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Onicas AI, Deighton S, Yeates KO, Bray S, Graff K, Abdeen N, Beauchamp MH, Beaulieu C, Bjornson B, Craig W, Dehaes M, Deschenes S, Doan Q, Freedman SB, Goodyear BG, Gravel J, Lebel C, Ledoux AA, Zemek R, Ware AL. Longitudinal Functional Connectome in Pediatric Concussion: An Advancing Concussion Assessment in Pediatrics Study. J Neurotrauma 2024; 41:587-603. [PMID: 37489293 DOI: 10.1089/neu.2023.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/26/2023] Open
Abstract
Advanced magnetic resonance imaging (MRI) techniques indicate that concussion (i.e., mild traumatic brain injury) disrupts brain structure and function in children. However, the functional connectivity of brain regions within global and local networks (i.e., functional connectome) is poorly understood in pediatric concussion. This prospective, longitudinal study addressed this gap using data from the largest neuroimaging study of pediatric concussion to date to study the functional connectome longitudinally after concussion as compared with mild orthopedic injury (OI). Children and adolescents (n = 967) 8-16.99 years with concussion or mild OI were recruited from pediatric emergency departments within 48 h post-injury. Pre-injury and 1-month post-injury symptom ratings were used to classify concussion with or without persistent symptoms based on reliable change. Subjects completed a post-acute (2-33 days) and chronic (3 or 6 months via random assignment) MRI scan. Graph theory metrics were derived from 918 resting-state functional MRI scans in 585 children (386 concussion/199 OI). Linear mixed-effects modeling was performed to assess group differences over time, correcting for multiple comparisons. Relative to OI, the global clustering coefficient was reduced at 3 months post-injury in older children with concussion and in females with concussion and persistent symptoms. Time post-injury and sex moderated group differences in local (regional) network metrics of several brain regions, including degree centrality, efficiency, and clustering coefficient of the angular gyrus, calcarine fissure, cuneus, and inferior occipital, lingual, middle occipital, post-central, and superior occipital gyrus. Relative to OI, degree centrality and nodal efficiency were reduced post-acutely, and nodal efficiency and clustering coefficient were reduced chronically after concussion (i.e., at 3 and 6 months post-injury in females; at 6 months post-injury in males). Functional network alterations were more robust and widespread chronically as opposed to post-acutely after concussion, and varied by sex, age, and symptom recovery at 1-month post-injury. Local network segregation reductions emerged globally (across the whole brain network) in older children and in females with poor recovery chronically after concussion. Reduced functioning between neighboring regions could negatively disrupt specialized information processing. Local network metric alterations were demonstrated in several posterior regions that are involved in vision and attention after concussion relative to OI. This indicates that functioning of superior parietal and occipital regions could be particularly susceptibile to the effects of concussion. Moreover, those regional alterations were especially apparent at later time periods post-injury, emerging after post-concussive symptoms resolved in most and persisted up to 6 months post-injury, and differed by biological sex. This indicates that neurobiological changes continue to occur up to 6 months after pediatric concussion, although changes emerge earlier in females than in males. Changes could reflect neural compensation mechanisms.
