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Anderson M, Reynolds E, Gilliland T, Hammonds K, Driver S. The Association Among Clinical Profiles, Modifiers, and Prolonged Recovery in Adolescents With Sport-Related Concussion. Clin J Sport Med 2024; 34:266-272. [PMID: 37937954 DOI: 10.1097/jsm.0000000000001197] [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] [Received: 06/30/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE The purposes were to (1) describe the prevalence of clinical profiles and modifiers, (2) examine the association between clinical profiles and prolonged recovery, and (3) examine the interaction between clinical profiles and modifiers and prolonged recovery in adolescents with sport-related concussion (SRC). DESIGN Retrospective, cross-sectional. SETTING Interdisciplinary specialty sports concussion clinic. PATIENTS Patients (n = 299) aged 12 to 19 years who were diagnosed with SRC within 30 days of injury. INDEPENDENT VARIABLES Clinical profiles and modifiers were decided by the clinical judgment of the clinical neuropsychologist and sports medicine physician, using data from the Clinical Profile Screen and information gathered from the clinical interview, neurocognitive, and vestibular and ocular motor testing. MAIN OUTCOME MEASURES Prolonged recovery was defined as ≥28 days from the date of injury to the date of clearance. RESULTS The most common clinical profiles were migraine (34.8%) and cognitive-fatigue (23.4%). There were no significant relationships between clinical profiles and prolonged recovery (Wald = 5.89, df = 4, P = 0.21). The presence of a modifier did not significantly affect the relationship between clinical profiles and prolonged recovery ( = 6.5, df = 5, P = 0.26). The presence of any modifier yielded a 10-day increase in median recovery time within the cognitive/fatigue clinical profile (Wilcoxon rank-sum = 268.5, P = 0.01). CONCLUSIONS Although patients with a clinical profile and modifier may not experience prolonged recovery, they may experience longer recovery time than patients with a clinical profile and no modifier.
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Affiliation(s)
- Morgan Anderson
- Baylor Scott & White Sports Therapy and Research, Frisco, Texas
- Baylor Scott & White Research Institute, Dallas, Texas
| | - Erin Reynolds
- Baylor Scott & White Sports Concussion Program, Frisco, Texas; and
| | - Taylor Gilliland
- Baylor Scott & White Sports Therapy and Research, Frisco, Texas
- Baylor Scott & White Research Institute, Dallas, Texas
| | | | - Simon Driver
- Baylor Scott & White Sports Therapy and Research, Frisco, Texas
- Baylor Scott & White Research Institute, Dallas, Texas
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Mathew AS, Caze T, Price AM, Vasquez D, Abt JP, Burkhart SO. Association between days for concussion recovery and initial specialty clinic evaluation within 48 hours. BMC Sports Sci Med Rehabil 2024; 16:75. [PMID: 38566116 PMCID: PMC10986090 DOI: 10.1186/s13102-024-00866-w] [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: 11/15/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Researchers have highlighted the importance of early access to concussion care within one week of injury in reducing recovery times. However, a persisting question for concussion researchers is "just how early is important?" The purpose of this study was to examine differences in recovery time as predicted by the number of days elapsed since injury (DSI) to initial evaluation among patients who had access to a specialty concussion clinic within seven days. We hypothesized that DSI group membership, even within seven days, would significantly predict risk of protracted recovery (i.e., beyond 21 days). METHODS In this archival study, retrospective data were gathered from electronic medical records between September 2020 to March 2022. Records of participants between ages 12-18, those diagnosed with a sports-related concussion based on initial clinic visit diagnosis by a medical provider and those who established care within seven days of injury at a large pediatric specialty concussion clinic were examined. Participants were divided into three DSI groups (patients seen in < 48 h: "acute", patients seen between 49 h < and < 96 h: "sub-acute", and patients seen between 97 < and < 168 h: "post-acute"). A general linear model was constructed to examine relationships between relevant concussion factors (e.g., Post Concussion Scale Score, neurodevelopmental history, psychiatric history, concussion history, migraine history, overall VOMS change score, cognitive testing, sex, age, race, and ethnicity) that were either significant in the preliminary analysis or in clinical judgement and recovery time. Adjusted odds ratios (OR) were derived from a binary logistic regression model, in which recovery time was normal (≤ 21 recovery days) or protracted (> 21 recovery days). RESULTS A total of 856 participants were eligible. Adolescents in the acute group (M = 15.12, SD = 8.04) had shorter recovery times in days compared to those in the sub-acute (M = 17.98, SD = 10.18) and post-acute (M = 21.12, SD = 10.12; F = 26.00, p < .001) groups. Further, participants in the acute (OR = 4.16) and sub-acute (OR = 1.37) groups who accessed specialty concussion clinics within 48 h were 4 times more likely to have a normal recovery and recovered approximately 6 days faster than the post-acute care group. CONCLUSIONS Earlier concussion care access predicted recovery times and was associated with lower risk for protracted recovery.
