therapies and Inpatient Rehabilitation Program, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mackenzie Utz
- Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA
| | - Vanessa Jacob
- Department of Psychological Sciences, Program in Communication Disorders, Case Western Reserve University, Cleveland, OH, USA
| | - Angela Hein Ciccia
- Department of Psychological Sciences, Program in Communication Disorders, Case Western Reserve University, Cleveland, OH, USA
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Alhaddad AY, Cabibihan JJ, Bonarini A. Head Impact Severity Measures for Small Social Robots Thrown During Meltdown in Autism. Int J Soc Robot 2018. [DOI: 10.1007/s12369-018-0494-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Haarbauer-Krupa J, Lee AH, Bitsko RH, Zhang X, Kresnow-Sedacca MJ. Prevalence of Parent-Reported Traumatic Brain Injury in Children and Associated Health Conditions. JAMA Pediatr 2018; 172:1078-1086. [PMID: 30264150 PMCID: PMC6248161 DOI: 10.1001/jamapediatrics.2018.2740] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Traumatic brain injury (TBI) in children results in a high number of emergency department visits and risk for long-term adverse effects. OBJECTIVES To estimate lifetime prevalence of TBI in a nationally representative sample of US children and describe the association between TBI and other childhood health conditions. DESIGN, SETTING, AND PARTICIPANTS Data were analyzed from the 2011-2012 National Survey of Children's Health, a cross-sectional telephone survey of US households with a response rate of 23%. Traumatic brain injury prevalence estimates were stratified by sociodemographic characteristics. The likelihood of reporting specific health conditions was compared between children with and without TBI. Age-adjusted prevalence estimates were computed for each state. Associations between TBI prevalence, insurance type, and parent rating of insurance adequacy were examined. Data analysis was conducted from February 1, 2016, through November 1, 2017. MAIN OUTCOMES AND MEASURES Lifetime estimate of TBI in children, associated childhood health conditions, and parent report of health insurance type and adequacy. RESULTS The lifetime estimate of parent-reported TBI among children was 2.5% (95% CI, 2.3%-2.7%), representing over 1.8 million children nationally. Children with a lifetime history of TBI were more likely to have a variety of health conditions compared with those without a TBI history. Those with the highest prevalence included learning disorders (21.4%; 95% CI, 18.1%-25.2%); attention-deficit/hyperactivity disorder (20.5%; 95% CI, 17.4%-24.0%); speech/language problems (18.6%; 95% CI, 15.8%-21.7%); developmental delay (15.3%; 95% CI, 12.9%-18.1%); bone, joint, or muscle problems (14.2%; 95% CI, 11.6%-17.2%); and anxiety problems (13.2%; 95% CI, 11.0%-16.0%). States with a higher prevalence of childhood TBI were more likely to have a higher proportion of children with private health insurance and higher parent report of adequate insurance. Examples of states with higher prevalence of TBI and higher proportion of private insurance included Maine, Vermont, Pennsylvania, Washington, Montana, Wyoming North Dakota, South Dakota, and Colorado. CONCLUSIONS AND RELEVANCE A large number of US children have experienced a TBI during childhood. Higher TBI prevalence in states with greater levels of private insurance and insurance adequacy may suggest an underrecognition of TBI among children with less access to care. For more comprehensive monitoring, health care professionals should be aware of the increased risk of associated health conditions among children with TBI.