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Affiliation(s)
- Adrian I Onicas
- MoMiLab, IMT School for Advanced Studies Lucca, Lucca, LU, Italy
- Computer Vision Group, Sano Centre for Computational Medicine, Kraków, Poland. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Deighton
- Department of Psychology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Signe Bray
- Department of Radiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kirk Graff
- Department of Radiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nishard Abdeen
- Department of Radiology, University of Ottawa, and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Christian Beaulieu
- Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce Bjornson
- Division of Neurology, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - William Craig
- University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Mathieu Dehaes
- Department of Radiology, Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Sylvain Deschenes
- Department of Radiology, Radio-oncology and Nuclear Medicine, Institute of Biomedical Engineering, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Quynh Doan
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Stephen B Freedman
- Departments of Pediatric and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Radiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jocelyn Gravel
- Department of Department of Pediatric Emergency Medicine, University of Montreal and CHU Sainte-Justine Hospital Research Center, Montréal, Quebec, Canada
| | - Catherine Lebel
- Department of Radiology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrée-Anne Ledoux
- Department of Cellular and Molecular Medicine, University of Ottawa, and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, and Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ashley L Ware
- Department of Psychology, Georgia State University, Atlanta, Georgia, USA, and Department of Neurology, University of Utah, Salt Lake City, Utah, USA
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Aaron RV, Rassu FS, Wegener ST, Holley AL, Castillo RC, Osgood GM, Fisher E. Psychological treatments for the management of pain after musculoskeletal injury: a systematic review and meta-analysis. Pain 2024; 165:3-17. [PMID: 37490624 PMCID: PMC10808265 DOI: 10.1097/j.pain.0000000000002991] [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] [Received: 09/09/2022] [Accepted: 06/05/2023] [Indexed: 07/27/2023]
Abstract
ABSTRACT Musculoskeletal injury is a leading cause of pain and disability worldwide; 35% to 75% of people experience persistent pain for months and years after injury. Psychological treatments can reduce pain, functional impairment, and psychological distress but are not widely used after injury. This systematic review and meta-analysis (PROSPERO ID: CRD42021236807) aimed to synthesize the literature testing psychological treatments for pain after musculoskeletal injury. We searched EMBASE, MEDLINE, PubMed, PsycINFO, and CENTRAL from inception to May 2022. We extracted participant, treatment, and injury characteristics and primary (eg, pain intensity, functional impairment, depression, anxiety, and PTSD symptoms) and secondary (treatment feasibility and acceptability) outcomes. Twenty-four randomized controlled trials (N = 1966) were included. Immediately posttreatment, people who received psychological treatments (versus any control) reported lower pain intensity (standardized mean differences [SMD] = -0.25, 95% confidence interval [-0.49, -0.02]), functional impairment (SMD = -0.32 [-0.55, -0.09]), and symptoms of depression (SMD = -0.46 [-0.64, -0.29]), anxiety (SMD = -0.34 [-0.65, -0.04]), and PTSD (SMD = -0.43 [-0.70, -0.15]); at 6-month follow-up, only depression symptoms were significantly lower. Included trials varied widely in treatment and injury characteristics. The certainty of evidence was low or very low for most effects and heterogeneity moderate to substantial. Most studies had risk of bias domains judged to be high or unclear. Owing to very low certainty of results, we are unsure whether psychological therapies reduce pain and functional impairment after musculoskeletal injury; they may result in improved depression immediately posttreatment and at follow-up. More research is needed to identify treatments that result in enduring effects.
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Affiliation(s)
- Rachel V Aaron
- Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD, United States
| | - Fenan S Rassu
- Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD, United States
| | - Stephen T Wegener
- Johns Hopkins School of Medicine, Department of Physical Medicine and Rehabilitation, Baltimore, MD, United States
| | - Amy L Holley
- Department of Pediatrics, Oregon Health Sciences University School of Medicine, Portland, OR, United States
| | - Renan C Castillo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Greg M Osgood
- Department of Orthopedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative and Support Care Review Group, Oxford, United Kingdom
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McClure M, Cooke B, Elphingstone J, Schick S, Paul K, Jardaly A, Brabston E, Momaya A, Ponce B. Orthopedic consequences of modern gladiators: a systematic review of lower extremity musculoskeletal issues in retired NFL players. PHYSICIAN SPORTSMED 2023; 51:539-548. [PMID: 36062826 DOI: 10.1080/00913847.2022.2119897] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/26/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The stressors that National Football League (NFL) athletes face are well-described and documented with regard to multisystem afflictions and injury prevalence. However, the majority of literature discusses the short-term effects rather than long-term outcomes of playing professional football. The purpose of this study was to characterize the long-term musculoskeletal issues in the retired NFL population. METHODS Publications from CENTRAL, Scopus, Medline, PubMed, Embase, and Google Scholar were searched from database inception to February 2021. A total of 9 cohort studies evaluating lower extremity arthritis in retired NFL athletes were included for review. Two reviewers extracted data from the individual studies, including demographic information (age, body mass index, length of career, position), injury descriptions (location of injury, number of injuries, diagnoses), and procedure (total knee and or hip arthroplasty) frequency. RESULTS Arthritis in retired NFL players was more than twice as prevalent than the general United States male population (95% CI: 2.1-2.3). Ankle osteoarthritis was directly correlated with the number of foot and ankle injuries. Players <50 years of age had a 16.1 and 13.8 times higher risk of undergoing TKA and THA, respectively, when compared to the general population. In older age groups, this trend held with retired NFL players being at least 4.3 and 4.6 times more likely than members of the general population to undergo TKA and THA, respectively. CONCLUSION This review demonstrates that the effects of NFL-related lower extremity injuries extend beyond the players' careers and present a higher risk for early-onset osteoarthritis and overall frequency of undergoing total knee and hip arthroplasty.