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Affiliation(s)
- Abel S Mathew
- Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, TX, USA.
- Present Address: Children's Health Andrews Institute for Orthopaedics and Sports Medicine, 7211 Preston Rd., Plano, TX, 75024, USA.
| | - Todd Caze
- Caze Concussion Institute, Omaha, NE, USA
| | - August M Price
- Bellapianta Orthopaedics and Sports Medicine, Montclair, NJ, USA
| | - Desi Vasquez
- Texas A&M International University, Laredo, TX, USA
| | - John P Abt
- Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, TX, USA
| | - Scott O Burkhart
- Children's Health Andrews Institute for Orthopedics and Sports Medicine, Plano, TX, USA
- University of Texas Southwestern-Psychiatry, Dallas, TX, USA
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Oyekan AA, Eagle S, Trbovich AM, Shaw JD, Schneider M, Collins M, Lee JY, Kontos AP. Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion. J Head Trauma Rehabil 2023; 38:417-424. [PMID: 36854136 PMCID: PMC10619635 DOI: 10.1097/htr.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To examine the frequency and association of neck pain symptoms in patients with a concussion. STUDY SETTING AND PARTICIPANTS Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021. DESIGN Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes. RESULTS Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms. CONCLUSION Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.
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Affiliation(s)
- Anthony A Oyekan
- Departments of Orthopaedic Surgery (Drs Oyekan, Trbovich, Shaw, Collins, Lee, and Kontos) and Physical Therapy (Dr Schneider), University of Pittsburgh, Pittsburgh, Pennsylvania; Pittsburgh Ortho Spine Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Oyekan, Shaw, and Lee); Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Eagle); and UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania (Drs Trbovich, Collins, and Kontos)
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Covassin T, Zynda AJ, Loftin MC, Pollard-McGrandy AM, Tracey AJ, Tomczyk CP. Changes in State and Trait Anxiety Throughout Concussion Recovery in High School- and College-Aged Individuals. J Athl Train 2023; 58:775-780. [PMID: 36972199 PMCID: PMC11215742 DOI: 10.4085/1062-6050-0536.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
CONTEXT Researchers have indicated that individuals may experience anxiety symptoms after concussion. A potential mechanism for these presentations is shifts in anxiety throughout recovery. OBJECTIVE To examine the levels of state and trait anxiety in individuals after concussion throughout recovery compared with the levels in individuals serving as uninjured matched control participants. DESIGN Prospective cohort study. SETTING University laboratory. PATIENTS OR OTHER PARTICIPANTS Seventy-eight high school- and college-aged individuals (concussion group = 39, age = 18.4 ± 2.3 years; matched control group = 39, age = 18.4 ± 2.3 years) were enrolled. MAIN OUTCOME MEASURE(S) The State-Trait Anxiety Inventory was administered within 72 hours of injury (day 0: first test session), 5 days (±1 day) after the first test session (day 5), and at the time of full medical clearance (+2 days). Separate 2 × 3 repeated-measures analyses of variance were used to investigate differences in state and trait anxiety for each group throughout recovery. RESULTS State and trait anxiety were higher in the concussion group than in the control group at day 0, day 5, and full medical clearance. For state anxiety, we observed a group × time interaction (F2,150 = 10.45, P < .001, ƞp2 = 0.12). For trait anxiety, we did not note an interaction (F1.74,150 = 1.5, P = .22, ƞp2 = 0.02) but did find main effects for time (F1.74,150 = 25.7, P < .001, ƞp2 = 0.3) and group (F1,75 = 7.23, P = .01, ƞp2 = 0.09). CONCLUSIONS Participants with concussion experienced higher levels of state anxiety throughout recovery than matched control individuals. Although trait anxiety was higher in the concussion group and decreased over time, no interaction was seen, demonstrating that concussion may not affect this aspect of personality. Postinjury anxiety may result from increased state anxiety, and clinicians should screen for and manage these symptoms throughout recovery.