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Affiliation(s)
- Juliet Haarbauer-Krupa
- Division of Unintentional Injury, National Centers for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Rebecca H. Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xinjian Zhang
- Division of Analysis, Research and Practice Integration, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marcie-jo Kresnow-Sedacca
- Division of Analysis, Research and Practice Integration, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ciccia AH, Beekman L, Ditmars E. A clinically focused systematic review of social communication in pediatric TBI. NeuroRehabilitation 2018; 42:331-344. [DOI: 10.3233/nre-172384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Angela Hein Ciccia
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
| | - Leah Beekman
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
| | - Emily Ditmars
- Department of Psychological Sciences, Communication Sciences Program, Case Western Reserve University, Cleveland, OH, USA
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Todis B, McCart M, Glang A. Hospital to school transition following traumatic brain injury: A qualitative longitudinal study. NeuroRehabilitation 2018; 42:269-276. [DOI: 10.3233/nre-172383] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bonnie Todis
- University of Oregon, Center on Brain Injury Research and Training, Eugene, OR, USA
| | - Melissa McCart
- University of Oregon, Center on Brain Injury Research and Training, Eugene, OR, USA
| | - Ann Glang
- University of Oregon, Center on Brain Injury Research and Training, Eugene, OR, USA
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Long-Term School Outcomes of Children and Adolescents With Traumatic Brain Injury. J Head Trauma Rehabil 2018; 32:E24-E32. [PMID: 26828713 DOI: 10.1097/htr.0000000000000218] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To better understand the impact of age at injury, severity of injury, and time since injury on long-term school outcomes of children with traumatic brain injury (TBI). PARTICIPANTS Four groups of children: complicated mild/moderate TBI (n = 23), severe TBI (n = 56), orthopedic injury (n = 35), and healthy controls (n = 42). Children with TBI were either 2 years postinjury or 6 years postinjury. DESIGN Cross-sectional design. MEASURES School records as well as parental ratings of functional academic skills and school competency. RESULTS Children with severe TBI had consistently high usage of school services and low school competency ratings than children with orthopedic injuries and healthy controls. In contrast, children with complicated-mild/moderate TBI were significantly more likely to receive school support services and have lower competence ratings at 6 years than at 2 years postinjury. Students injured at younger ages had lower functional academic skill ratings than those injured at older ages. CONCLUSIONS These findings highlight the increasing academic challenges faced over time by students with complicated-mild/moderate TBI and the vulnerability of younger children to poorer development of functional academic skills.
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Glang A, Todis B, Ettel D, Wade SL, Yeates KO. Results from a randomized trial evaluating a hospital-school transition support model for students hospitalized with traumatic brain injury. Brain Inj 2018; 32:608-616. [PMID: 29388885 DOI: 10.1080/02699052.2018.1433329] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the utility of the STEP model, a systematic hospital-school transition protocol for children hospitalized for TBI. SETTING Five children's hospitals in Colorado, Ohio, and Oregon. PARTICIPANTS Hundred families of children with mild, complicated mild, moderate, or severe TBI. DESIGN Randomized controlled trial (RCT); participants were randomized while hospitalized to the STEP (a standardized hospital-school transition protocol for children treated for TBI) or usual care condition. MAIN MEASURES Questionnaire about child's special education eligibility status, support services, and academic accommodations; Achenbach Child Behaviour Checklist (CBCL); Behaviour Rating Inventory of Executive Function (BRIEF); Child and Adolescent Scale of Participation (CASP); Child and Adolescent Scales of Environment (CASE) Results: There were no significant effects, indicating that STEP participants did not differ from usual care participants on any study outcome at one month post-discharge or at one-year follow-up. CONCLUSION The lack of significant findings in this study does not imply that effective hospital-to-school transition programming is unnecessary. Rather, the findings raise important questions regarding timing and dosage/intensity of intervention, appropriate measurement of outcomes, and fidelity of programme delivery. The study highlights difficulties involved in the conduct of community-based RCTs in the paediatric TBI population.