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Affiliation(s)
- Mark McClure
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brett Cooke
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joseph Elphingstone
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Samuel Schick
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kyle Paul
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Achraf Jardaly
- The Hughston Clinic, Columbus GA, USA
- The Hughston Foundation, Columbus, GA, USA
| | - Eugene Brabston
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amit Momaya
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent Ponce
- The Hughston Clinic, Columbus GA, USA
- The Hughston Foundation, Columbus, GA, USA
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Marbil MG, Ware AL, Galarneau JM, Minich NM, Hershey AD, Orr SL, Defta DM, Taylor HG, Bigler ED, Cohen DM, Mihalov LK, Bacevice A, Bangert BA, Yeates KO. Longitudinal trajectories of posttraumatic headache after pediatric mild traumatic brain injury. Cephalalgia 2023; 43:3331024231161740. [PMID: 37177818 DOI: 10.1177/03331024231161740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This prospective, longitudinal cohort study examined the trajectory, classification, and features of posttraumatic headache after pediatric mild traumatic brain injury. METHODS Children (N = 213; ages 8.00 to 16.99 years) were recruited from two pediatric emergency departments <24 hours of sustaining a mild traumatic brain injury or mild orthopedic injury. At 10 days, three months, and six months postinjury, parents completed a standardized questionnaire that was used to classify premorbid and posttraumatic headache as migraine, tension-type headache, or not otherwise classified. Multilevel mixed effects models were used to examine posttraumatic headache rate, severity, frequency, and duration in relation to group, time postinjury, and premorbid headache, controlling for age, sex, and site. RESULTS PTH risk was greater after mild traumatic brain injury than mild orthopedic injury at 10 days (odds ratio = 197.41, p < .001) and three months postinjury (odds ratio = 3.50, p = .030), especially in children without premorbid headache. Posttraumatic headache was more frequent after mild traumatic brain injury than mild orthopedic injury, β (95% confidence interval) = 0.80 (0.05, 1.55). Groups did not differ in other examined headache features and classification any time postinjury. CONCLUSIONS Posttraumatic headache risk increases after mild traumatic brain injury relative to mild orthopedic injury for approximately three months postinjury, but is not clearly associated with a distinct phenotype.