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Affiliation(s)
- Tracey Covassin
- Department of Kinesiology, Michigan State University, East Lansing
| | - Aaron J. Zynda
- Department of Kinesiology, Michigan State University, East Lansing
| | - Megan C. Loftin
- Department of Kinesiology, Michigan State University, East Lansing
| | | | - Allie J. Tracey
- Department of Kinesiology, Michigan State University, East Lansing
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D'Alonzo BA, Wiebe DJ, Master CL, Castellana MC, Willer BS, Leddy JJ. Relationship between anxiety and concussion symptoms among adolescents enrolled in a randomized controlled trial of aerobic exercise. NeuroRehabilitation 2023; 53:187-198. [PMID: 37638452 DOI: 10.3233/nre-220221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Affective symptoms, specifically, anxiety, are often overlooked after sport-related concussion (SRC), and may contribute to prolonged recovery. OBJECTIVE To examine the impact of anxiety during clinical recovery among adolescents (13-18y) enrolled in a randomized trial of aerobic exercise for SRC. METHODS Patients at three sites were randomized into aerobic exercise or stretching arms, and enrolled in the 4-week intervention. The relationship between PROMIS Anxiety score at initial visit and time to symptom resolution was evaluated with survival analysis. The relationship between weekly PROMIS Anxiety score and Post-concussion Symptom Inventory (PCSI) score was evaluated with Linear Mixed Models. Analyses adjusted for study arm and baseline covariates. RESULTS Among 54 adolescents (median age = 15.8y, initial visit PCSI score = 32, pre-injury PROMIS Anxiety score = 2), median time to symptom resolution was 10 days (25th-75th percentiles: 6-24) in the Low-PROMIS Anxiety group and 12 days (25th-75th percentiles: 5-21) in the High-PROMIS Anxiety group (p = 0.62). Each additional unit of PROMIS Anxiety score corresponded to a 1.52-unit higher PCSI total score (p < 0.01). Neither effect varied by aerobic exercise/stretching group. CONCLUSION Higher initial PROMIS Anxiety score was not significantly associated with delayed symptom resolution. However, over time, PROMIS Anxiety score was significantly associated with elevated PCSI score, regardless of exercise/stretching group.
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Affiliation(s)
- Bernadette A D'Alonzo
- Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas J Wiebe
- Department of Biostatistics Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina L Master
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew C Castellana
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
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Mooney J, Pate J, Cummins I, McLeod MC, Gould S. Effects of prior concussion on symptom severity and recovery time in acute youth concussion. J Neurosurg Pediatr 2022; 30:263-271. [PMID: 35901756 DOI: 10.3171/2022.5.peds2248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many studies have identified factors associated with increased symptom burden and prolonged recovery after pediatric and adolescent concussion. Few have systematically examined the effects of prior concussion on these outcomes in patients with concussion due to any mechanism. An improved understanding of the short- and long-term effects of a multiple concussion history will improve counseling and management of this subgroup of patients. METHODS A retrospective review of adolescent and young adult acute concussion patients presenting to the multidisciplinary concussion clinic between 2018 and 2019 was conducted at a single center. Patient demographic data, medical history including prior concussion, initial symptom severity score (SSS), injury mechanisms, and recovery times were collected. Univariate and multivariable analyses were conducted to identify associations of history of prior concussion and patient and injury characteristics with symptom score and recovery time. RESULTS A total of 266 patients with an average age of 15.4 years (age range 13-27 years) were included. Prior concussion was reported in 35% of patients. The number of prior concussions per patient was not significantly associated with presenting symptom severity, recovery time, or recovery within 28 days. Male sex and sports-related concussion (SRC) were associated with lower presenting SSS and shorter recovery time on univariate but not multivariable analysis. However, compared to non-sport concussion mechanisms, SRC was associated with 2.3 times higher odds of recovery within 28 days (p = 0.04). A history of psychiatric disorders was associated with higher SSS in univariate analysis and longer recovery time in univariate and multivariable analyses. Multivariable log-linear regression also demonstrated 5 times lower odds of recovery within 28 days for those with a psychiatric history. CONCLUSIONS The results of this study demonstrated that an increasing number of prior concussions was associated with a trend toward higher presenting SSS after youth acute concussion but did not show a significant association with recovery time or delayed (> 28 days) recovery. Presence of psychiatric history was found to be significantly associated with longer recovery and lower odds of early (≤ 28 days) recovery. Future prospective, long-term, and systematic study is necessary to determine the optimal counseling and management of adolescent and young adult patients with a history of multiple concussions.