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Affiliation(s)
- Ann Glang
- a Center on Brain Injury Research and Training, University of Oregon , Eugene , OR , USA
| | - Bonnie Todis
- a Center on Brain Injury Research and Training, University of Oregon , Eugene , OR , USA
| | - Debbie Ettel
- b Springfield School District , Springfield , OR , USA
| | - Shari L Wade
- c Division of Physical Medicine and Rehabilitation , Cincinnati Children's Hospital , Cincinnati , OH , USA
| | - Keith Owen Yeates
- d Department of Psychology , University of Calgary , Calgary , AB , Canada
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Crowe LM, Hearps S, Anderson V, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Oakley E, Dalziel SR, Babl FE. Investigating the Variability in Mild Traumatic Brain Injury Definitions: A Prospective Cohort Study. Arch Phys Med Rehabil 2018; 99:1360-1369. [PMID: 29407521 DOI: 10.1016/j.apmr.2017.12.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To prospectively compare the proportion of traumatic brain injuries (TBIs) that would be classified as mild by applying different published definitions of mild TBI to a large prospectively collected dataset, and to examine the variability in the proportions included by various definitions. DESIGN Prospective observational study. SETTING Hospital emergency departments. PARTICIPANTS Children (N=11,907) aged 3 to 16 years (mean age, 8.2±3.9y). Of the participants, 3868 (32.5%) were girls, and 7374 (61.9%) of the TBIs were the result of a fall. Median Glasgow Coma Scale score was 15. MAIN OUTCOME MEASURES We applied 17 different definitions of mild TBI, identified through a published systematic review, to children aged 3 to 16 years. Adjustments and clarifications were made to some definitions. The number and percentage identified for each definition is presented. RESULTS Adjustments had to be made to the 17 definitions to apply to the dataset: none in 7, minor to substantial in 10. The percentage classified as mild TBI across definitions varied from 7.1% (n=841) to 98.7% (n=11,756) and varied by age group. CONCLUSIONS When applying the 17 definitions of mild TBI to a large prospective multicenter dataset of TBI, there was wide variability in the number of cases classified. Clinicians and researchers need to be aware of this variability when examining literature concerning children with mild TBI.
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Affiliation(s)
- Louise M Crowe
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Melbourne School of Psychological Science, University of Melbourne, Melbourne, VIC, Australia; Psychology Department, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Melbourne School of Psychological Science, University of Melbourne, Melbourne, VIC, Australia; Psychology Department, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Meredith L Borland
- Emergency Department, Princess Margaret Hospital for Children, Perth, WA, Australia; Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Natalie Phillips
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Amit Kochar
- Emergency Department, Women's & Children's Hospital, Adelaide, SA, Australia
| | - Sarah Dalton
- Emergency Department, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - John A Cheek
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Emergency Department, Royal Children's Hospital, Melbourne, VIC, Australia; Monash Medical Centre, Melbourne, VIC, Australia
| | - Yuri Gilhotra
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Jeremy Furyk
- Emergency Department, The Townsville Hospital, Townsville, QLD, Australia
| | - Jocelyn Neutze
- Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Mark D Lyttle
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Bristol Royal Hospital for Children, Bristol, United Kingdom; Academic Department of Emergency Care, University of the West of England, Bristol, United Kingdom
| | - Silvia Bressan
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Susan Donath
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Charlotte Molesworth
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Ed Oakley
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Emergency Department, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Stuart R Dalziel
- Starship Children's Health, Auckland, New Zealand; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Franz E Babl
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Emergency Department, Royal Children's Hospital, Melbourne, VIC, Australia
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El-Menyar A, Consunji R, Al-Thani H, Mekkodathil A, Jabbour G, Alyafei KA. Pediatric Traumatic Brain Injury: a 5-year descriptive study from the National Trauma Center in Qatar. World J Emerg Surg 2017; 12:48. [PMID: 29151847 PMCID: PMC5678808 DOI: 10.1186/s13017-017-0159-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 10/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background The epidemiologic characteristics and outcomes of pediatric traumatic brain injury (pTBI) have not been adequately documented from the rapidly developing countries in the Arab Middle East. We aimed to describe the hospital-based epidemiologic characteristics, injury mechanisms, clinical presentation, and outcomes of pTBI and analyze key characteristics and determinant of pTBI that could help to make recommendations for policies to improve their care. Methods We