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Affiliation(s)
- Mica Gabrielle Marbil
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | | | - Nori Mercuri Minich
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
- Rainbow Babies & Children's Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Andrew D Hershey
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Serena L Orr
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Dana M Defta
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Daniel M Cohen
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Leslie K Mihalov
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara A Bangert
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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5
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Sanchez E, Blais H, Duclos C, Arbour C, Van Der Maren S, El-Khatib H, Baril AA, Bernard F, Carrier J, Gosselin N. Sleep from acute to chronic traumatic brain injury and cognitive outcomes. Sleep 2022; 45:zsac123. [PMID: 35640250 PMCID: PMC9366647 DOI: 10.1093/sleep/zsac123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 01/27/2022] [Revised: 05/13/2022] [Indexed: 09/29/2023] Open
Abstract
STUDY OBJECTIVES Traumatic brain injuries (TBIs) cause persistent cerebral damage and cognitive deficits. Because sleep may be a critical factor for brain recovery, we characterized the sleep of patients with TBI from early hospitalization to years post-injury and explored the hypothesis that better sleep during hospitalization predicts more favorable long-term cognitive outcomes. METHODS We tested patients with moderate-to-severe TBI in the hospitalized (n = 11) and chronic (n = 43) stages using full-night polysomnography, with 82% of the hospitalized group being retested years post-injury. Hospitalized patients with severe orthopedic and/or spinal cord injury (n = 14) and healthy participants (n = 36) were tested as controls for the hospitalized and chronic TBI groups, respectively. Groups had similar age and sex and were compared for sleep characteristics, including slow waves and spindles. For patients with TBI, associations between sleep during hospitalization and long-term memory and executive function were assessed. RESULTS Hospitalized patients with TBI or orthopedic injuries had lower sleep efficiency, higher wake after sleep onset, and lower spindle density than the chronic TBI and healthy control groups, but only hospitalized patients with brain injury had an increased proportion of slow-wave sleep. During hospitalization for TBI, less fragmented sleep, more slow-wave sleep, and higher spindle density were associated to more favorable cognitive outcomes years post-injury, while injury severity markers were not associated with these outcomes. CONCLUSION These findings highlight the importance of sleep following TBI, as it could be a strong predictor of neurological recovery, either as a promoter or an early marker of cognitive outcomes.
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Affiliation(s)
- Erlan Sanchez
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Neuroscience, Université de Montréal, Montreal, Quebec, Canada
| | - Hélène Blais
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
| | - Catherine Duclos
- Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Caroline Arbour
- Centre Intégré de Traumatologie, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Solenne Van Der Maren
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Héjar El-Khatib
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Andrée-Ann Baril
- Douglas Mental Health University Institute, Montréal, Quebec, Canada
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada
| | - Francis Bernard
- Centre Intégré de Traumatologie, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julie Carrier
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Nadia Gosselin
- Center for Advanced Research in Sleep Medicine, Centre Intégré Universitaire de Santé et Services Sociaux du Nord de l’Île-de-Montréal, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
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Bezabih Y, Tesfaye B, Melaku B, Asmare H. Pattern of Orthopedic Injuries Related to Road Traffic Accidents Among Patients Managed at the Emergency Department in Black Lion Hospital, Addis Ababa, Ethiopia, 2021. Open Access Emerg Med 2022; 14:347-354. [PMID: 35903799 PMCID: PMC9314752 DOI: 10.2147/oaem.s368324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Studies showed that each year people lose their life on the road and many people are disabled. The majority of this disability was caused by orthopedic injury related to road traffic accidents. However, in the context of Ethiopia, studies ascribed to orthopedic injuries related to road traffic accidents are limited. The study aimed to assess the pattern of orthopedic injuries related to road traffic accidents among patients managed at the emergency department of Black Lion Hospital. Methods An institutional-based cross-sectional study was conducted on 354 victims of road traffic accidents with orthopedic injuries who were visiting the Emergency department of Black Lion Hospital. Patient charts were selected by systematic random sampling technique and the data was entered into Epi-data version 4.4.2.2 and exported to the static package for social science window version 26, and descriptive statistics were used for analysis. Results The study reveals that males were mostly injured persons (71.7%) with the age group of 13-24 were the most injured. Passenger car accounts 36.3% of causes of injury followed by motorbikes (27.4%) and lower limbs were the most common anatomic site of injuries (47.9). Of all injury types, a fracture is the most common one with 71.1%, especially lower limb fracture (42.1%). More than half victims (59.5%) had open wounds, and almost half of the study subjects (51.8%) experience Road traffic accidents while they are crossing or walking along the way. Conclusion Orthopedic injuries related to road traffic accidents are the main cause of death and disability in many individuals, especially in reproductive age groups. Therefore, policy-makers should be aware of different patterns of orthopedic injuries associated with a victim of road traffic accidents to have an appropriate and sustainable capacity to manage the orthopedic injuries.