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Affiliation(s)
| | | | | | | | - Sara Gould
- 4Department of Orthopedic Surgery, University of Alabama at Birmingham, Alabama
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7
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D'Alonzo BA, Bretzin AC, Wiebe DJ. The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion. Am J Sports Med 2022; 50:2258-2270. [PMID: 35647797 PMCID: PMC10898515 DOI: 10.1177/03635465221098112] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is growing awareness and clinical interest in athletes with affective symptoms after sport-related concussion (SRC), as these symptoms may contribute to overall symptoms and represent a modifiable risk factor of longer recovery. However, evidence of their effects on the entire return-to-play (RTP) trajectory, particularly among women and men, is limited. PURPOSE/HYPOTHESIS To examine the relationship between affective symptom reporting and RTP progression after SRC among a cohort of Division 1 student-athletes. We hypothesized that those endorsing affective symptoms, specifically nervous-anxious symptoms, spend more time in RTP progression and recovery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Using SRC data from the Ivy League-Big Ten Epidemiology of Concussion Study among varsity athletes through February 2020, we identified the 4 affective symptoms from the Sport Concussion Assessment Tool symptom inventory. We modeled the relationship between a 4-category affective symptom variable and time to symptom resolution, RTP, and RTP progression, adjusting for nonaffective symptom prevalence and concussion history. Cox regressions were used to estimate hazard ratios for time to event outcomes, and linear regressions were used to evaluate mean differences for continuous outcomes. RESULTS Among 2077 student-athletes (men, 63.5%) with SRC symptoms, affective symptom prevalence was 47.6% and 44.3% in women and men, respectively, and nervous-anxious prevalence was 24.2% and 22.5%, respectively. When comparing women with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with affective symptoms, and women with nervous-anxious symptoms spent significantly longer in RTP progression. When comparing men with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with co-occurring affective symptoms, and affective symptoms were not associated with time in RTP progression. CONCLUSION Student-athletes with affective symptoms and nervous-anxious symptoms exhibited delayed clinical recovery and RTP timelines, particularly for time in RTP. Symptom prevalence and concussion history contributed to this; however, unmeasured confounding remains, as indicated by the poor model fit. This study motivates future work to explore affective symptoms and RTP timelines, considering anxiety and risk/protective factors over time.
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Affiliation(s)
- Bernadette A D'Alonzo
- Investigation performed at the Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abigail C Bretzin
- Investigation performed at the Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas J Wiebe
- Investigation performed at the Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Worts PR, Haider MN, Mason JR, Schatz P. Norm-Based Cutoffs as Predictors of Prolonged Recovery After Adolescent Sport-Related Concussion. Clin J Sport Med 2022; 32:e391-e399. [PMID: 34173784 DOI: 10.1097/jsm.0000000000000952] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To identify predictors of prolonged recovery (ie, >28 days) using patient demographic factors and healthy, norm-based cutoffs on a multimodal test battery in adolescents after sport-related concussions (SRCs). DESIGN Retrospective cohort. Patients were deemed recovered after successful completion of return-to-play/school protocols and received medical clearance. SETTING Community concussion clinic. PATIENTS Male and female adolescent student athletes diagnosed with a SRC and evaluated within 1 week of injury. INDEPENDENT VARIABLES Patient demographics, medical history, injury description, computerized neurocognitive testing, vestibular/ocular testing, and symptoms at initial clinical visit. MAIN OUTCOME MEASURES Performance on clinical testing to predict recovery duration, classified as normal (<28 days) or prolonged (>28 days). RESULTS A total of 201 adolescent student athletes (age = 15.3 ± 1.4 years) were included (female 35%). Average recovery duration for the entire cohort was 22.3 ± 13.3 days, with 22% (n = 45) of adolescent student athletes taking >28 days to recover. The final model was 88.3% accurate in classifying normal and prolonged recovery. Predictor variables included sex, loss of consciousness, history of ocular disorder, history of concussion, performance on visual motor speed composite, visual motion sensitivity symptom provocation and near point of convergence distance, number-naming total time, and symptom count. CONCLUSIONS These findings suggest that using norm-based cutoffs from cognitive, oculomotor, and vestibulo-ocular testing and symptom reporting, clinicians can accurately predict a prolonged recovery (sensitivity = 81%) and normal recovery (specificity = 83%) in an adolescent, SRC cohort.
