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Giza CC, Gioia G, Cook LJ, Asarnow R, Snyder A, Babikian T, Thompson P, Bazarian JJ, Whitlow CT, Miles CM, Otallah S, Kamins J, Didehbani N, Rosenbaum PE, Chrisman SP, Vaughan CG, Cullum M, Popoli DM, Choe M, Gill J, Dennis EL, Donald CLM, Rivara FP. CARE4Kids Study: Endophenotypes of Persistent Post-Concussive Symptoms in Adolescents: Study Rationale and Protocol. J Neurotrauma 2024; 41:171-185. [PMID: 37463061 PMCID: PMC11071085 DOI: 10.1089/neu.2023.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Treatment of youth concussion during the acute phase continues to evolve, and this has led to the emergence of guidelines to direct care. While symptoms after concussion typically resolve in 14-28 days, a portion (∼20%) of adolescents endorse persistent post-concussive symptoms (PPCS) beyond normal resolution. This report outlines a study implemented in response to the National Institute of Neurological Diseases and Stroke call for the development and initial clinical validation of objective biological measures to predict risk of PPCS in adolescents. We describe our plans for recruitment of a Development cohort of 11- to 17-year-old youth with concussion, and collection of autonomic, neurocognitive, biofluid, and imaging biomarkers. The most promising of these measures will then be validated in a separate Validation cohort of youth with concussion, and a final, clinically useful algorithm will be developed and disseminated. Upon completion of this study, we will have generated a battery of measures predictive of high risk for PPCS, which will allow for identification and testing of interventions to prevent PPCS in the most high-risk youth.
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Affiliation(s)
- Christopher C. Giza
- Department of Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Neurosurgery, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- UCLA BrainSPORT Program, Los Angeles, California, USA
| | - Gerard Gioia
- Department of Neuropsychology, Children's National Hospital and George Washington University School of Medicine, Washington, DC, USA
| | - Lawrence J. Cook
- Department of Pediatric Critical Care, University of Utah, Salt Lake City, Utah, USA
| | - Robert Asarnow
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Department of Psychology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Aliyah Snyder
- UCLA BrainSPORT Program, Los Angeles, California, USA
- Departent of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- Fixel Institute, University of Florida, Gainesville, Florida, USA
| | - Talin Babikian
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Paul Thompson
- Departments of Ophthalmology, Neurology, Psychiatry and the Behavioral Sciences, and Radiology and Engineering, University of Southern California, Los Angeles, California, USA
| | - Jeffery J. Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Christopher T. Whitlow
- Department of Radiology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Christopher M. Miles
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Scott Otallah
- Department of Neurology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Joshua Kamins
- Department of Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Nyaz Didehbani
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Philip E. Rosenbaum
- Department of Neurosurgery, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- UCLA BrainSPORT Program, Los Angeles, California, USA
| | - Sara P.D. Chrisman
- Department of Pediatrics, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christopher G. Vaughan
- Department of Neuropsychology, Children's National Hospital and George Washington University School of Medicine, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | - Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David M. Popoli
- Department of Orthopedics and Rehabilitation, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Meeryo Choe
- Department of Pediatric Neurology, UCLA School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jessica Gill
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Emily L. Dennis
- TBI and Concussion Center, University of Utah, Salt Lake City, Utah, USA
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Christine L. Mac Donald
- Department of Neurological Surgery, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
| | - Frederick P. Rivara
- Department of Pediatrics, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington School of Medicine University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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Rosenbaum PE, Locandro C, Chrisman SPD, Choe MC, Richards R, Pacchia C, Cook LJ, Rivara FP, Gioia GA, Giza CC. Characteristics of Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population. JAMA Netw Open 2020; 3:e2021463. [PMID: 33196804 PMCID: PMC7670312 DOI: 10.1001/jamanetworkopen.2020.21463] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Pediatric mild traumatic brain injury (TBI) and concussion are a public health challenge with up to 30% of patients experiencing prolonged recovery. Pediatric patients presenting to concussion clinics often have ongoing impairments and may be at increased risk for persistent symptoms. Understanding this population is critical for improved prognostic estimates and optimal treatment. OBJECTIVE To describe pediatric patients presenting to concussion clinics and characterize factors associated with their recovery. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included patients enrolled at multicenter concussion specialty clinics from the Four Corners Youth Consortium from December 2017 to July 2019, with up to 12-month follow-up. Patients were eligible if they were aged 5 to 18.99 years with a diagnosis of mild TBI or concussion presenting to participating clinics within 8 weeks of injury. Patients were excluded if the patient or their parents were unable to read or sign the consent document, or if the patient had a Glasgow Coma Scale score less than 13 or a penetrating injury. Data were analyzed from February 2019 to April 2020. EXPOSURES Diagnosis of mild TBI or concussion. MAIN OUTCOMES AND MEASURES This study used National Institute of Neurological Disorders and Stroke common data elements, including data on demographic characteristics, injury details, history, neurological and neuropsychological assessments, and treatment. RESULTS A total of 600 patients were consecutively enrolled, among whom 324 (54.0%) were female and 435 (72.5%) were adolescents (ie, aged 13-18 years). A higher proportion of girls and women (248 patients [76.5%]) were adolescents compared with boys and men (187 patients [67.8%]) (P = .02), and girls and women reported significantly more preexisting anxiety compared with boys and men (80 patients [26.7%] vs 46 patients [18.7%]; P = .03). Significantly more adolescents reported preexisting migraines compared with preadolescents (82 patients [20.9%] vs 15 patients [10.9%]; P = .01). Girls and women recovered more slowly than boys and men (persistent symptoms after injury: week 4, 217 patients [81.6%] vs 156 patients [71.2%]; week 8, 146 patients [58.9%] vs 89 patients [44.3%]; week 12, 103 patients [42.6%] vs 58 patients [30.2%]; P = .01). Patients with history of migraine or anxiety or depression recovered more slowly than those without, regardless of sex. CONCLUSIONS AND RELEVANCE These findings suggest that identification of subgroups of pediatric patients with mild TBI or concussion at risk for prolonged recovery could aid in better prognostic estimates and more targeted treatment interventions.
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Affiliation(s)
- Philip E. Rosenbaum
- David Geffen School of Medicine, Department of Neurosurgery, University of California, Los Angeles
- Steve Tisch BrainSPORT Program, University of California, Los Angeles
| | | | - Sara P. D. Chrisman
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Meeryo C. Choe
- Steve Tisch BrainSPORT Program, University of California, Los Angeles
- David Geffen School of Medicine, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, California
| | | | | | | | - Frederick P. Rivara
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, Seattle, Washington
| | - Gerard A. Gioia
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Washington, District of Columbia
- Children’s National Hospital, Rockville, Maryland
| | - Christopher C. Giza
- David Geffen School of Medicine, Department of Neurosurgery, University of California, Los Angeles
- Steve Tisch BrainSPORT Program, University of California, Los Angeles
- David Geffen School of Medicine, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, California
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