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Affiliation(s)
- Yetnayet Bezabih
- Department of Emergency and Critical Care Nursing, Saint Peter Hospital, Addis Ababa, Ethiopia
| | - Birhanu Tesfaye
- Department of Emergency Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birhanu Melaku
- Department of Emergency Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hailu Asmare
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
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Galdieri JD, Sood A, Edinoff AN, Cornett EM, Kaye AD, Seidenberg PH. Descriptive epidemiology of orthopedic injury and illness during the Special Olympics of Pennsylvania Summer Games from 2008 to 2017. Orthop Rev (Pavia) 2022; 14:35276. [PMID: 35769660 DOI: 10.52965/001c.35276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 11/19/2021] [Accepted: 01/12/2022] [Indexed: 01/14/2023] Open
Abstract
Background The Special Olympics Pennsylvania Summer Games attract over 2000 athletes each year. Volunteer medical staff ensures their safety throughout this period. However, few studies have examined the incidence of orthopedic injury and sickness in this group, especially with a large sample. Objective Identify the incidence of orthopedic injury and Illness at the Special Olympics Pennsylvania Summer Games based on demographic criteria and identify the incidence of transports required for advanced care. Methods Data was collected from logs provided by Special Olympics Pennsylvania. The data were analyzed and stratified by gender, age, sport, and type of encounter. We summarized the data and compared it to data from other years and the average. Results An average of 1971 athletes competed annually. On average, 10% (N=144) of competitors required medical care. Males comprised 58.2% (N = 837) of encounters, females 33.6% (N = 483), and in 8.1% (N = 117) of encounters gender was not identified/recorded. The mean age of participants was 29 years of age (range from 10 to 83). 56.6% (N= 813) of encounters required first aid management only. Injuries made up 31.7% (N = 455) of total encounters, and 11.8% (N=169) of encounters were classified as illnesses. Basketball was the sport with the most injuries, 49.5% (N = 711). An average of 9.8 transports was required annually. Conclusions Special Olympics athletes suffer the same injuries as regular athletes, but they are also prone to various medical disorders that regular athletes are not.
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Affiliation(s)
| | - Alka Sood
- Department of Family and Community Medicine, University of Toronto
| | - Amber N Edinoff
- Department of Psychiatry, Louisiana State University Health Sciences Center, School of Medicine
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center, School of Medicine
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, School of Medicine
| | - Peter H Seidenberg
- Department of Family Medicine, Louisiana State University Health Sciences Center, School of Medicine
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8
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Morgan C, Morgan R, Dela Cruz NJMV, Ng Man Sun S, Sarraf KM. Pediatric electric scooter injuries in the UK: Case series and review of literature. Traffic Inj Prev 2022; 23:369-371. [PMID: 35687112 DOI: 10.1080/15389588.2022.2084540] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/14/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Electric scooters are being used worldwide as a new means of transport and e-scooter shared schemes are currently being piloted in cities across the UK. At present, there is no data published looking at pediatric e-scooter injuries within the UK. We aim to assess if e-scooters pose a risk to children and the patterns and severity of orthopedic injuries related to their use. METHODS We performed a retrospective review of all orthopedic pediatric referrals relating to e-scooter use from January 1 to December 31, 2020 at two hospitals, including one pediatric Major Trauma Center in central London. Data including patient demographics, mechanism of injury, diagnosis, and treatment were collected. RESULTS Ten patients were identified in this series, of which 5 required orthopedic surgery. Four patients required admission to hospital from the emergency department. The median age was 15 (range 13-17 years) and all were male. All e-scooters were privately owned and all sustained a fall whilst riding the e-scooter. No patient was wearing a helmet. Six sustained lower limb injuries and four upper limb injuries. Two patients were trauma called and one patient sustained an open fracture. There were no mortalities at 30 days. CONCLUSION E-scooters pose a significant risk to children and can be associated with severe musculoskeletal injury. The risk they pose to the pediatric population should not be overlooked and these findings may inform public policy regarding the restriction of electric scooter use in children.