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Affiliation(s)
- Phillip R Worts
- Tallahassee Orthopedic Clinic, Tallahassee, Florida.,Department of Nutrition, Food, and Exercise Sciences, the Florida State University, Tallahassee, Florida.,Florida State University Institute of Sports Sciences and Medicine, Tallahassee, Florida
| | - Mohammad N Haider
- UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York
| | - Justin R Mason
- Department of Occupational Therapy, University of Florida, Gainesville, Florida; and
| | - Philip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania
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Sheldrake E, Al-Hakeem H, Lam B, Goldstein BI, Wheeler AL, Burke M, Dunkley BT, Reed N, Scratch SE. Mental Health Outcomes Across the Lifespan in Individuals With Persistent Post-Concussion Symptoms: A Scoping Review. Front Neurol 2022; 13:850590. [PMID: 35481264 PMCID: PMC9035995 DOI: 10.3389/fneur.2022.850590] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective:Concussion is a common yet heterogenous injury. Approximately 15–30% of cases present with persistent post-concussion symptoms (PPCS), continuing 4 weeks or more post-injury in children, youth, and adolescents, and 3 months or more in adults. There are known bidirectional links between PPCS and mental health outcomes. The focus of this scoping review is to explore the literature on mental health outcomes in individuals experiencing PPCS. Research objectives were to explore: (1) the mental health outcomes of individuals with PPCS and types of assessments used to identify mental health outcomes this group, and (2) how mental health outcomes compare in terms of similarities and differences among pediatric and adult populations with PPCS.MethodOvid MEDLINE; EMBASE; CINAHL, and PsycInfo databases were searched. After title and abstract screening of 11,920 studies, 481 articles were reviewed. Twenty-five papers met inclusion criteria. Results were organized by mental health outcomes of pediatric and adult populations, separately.ResultsThere was a significantly higher number of studies devoted to adult populations. Of the 25 studies, 19 (76%) focused on adults, while six (24%) focused on adolescents. In adult populations, studies focused on symptoms of: anxiety (n = 2), depression (n = 8), and anxiety and depression (n = 9). Two studies assessed other emotional outcomes (10.5%). Within pediatric populations, an equal number of studies explored symptoms of: anxiety (n = 2), depression (n = 2), and anxiety and depression (n = 2). No studies focused on other emotional outcomes. Studies ranged greatly in methods, design, and control group. Most studies reported higher psychiatric symptoms of anxiety and/or depression in those with PPCS compared to individuals with recovered concussion or healthy controls.DiscussionThis review contributes to the understanding of mental health outcomes in those experiencing PPCS. Mental health and PPCS requires greater attention in pediatric populations, and consider strategies for those experiencing PPCS and mental health impacts. Future studies should consider including a wider range of emotional outcomes in their design, not limited to anxiety and depression. Study results may lead to improvements and research in the identification, assessment, and management of PPCS and mental health.
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Affiliation(s)
- Elena Sheldrake
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- *Correspondence: Elena Sheldrake
| | - Hiba Al-Hakeem
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Brendan Lam
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Benjamin I. Goldstein
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Anne L. Wheeler
- Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - Matthew Burke
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Benjamin T. Dunkley
- Neuroscience and Mental Health Program, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Nick Reed
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Shannon E. Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
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Patterson Gentile C, Aguirre GK, Arbogast KB, Master CL. Relationship between Visually Evoked Effects and Concussion in Youth. J Neurotrauma 2022; 39:841-849. [PMID: 35166126 PMCID: PMC9225424 DOI: 10.1089/neu.2021.0475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Increased sensitivity to light is common after concussion. Viewing a flickering light can also produce uncomfortable somatic sensations like nausea or headache. We examined effects evoked by viewing a patterned, flickering screen in a cohort of 81 uninjured youth athletes and 84 concussed youth. We used Multiple correspondence analysis and identified two primary dimensions of variation: the presence or absence of visually evoked effects and variation in the tendency to manifest effects that localized to the eyes (e.g., eye watering) versus more generalized neurological effects (e.g., headache). Based on these two primary dimensions, we grouped participants into three categories of evoked symptomatology: no effects, eye-predominant effects, and brain-predominant effects. A similar proportion of participants reported eye-predominant effects in the uninjured (33.3%) and concussed (32.1%) groups. By contrast, participants who experienced brain-predominant effects were almost entirely from the concussed group (1.2% of uninjured, 35.7% of concussed). The presence of brain-predominant effects was associated with a higher concussion symptom burden and reduced performance on visio-vestibular tasks. Our findings indicate that the experience of negative constitutional, somatic sensations in response to a dynamic visual stimulus is a salient marker of concussion and is indicative of more severe concussion symptomatology. We speculate that differences in visually evoked effects reflect varying levels of activation of the trigeminal nociceptive system.
