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Podolak OE, Chaudhary S, Haarbauer-Krupa J, Metzger KB, Curry AE, Kessler RS, Pfeiffer MR, Breiding MJ, Master CL, Arbogast KB. Characteristics of Diagnosed Concussions in Children Aged 0 to 4 Years Presenting to a Large Pediatric Healthcare Network. Pediatr Emerg Care 2021; 37:e1652-e1657. [PMID: 32555016 PMCID: PMC7927314 DOI: 10.1097/pec.0000000000002148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of the study was to comprehensively describe the natural history of concussion in early childhood between 0 and 4 years. METHODS Retrospective cohort study of 329 patients aged 0 to 4 years, with an International Classification of Diseases, Ninth Revision, concussion diagnosis in the Children's Hospital of Philadelphia healthcare network from October 1, 2013, to September 30, 2015. Clinical data were abstracted from the Children's Hospital of Philadelphia electronic health record, which captured all clinical care visits and injury characteristics. RESULTS Nearly 9 (86.6%) of 10 patients sought care in the emergency department or urgent care setting, most commonly on the day of injury (56.2%) and as a result of a fall (64.4%). More than two-thirds (64.4%) of patients or their parent/caregiver reported somatic symptoms (ie, vomiting or headache), whereas close to half (49.2%) reported sleep issues. One of 5 patients identified emotional symptoms (21.9%) or visio-vestibular dysfunction (20.4%). Many patients also experienced symptoms not included in standard assessment tools including personality changes (34.0%) and change in appetite (12.8%). CONCLUSIONS These results provide insight into the clinical characteristics of concussion in early childhood up to 4 years of age. Because assessment in this group relies heavily on parent/caregiver symptom reporting, rather than patient self-report, these results will aid clinicians with the challenge of diagnosing concussions in this population. These findings highlight the need to develop additional tools to adequately and systematically assess common signs and symptoms of concussion in early childhood that may not be included in standard assessment scales routinely used in older adolescents and adults.
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Affiliation(s)
- Olivia E. Podolak
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Sofia Chaudhary
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Juliet Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kristina B. Metzger
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Allison E. Curry
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Ronni S. Kessler
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Melissa R. Pfeiffer
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Matthew J. Breiding
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, PA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Curry AE, Arbogast KB, Metzger KB, Kessler RS, Breiding MJ, Haarbauer-Krupa J, DePadilla L, Greenspan A, Master CL. Risk of Repeat Concussion Among Patients Diagnosed at a Pediatric Care Network. J Pediatr 2019; 210:13-19.e2. [PMID: 31101406 PMCID: PMC6645379 DOI: 10.1016/j.jpeds.2019.04.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To quantify the risk of repeat concussions for children and identify demographic and clinical aspects of the index concussion associated with repeat injury. STUDY DESIGN For this retrospective cohort study, we queried the Children's Hospital of Philadelphia healthcare network's unified electronic health record to identify all 5- to 15-year-old patients who had their first clinical visit for an index concussion at a Children's Hospital of Philadelphia location from July 2012 through June 2013. A 25% random sample (n = 536) were selected. Clinical data were abstracted for their index concussion and all concussion-related visits for 2 years following the index concussion. RESULTS Overall, 16.2% (n = 87) of patients experienced at least 1 repeat concussion within 2 years of their index concussion. The risk of repeat concussion increased with patient age (9.5% for ages 5-8 years; 10.7% for ages 9-11 years; and 19.8% for ages 12-15 years). After we adjusted for other factors, risk was particularly heightened among patients whose index concussion had a longer clinical course (>30 vs 0-7 days, adjusted risk ratio 1.65 [1.01-2.69]) and greater symptom burden (>11 vs 0-2 symptoms, adjusted risk ratio 2.12 [1.12-3.72]). CONCLUSIONS We estimate that 1 in 6 youth diagnosed with a concussion are diagnosed with a subsequent concussion within 2 years and that several clinical characteristics of the index concussion increase this risk. Identifying factors associated with a repeat injury is essential to inform the clinical management of concussion and direct injury prevention efforts.
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Affiliation(s)
- Allison E Curry
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Kristy B Arbogast
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kristina B Metzger
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ronni S Kessler
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Matthew J Breiding
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Juliet Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lara DePadilla
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Arlene Greenspan
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Christina L Master
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA; Sports Medicine and Performance Center, Children's Hospital of Philadelphia, Philadelphia, PA
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Arbogast KB, Curry AE, Metzger KB, Kessler RS, Bell JM, Haarbauer-Krupa J, Zonfrillo MR, Breiding MJ, Master CL. Improving Primary Care Provider Practices in Youth Concussion Management. Clin Pediatr (Phila) 2017; 56:854-865. [PMID: 28521519 PMCID: PMC6082149 DOI: 10.1177/0009922817709555] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary care providers are increasingly providing youth concussion care but report insufficient time and training, limiting adoption of best practices. We implemented a primary care-based intervention including an electronic health record-based clinical decision support tool ("SmartSet") and in-person training. We evaluated consequent improvement in 2 key concussion management practices: (1) performance of a vestibular oculomotor examination and (2) discussion of return-to-learn/return-to-play (RTL/RTP) guidelines. Data were included from 7284 primary care patients aged 0 to 17 years with initial concussion visits between July 2010 and June 2014. We compared proportions of visits pre- and post-intervention in which the examination was performed or RTL/RTP guidelines provided. Examinations and RTL/RTP were documented for 1.8% and 19.0% of visits pre-intervention, respectively, compared with 71.1% and 72.9% post-intervention. A total of 95% of post-intervention examinations were documented within the SmartSet. An electronic clinical decision support tool, plus in-person training, may be key to changing primary care provider behavior around concussion care.