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Affiliation(s)
- Catrin Morgan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Rebecca Morgan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | | | - Khaled M Sarraf
- St Marys and Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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9
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Ware AL, Yeates KO, Geeraert B, Long X, Beauchamp MH, Craig W, Doan Q, Freedman SB, Goodyear BG, Zemek R, Lebel C. Structural connectome differences in pediatric mild traumatic brain and orthopedic injury. Hum Brain Mapp 2021; 43:1032-1046. [PMID: 34748258 PMCID: PMC8764485 DOI: 10.1002/hbm.25705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 01/06/2023] Open
Abstract
Sophisticated network‐based approaches such as structural connectomics may help to detect a biomarker of mild traumatic brain injury (mTBI) in children. This study compared the structural connectome of children with mTBI or mild orthopedic injury (OI) to that of typically developing (TD) children. Children aged 8–16.99 years with mTBI (n = 83) or OI (n = 37) were recruited from the emergency department and completed 3T diffusion MRI 2–20 days postinjury. TD children (n = 39) were recruited from the community and completed diffusion MRI. Graph theory metrics were calculated for the binarized average fractional anisotropy among 90 regions. Multivariable linear regression and linear mixed effects models were used to compare groups, with covariates age, hemisphere, and sex, correcting for multiple comparisons. The two injury groups did not differ on graph theory metrics, but both differed from TD children in global metrics (local network efficiency: TD > OI, mTBI, d = 0.49; clustering coefficient: TD < OI, mTBI, d = 0.49) and regional metrics for the fusiform gyrus (lower degree centrality and nodal efficiency: TD > OI, mTBI, d = 0.80 to 0.96; characteristic path length: TD < OI, mTBI, d = −0.75 to −0.90) and in the superior and middle orbital frontal gyrus, paracentral lobule, insula, and thalamus (clustering coefficient: TD > OI, mTBI, d = 0.66 to 0.68). Both mTBI and OI demonstrated reduced global and regional network efficiency and segregation as compared to TD children. Findings suggest a general effect of childhood injury that could reflect pre‐ and postinjury factors that can alter brain structure. An OI group provides a more conservative comparison group than TD children for structural neuroimaging research in pediatric mTBI.
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Affiliation(s)
- Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Bryce Geeraert
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Xiangyu Long
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal & CHU Sainte-Justine Hospital Research Center, Montreal, Quebec, Canada
| | - William Craig
- University of Alberta and Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Quynh Doan
- Pediatric Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen B Freedman
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Roger Zemek
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Catherine Lebel
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
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10
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Abstract
The COVID-19 pandemic has created a unique challenge for sports medicine staffs as they are attempting to safely transition elite athletes into sport participation after a COVID-19 infection. Athletes must isolate for a period of time after testing positive for COVID-19 to prevent the spread of the virus within a community. After an isolation period, a battery of cardiac tests must be given to assess whether or not an athlete is ready to begin a reconditioning protocol. A return-to-play plan should be established to safely re-integrate high-level athletes into strength and conditioning, sport-specific drill work, and contact drill work. Elite athletes should also be gradually eased back into full training loads in order to avoid increases in orthopedic injuries after a prolonged absence from training.