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Affiliation(s)
- Carlyn Patterson Gentile
- Department of Pediatrics, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Injury Research and Prevention, Children”s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Geoffrey K. Aguirre
- Department of Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristy B. Arbogast
- Department of Pediatrics, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Injury Research and Prevention, Children”s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christina L. Master
- Department of Pediatrics, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Injury Research and Prevention, Children”s Hospital of Philadelphia, Philadelphia, Pennsylvania
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11
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Babl FE, Rausa VC, Borland ML, Kochar A, Lyttle MD, Phillips N, Gilhotra Y, Dalton S, Cheek JA, Furyk J, Neutze J, Bressan S, Davis GA, Anderson V, Williams A, Oakley E, Dalziel SR, Crowe LM, Hearps SJC. Characteristics of concussion based on patient age and sex: a multicenter prospective observational study. J Neurosurg Pediatr 2021:1-10. [PMID: 34598158 DOI: 10.3171/2021.6.peds20953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Children with concussion frequently present to emergency departments (EDs). There is limited understanding of the differences in signs, symptoms, and epidemiology of concussion based on patient age. Here, the authors set out to assess the association between age and acute concussion presentations. METHODS The authors conducted a multicenter prospective observational study of head injuries at 10 EDs in Australia and New Zealand. They identified children aged 5 to < 18 years, presenting with a Glasgow Coma Scale score of 13-15, presenting < 24 hours postinjury, with no abnormalities on CT if performed, and one or more signs or symptoms of concussion. They extracted demographic, injury-related, and signs and symptoms information and stratified it by age group (5-8, 9-12, 13 to < 18 years). RESULTS Of 8857 children aged 5 to < 18 years, 4709 patients met the defined concussion criteria (5-8 years, n = 1546; 9-12 years, n = 1617; 13 to < 18 years, n = 1546). The mean age of the cohort was 10.9 years, and approximately 70% of the patients were male. Sport-related concussion accounted for 43.7% of concussions overall, increasing from 19.1% to 48.9% to 63.0% in the 5-8, 9-12, and 13 to < 18 years age groups. The most common acute symptoms postinjury were headache (64.6%), disorientation (36.2%), amnesia (30.0%), and vomiting (27.2%). Vomiting decreased with increasing age and was observed in 41.7% of the 5-8 years group, 24.7% of the 9-12 years group, and 15.4% of the 13 to < 18 years group, whereas reported loss of consciousness (LOC) increased with increasing age, occurring in 9.6% in the 5-8 years group, 21.0% in the 9-12 years group, 36.7% in the 13 to < 18 years group, and 22.4% in the entire study cohort. Headache, amnesia, and disorientation followed the latter trajectory. Symptom profiles were broadly similar between males and females. CONCLUSIONS Concussions presenting to EDs were more sports-related as age increased. Signs and symptoms differed markedly across age groups, with vomiting decreasing and headache, LOC, amnesia, and disorientation increasing with increasing age.