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Affiliation(s)
- Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Allison E. Curry
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kristina B. Metzger
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ronni S. Kessler
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jeneita M. Bell
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Juliet Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mark R. Zonfrillo
- Hasbro Children’s Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Matthew J. Breiding
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina L. Master
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA,Sport Medicine and Performance Center, The Children’s Hospital of Philadelphia, PA, USA
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Nikulin VN, Boudard A, Clajus M, Fabbro B, Garçon M, Kessler RS, Lytkin LK, Mayer B, Nefkens BM, Plouin F, Poitou J, Tomasi-Gustafsson E, White D, Wilkin C. The d. Phys Rev C Nucl Phys 1996; 54:1732-1740. [PMID: 9971520 DOI: 10.1103/physrevc.54.1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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White DB, Tippens WB, Abegg R, Baldisseri A, Boudard A, Briscoe W, Fabbro B, Garçon M, Hermes EA, Jacobs WW, Kessler RS, Lytkin L, Mayer B, Nefkens BM, Niebuhr C, Petrov AM, Poitou J, Saudinos J, Tomasi-Gustafsson E, Vigdor SE, Wang M. Search for the decays eta --> microe and eta -->e+e-. Int J Clin Exp Med 1996; 53:6658-6661. [PMID: 10019948 DOI: 10.1103/physrevd.53.6658] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mayer B, Boudard A, Fabbro B, Garçon M, Kerboul C, Poitou J, Wellers F, Jacobs WW, Saudinos J, Tomasi-Gustafsson E, Mouly JP, Kessler RS, Nefkens BM, Tippens B, Abegg R, Briscoe W, Petrov A, Moalem A. Reactions pd-->3He eta and pd-->3He pi + pi - near the eta threshold. Phys Rev C Nucl Phys 1996; 53:2068-2074. [PMID: 9971183 DOI: 10.1103/physrevc.53.2068] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
Developments from various theorists and practitioners suggest an increasing interest in the use of future time frames in hypnosis and psychotherapy. We will present the development of a position focusing on the use of the future time frame without the necessary use of formal hypnosis. This position supposes an active, as opposed to a passive client role in the clinical interaction, and the techniques are applicable to a broader range of client population than other future oriented techniques. Thereafter, the use of this future time frame position is illustrated with case material, and potential interpretations of the case material are suggested.
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Affiliation(s)
- R S Kessler
- Department of Behavioral Medicine, Copley Hospital, Morrisville, Vermont 05661, USA
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Abegg R, Baldisseri A, Boudard A, Briscoe W, Fabbro B, Garçon M, Hermes EA, Jacobs WW, Kessler RS, Lytkin L, Mayer B, Nefkens BM, Niebuhr C, Petrov AM, Poitou J, Saudinos J, Tippens B, Tomasi-Gustafsson E, Vigdor SE, Wang M, White D. Measurement of the branching ratio for the decay eta --> micro+ micro-. Phys Rev D Part Fields 1994; 50:92-103. [PMID: 10017514 DOI: 10.1103/physrevd.50.92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Kessler RS, Abegg R, Baldisseri A, Boudard A, Briscoe W, Fabbro B, Garçon M, Hermes EA, Jacobs WW, Lytkin L, Mayer B, Nefkens BM, Niebuhr C, Petrov AM, Poitou J, Saudinos J, Tippens B, Tomasi-Gustafsson E, Vigdor SE, Wang M, White D. Measurement of the branching ratio for the decay eta --> micro+ micro-. Phys Rev Lett 1993; 70:892-895. [PMID: 10054231 DOI: 10.1103/physrevlett.70.892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Barlow DB, Kessler RS, Kim GJ, Nefkens BM, Pillai C, Price JW, Wightman JA, Hall S, Lane DW, Loe SR, Morton LK, Sadler ME, Adrian SD, Briscoe WJ, Kramer LH, Mokhtari A, Petrov AM, Seftor CJ, Taragin MF, Davis JF, Supek I. Measurement of the spin-rotation parameters A and R for pi +p--> pi +p and pi -p--> pi -p scattering from 471 to 625 MeV/c. Phys Rev Lett 1989; 62:1009-1012. [PMID: 10040401 DOI: 10.1103/physrevlett.62.1009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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