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Affiliation(s)
- Ryan Ross
- Performance Transition and Recovery Specialist, Baylor Athletic Medicine,
| | - Laura Irvin
- Director of Primary Care Sports Medicine, Baylor Athletic Medicine,
| | - Rich Severin
- Clinical Assistant Professor, Baylor University Doctor of Physical Therapy Program, Waco, TX,
| | - Brian Ellis
- Athletics Performance Coach, Baylor Football, Waco, TX,
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11
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Abstract
BACKGROUND Millions of Americans are injured each year, with 75% suffering orthopedic injuries. Those with orthopedic injury often experience postinjury symptoms, such as anxiety, that negatively influence long-term outcomes. The purpose of this systematic review was to evaluate (1) the prevalence of anxiety symptoms chronologically in relation to time of orthopedic injury, (2) the associations of anxiety symptoms with other symptoms in individuals with orthopedic injury, and (3) the associations between anxiety symptoms and functional performance and mental health outcomes in individuals with orthopedic injury. METHODS The databases CINAHL, Ovid MEDLINE, Ovid PsycInfo, Ovid Embase, ProQuest, and ClinicalTrials.gov were searched on June 25, 2020. Studies were selected for review if (1) participants were 16 years or older, (2) the prevalence of anxiety symptoms was listed, (3) anxiety symptoms were assessed using a validated instrument, (4) the study was published in English, and (5) more than 50% of the participants suffered orthopedic injury to the appendicular skeleton or pelvic ring. RESULTS Anxiety symptoms were present in 11.5%-55.9% of individuals up to 10 years after orthopedic injury and often co-occurred with those of depression, pain, and posttraumatic stress disorder to negatively influence functional performance and mental health outcomes. CONCLUSIONS Anxiety symptoms post-orthopedic injury are highly prevalent and persistent. Anxiety symptoms are associated with other distressing symptoms and influence long-term outcomes. These findings highlight the need to screen for and treat anxiety symptoms following orthopedic injury and may help in designing future self-management interventions.
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Affiliation(s)
- Stephen Breazeale
- Yale University, New Haven, Connecticut (Mr Breazeale and Drs Conley and Redeker); and Yale New Haven Hospital, New Haven, Connecticut (Mr Gaiser)
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12
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Johnson RS, Scott KH, Lynall RC. A Proposal for Complex Gait Evaluation Using Dual-Task Gait Termination Time. J Sport Rehabil 2020; 30:525-30. [PMID: 32963127 DOI: 10.1123/jsr.2020-0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/02/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Gait termination time (GTT) has been used to predict falls in older adults but has not been explored in the sport rehabilitation setting. The incorporation of a concurrent cognitive task as a complex measure of gait in this clinical population could lead to better health-related outcomes. OBJECTIVE To compare the effect of planned and unplanned gait termination with and without a concurrent cognitive task on reaction time (RT), gait velocity, and GTT. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Twenty young adults (females 60.0%, age 20.1 [0.9] y, height 169.5 [8.8] cm, mass 67.4 [10.8] kg). INTERVENTION Participants completed 6 planned and 6 unplanned gait termination trials on an instrumented gait mat with and without a cognitive task. MAIN OUTCOME MEASURES The authors measured RT (s), gait velocity (m/s), GTT (s), and normalized GTT (s2/m). A 2 (motor) × 2 (cognitive) repeated-measures analysis of variance (α = .05) was used; significant interaction effects were explored using Bonferroni-corrected t tests (α < .008). RESULTS Participants walked more slowly during dual-task trials compared with single-task trials (F1,19 = 4.401, P = .050). Participants walked significantly more slowly with a cognitive task during planned (P < .001, mean difference = -0.184 m/s, 95% CI, -0.256 to -0.111) and unplanned (P = .001, mean difference = -0.111 m/s, 95% CI, -0.173 to -0.050) gait termination. Participants walked significantly more slowly (P < .001, mean difference = -0.142 m/s, 95% CI, -0.210 to -0.075) when performing the most difficult task, unplanned termination with a cognitive task, than when performing the least difficult task, planned termination with no cognitive task. We observed a cognitive task main effect such that adding a cognitive task increased RT (F1,19 = 16.375, P = .001, mean difference = -0.118 s, 95% CI, -0.178 to -0.057) and slowed normalized GTT (F1,19 = 5.655, P = .028, mean difference = -0.167 s2/m, 95% CI, -0.314 to -0.020). CONCLUSIONS Overall, participants displayed more conservative gait strategies and slower RT, normalized GTT, and gait velocity as task difficulty increased. More investigation is needed to truly understand the clinical meaningfulness of these measures in athletic injuries.