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Affiliation(s)
- Franz E Babl
- 1Emergency Department, Royal Children's Hospital, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Vanessa C Rausa
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
| | - Meredith L Borland
- 20Emergency Department, Perth Children's Hospital, Perth, Australia; and.,21School of Medicine, Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Australia
| | - Amit Kochar
- 7Emergency Department, Women's & Children's Hospital, Adelaide, Australia
| | - Mark D Lyttle
- 8Faculty of Health & Life Sciences, University of the West of England, Bristol, United Kingdom
| | - Natalie Phillips
- 9Emergency Department, Queensland Children's Hospital, Brisbane.,10Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane
| | - Yuri Gilhotra
- 9Emergency Department, Queensland Children's Hospital, Brisbane
| | - Sarah Dalton
- 11Emergency Department, The Children's Hospital at Westmead, Sydney
| | - John A Cheek
- 1Emergency Department, Royal Children's Hospital, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne.,12Emergency Department, Monash Medical Centre, Melbourne, Australia
| | - Jeremy Furyk
- 13Emergency Department, The Townsville Hospital, Townsville, Queensland.,15School of Medicine, Faculty of Health, Deakin University, Geelong, Australia
| | - Jocelyn Neutze
- 16Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
| | - Silvia Bressan
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,17Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gavin A Davis
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,4Department of Neurosurgery, Austin and Cabrini Hospitals, Melbourne
| | - Vicki Anderson
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,5School of Psychological Sciences, University of Melbourne, Melbourne.,6Psychology Service, Royal Children's Hospital, Melbourne
| | - Amanda Williams
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne
| | - Ed Oakley
- 1Emergency Department, Royal Children's Hospital, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne
| | - Stuart R Dalziel
- 18Emergency Department, Starship Children's Health, Auckland.,19Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Louise M Crowe
- 2Clinical Sciences, Murdoch Children's Research Institute, Melbourne.,3Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne.,5School of Psychological Sciences, University of Melbourne, Melbourne.,6Psychology Service, Royal Children's Hospital, Melbourne
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12
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Lima Santos JP, Kontos AP, Mailliard S, Eagle SR, Holland CL, Suss SJ, Abdul-Waalee H, Stiffler RS, Bitzer HB, Blaney NA, Colorito AT, Santucci CG, Brown A, Kim T, Iyengar S, Skeba A, Diler RS, Ladouceur CD, Phillips ML, Brent D, Collins MW, Versace A. White Matter Abnormalities Associated With Prolonged Recovery in Adolescents Following Concussion. Front Neurol 2021; 12:681467. [PMID: 34248824 PMCID: PMC8264142 DOI: 10.3389/fneur.2021.681467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Concussion symptoms in adolescents typically resolve within 4 weeks. However, 20 - 30% of adolescents experience a prolonged recovery. Abnormalities in tracts implicated in visuospatial attention and emotional regulation (i.e., inferior longitudinal fasciculus, ILF; inferior fronto-occipital fasciculus, IFOF; uncinate fasciculus; UF) have been consistently reported in concussion; yet, to date, there are no objective markers of prolonged recovery in adolescents. Here, we evaluated the utility of diffusion MRI in outcome prediction. Forty-two adolescents (12.1 - 17.9 years; female: 44.0%) underwent a diffusion Magnetic Resonance Imaging (dMRI) protocol within the first 10 days of concussion. Based on days of injury until medical clearance, adolescents were then categorized into SHORT (<28 days; N = 21) or LONG (>28 days; N = 21) recovery time. Fractional anisotropy (FA) in the ILF, IFOF, UF, and/or concussion symptoms were used as predictors of recovery time (SHORT, LONG). Forty-two age- and sex-matched healthy controls served as reference. Higher FA in the ILF (left: adjusted odds ratio; AOR = 0.36, 95% CI = 0.15 - 0.91, P = 0.030; right: AOR = 0.28, 95% CI = 0.10 - 0.83, P = 0.021), IFOF (left: AOR = 0.21, 95% CI = 0.07 - 0.66, P = 0.008; right: AOR = 0.30, 95% CI = 0.11 - 0.83, P = 0.020), and UF (left: AOR = 0.26, 95% CI = 0.09 - 0.74, P = 0.011; right: AOR = 0.28, 95% CI = 0.10 - 0.73, P = 0.010) was associated with SHORT recovery. In additional analyses, while adolescents with SHORT recovery did not differ from HC, those with LONG recovery showed lower FA in the ILF and IFOF (P < 0.014). Notably, inclusion of dMRI findings increased the sensitivity and specificity (AUC = 0.93) of a prediction model including clinical variables only (AUC = 0.75). Our findings indicate that higher FA in long associative tracts (especially ILF) might inform a more objective and accurate prognosis for recovery time in adolescents following concussion.