conducted a retrospective observational study in a level 1 trauma center (2010-2014) for all pTBI patients. Data were analyzed and compared according to different patient age groups. Results Out of 945 traumatic brain injury patients, 167 (17.7%) were ≤ 18 years old with a mean age of 10.6 ± 5.9 and 81% were males. The rate of pTBI varied from 5 to 14 cases per 100,000 children per year. The most affected group was teenagers (15-18 years; 40%) followed by infants/toddlers (≤ 4 years; 23%). Motor vehicle crash (MVC; 47.3%) was the most frequent mechanism of injury followed by falls (21.6%). MVC accounted for a high proportion of pTBI among teenagers (77.3%) and adolescents (10-14 years; 48.3%). Fall was a common cause of pTBI for infants/toddlers (51.3%) and 5-9 years old group (30.3%). The proportion of brain contusion was significantly higher in adolescents (61.5%) and teenagers (58.6%). Teenagers had higher mean Injury Severity Scoring of 24.2 ± 9.8 and lower median (range) Glasgow Coma Scale of 3 (3-15) (P = 0.001 for all). The median ventilatory days and intensive care unit and hospital length of stay were significantly prolonged in the teenage group. Also, pTBI in teenage group showed higher association with pneumonia (46.4%) and sepsis (17.3%) than other age groups (P = 0.01). The overall mortality rate was 13% (n = 22); 11 died within the first 24 h, 7 died between the second and seventh day and 4 died one week post-admission. Among MVC victims, a decreasing trend of case fatality rate (CFR) was observed with age; teenagers had the highest CFR (85.7) followed by adolescents (75.0), young children (33.3), and infants/toddlers (12.5). Conclusions This local experience to describe the burden of pTBI could be a basis to adopt and form an efficient, tailored strategy for safety in the pediatric population.
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Affiliation(s)
- Ayman El-Menyar
- Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.,Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Rafael Consunji
- Hamad Injury Prevention Program, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | | | | | - Gaby Jabbour
- Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Khalid A Alyafei
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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Jenness JL, Witt CE, Quistberg DA, Johnston BD, Rowhani-Rahbar A, Mackelprang JL, McLaughlin KA, Vavilala MS, Rivara FP. Association of physical injury and mental health: Results from the national comorbidity survey- adolescent supplement. J Psychiatr Res 2017; 92:101-107. [PMID: 28414929 PMCID: PMC5689078 DOI: 10.1016/j.jpsychires.2017.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/28/2017] [Accepted: 03/31/2017] [Indexed: 10/19/2022]
Abstract
Nonfatal injury is common among adolescents in the U.S., but little is known about the bi-directional associations between injury and mental health. Utilizing a nationally representative sample of U.S. adolescents, we examined 1) associations between lifetime mental health history and subsequent injury; 2) concurrent associations between injury and mental health; and 3) associations between injury and subsequent mental disorders. Data were drawn from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), a national survey of adolescents aged 13 through 17 years (N = 10,123). Twelve-month prevalence of nonfatal injury requiring medical attention was assessed along with lifetime, 12-month, and 30-day prevalence of DSM-IV depressive, anxiety, behavior, substance use, and bipolar disorders. We used Poisson regression to examine associations between 1) lifetime history of mental disorders and 12-month exposure to injury; 2) concurrent associations between 12-month exposure to injury and 12-month prevalence of mental disorders; and 3) 12-month exposure to injury and 30-day prevalence of mental disorders. A total of 11.6% of adolescents experienced an injury requiring medical attention in the year before the survey. Lifetime history of mental disorders was not associated with past-year injury. Behavior and bipolar disorders were concurrently associated with past-year injury. Past-year injury occurrence predicted increased risk for past-month anxiety disorders and decreased risk of past-month depressive disorders. Our findings reveal reciprocal associations between injury and mental disorders and highlight the need for systematic assessment, prevention, and treatment of mental disorders among injured youth.
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Affiliation(s)
- Jessica L. Jenness
- Department of Pediatrics, Harborview Injury Prevention and Research Center, University of Washington
| | - Cordelie E. Witt
- Department of Surgery, Harborview Injury Prevention and Research Center, University of Washington
| | - D. Alex Quistberg
- Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, University of Washington
| | - Brian D. Johnston
- Department of Pediatrics, Harborview Injury Prevention and Research Center, University of Washington
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, Harborview Injury Prevention and Research Center, University of Washington
| | | | | | - Monica S. Vavilala
- Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, University of Washington
| | - Frederick P. Rivara
- Department of Pediatrics, Harborview Injury Prevention and Research Center, University of Washington
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