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Affiliation(s)
- João Paulo Lima Santos
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarrah Mailliard
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Shawn R Eagle
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Cynthia L Holland
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Stephen J Suss
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Halimah Abdul-Waalee
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Richelle S Stiffler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Hannah B Bitzer
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Nicholas A Blaney
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Adam T Colorito
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Christopher G Santucci
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Allison Brown
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Tae Kim
- Department of Radiology, Magnetic Resonance Research Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Satish Iyengar
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alexander Skeba
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rasim S Diler
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Cecile D Ladouceur
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mary L Phillips
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - David Brent
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael W Collins
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center (UPMC) Sports Concussion Program-University of Pittsburgh, Pittsburgh, PA, United States
| | - Amelia Versace
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Radiology, Magnetic Resonance Research Center, University of Pittsburgh, Pittsburgh, PA, United States
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13
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Walker GA, Wilson JC, Seehusen CN, Provance AJ, Howell DR. Is near point of convergence associated with symptom profiles or recovery in adolescents after concussion? Vision Res 2021; 184:52-57. [PMID: 33866266 DOI: 10.1016/j.visres.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/22/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
Our purpose was to compare the clinical and injury characteristics of concussion patients with a receded near point of convergence (NPC) vs those without a receded NPC. Concussion patients were seen within 14 days of injury. We compared those with receded a NPC (>6 cm) break point distance and those with a normal NPC distance on symptom, behavioral, and clinical assessments. We also compared NPC break points between those who did/did not recover within 28 days of injury. 123 patients completed the assessment. 77/123 (63%) of participants demonstrated a receded NPC when tested within 14 days of injury. Those with receded a NPC break point (n = 77; mean = 14.9, SD = 1.5 years; 47% female) were significantly younger than those with a normal NPC break point (n = 46; mean = 15.7, SD = 1.7 years; 46% female). The receded NPC break point group had a significantly greater proportion of patients reporting headaches (86% vs. 61%), as well as significantly greater cognitive (mean = 13.4, SD = 8.7 vs. mean = 8.8, SD = 8.6), somatic (mean = 10.0, SD = 5.9 vs. mean = 6.9, SD = 6.6), and overall (mean = 23.7, SD = 13.6 vs. mean = 15.8, SD = 14.4) symptom severity. Our multivariable model indicated among all potential predictor variables, more severe somatic symptoms were significantly associated with a greater NPC break point (β = 0.26; 95% CI = 0.01, 0.52). The group who went onto experience persistent symptoms had a significantly greater NPC break point at initial evaluation than those without persistent symptoms (mean = 9.7, SD = 7.5 cm vs. mean = 7.0, SD = 4.0 cm). Those with a receded NPC break point at initial evaluation showed an increased symptom burden, most notable with somatic symptoms, compared with those without a receded NPC break point.
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Affiliation(s)
- Gregory A Walker
- Sports Medicine Center, Children's Hospital Colorado, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, CO, USA
| | - Julie C Wilson
- Sports Medicine Center, Children's Hospital Colorado, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, CO, USA
| | | | - Aaron J Provance
- Sports Medicine Center, Children's Hospital Colorado, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, CO, USA
| | - David R Howell
- Sports Medicine Center, Children's Hospital Colorado, CO, USA; Department of Orthopedics, University of Colorado School of Medicine, CO, USA.
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14
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Pickett B, Bytomski JR, Zafonte RD. Evidence based management of sports related concussion. J Osteopath Med 2021; 121:499-502. [PMID: 33831982 DOI: 10.1515/jom-2021-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/25/2021] [Indexed: 11/15/2022]
Abstract
Sports related concussion (SRC) is a common condition evaluated by healthcare professionals. In an article entitled "Return to Play After Concussion: Clinical Guidelines for Young Athletes" published in the December 2019 issue of the Journal of the American Osteopathic Association, guidelines for the management of SRC were presented to assist healthcare professionals in the management of patients with SRC. However, much of the information presented in that article is contradicted by current expert recommendations and evidence based practice guidelines. The management of SRC has evolved to a nuanced, domain driven diagnosis requiring a multidisciplinary treatment team and a customized management plan for each patient to ensure competent treatment of patients with SRC. As such, this Commentary summarizes current recommendations for diagnosis and management of SRC.
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Affiliation(s)
- Brent Pickett
- James R. Urbaniak, MD, Sports Sciences Institute, Duke Health, Durham, NC, USA
| | - Jeffrey R Bytomski
- James R. Urbaniak, MD, Sports Sciences Institute, Duke Health, Durham, NC, USA
| | - Ross D Zafonte
- Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
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