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13
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Vukovic AA, Keiner E, Hanson HR. Understanding the Process of Procedural Sedation for Orthopedic Injuries in the Pediatric Emergency Department. J Patient Exp 2020; 7:311-315. [PMID: 32821789 PMCID: PMC7410132 DOI: 10.1177/2374373519846659] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To establish a procedural sedation (PS) time line for patients in the pediatric emergency department (PED) with orthopedic injuries. Methods: Retrospective review of patients requiring PS for orthopedic injuries. Process times were collected. Ten percent of encounters were co-reviewed. Interrater reliability and descriptive statistics were calculated. Results: A total of 189 patients were included. Co-abstracted data demonstrated excellent agreement. The median time to PS and length of stay (LOS) were 214 (interquartile range [IQR]: 160-282) and 320 (IQR: 257-402) minutes, respectively. Conclusion: Patients with orthopedic injuries requiring PS experience prolonged PED visits. Interventions should target safely reducing the time to PS and LOS.
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Affiliation(s)
- Adam A Vukovic
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Pediatric Emergency Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth Keiner
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Holly R Hanson
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Howard EE, Pasiakos SM, Fussell MA, Rodriguez NR. Skeletal Muscle Disuse Atrophy and the Rehabilitative Role of Protein in Recovery from Musculoskeletal Injury. Adv Nutr 2020; 11:989-1001. [PMID: 32167129 PMCID: PMC7360452 DOI: 10.1093/advances/nmaa015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/29/2019] [Accepted: 02/04/2020] [Indexed: 01/05/2023] Open
Abstract
Muscle atrophy and weakness occur as a consequence of disuse after musculoskeletal injury (MSI). The slow recovery and persistence of these deficits even after physical rehabilitation efforts indicate that interventions designed to attenuate muscle atrophy and protect muscle function are necessary to accelerate and optimize recovery from MSI. Evidence suggests that manipulating protein intake via dietary protein or free amino acid-based supplementation diminishes muscle atrophy and/or preserves muscle function in experimental models of disuse (i.e., immobilization and bed rest in healthy populations). However, this concept has rarely been considered in the context of disuse following MSI, which often occurs with some muscle activation during postinjury physical rehabilitation. Given that exercise sensitizes skeletal muscle to the anabolic effect of protein ingestion, early rehabilitation may act synergistically with dietary protein to protect muscle mass and function during postinjury disuse conditions. This narrative review explores mechanisms of skeletal muscle disuse atrophy and recent advances delineating the role of protein intake as a potential countermeasure. The possible synergistic effect of protein-based interventions and postinjury rehabilitation in attenuating muscle atrophy and weakness following MSI is also considered.
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Affiliation(s)
- Emily E Howard
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT, USA,Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA,Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Stefan M Pasiakos
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, USA
| | - Maya A Fussell
- Department of Nutritional Sciences, University of Connecticut, Storrs, CT, USA
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15
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Ware AL, Goodrich-Hunsaker NJ, Lebel C, Shukla A, Wilde EA, Abildskov TJ, Bigler ED, Cohen DM, Mihalov LK, Bacevice A, Bangert BA, Taylor HG, Yeates KO. Post-Acute Cortical Thickness in Children with Mild Traumatic Brain Injury versus Orthopedic Injury. J Neurotrauma 2020; 37:1892-1901. [PMID: 32178577 DOI: 10.1089/neu.2019.6850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Studies of brain morphometry may illuminate the effects of pediatric mild traumatic brain injury (TBI; e.g., concussion). However, no published studies have examined cortical thickness in the early injury phases of pediatric mild TBI using an appropriate comparison group. The current study used an automated approach (i.e., FreeSurfer) to determine whether cortical thickness differed in children following a mild TBI or a mild orthopedic injury (OI), and to examine whether post-acute cortical thickness predicted post-acute and chronic post-concussive symptoms (PCS). Children ages 8.00-16.99 years with mild TBI (n = 136) or OI (n = 70) were recruited at emergency department visits to two children's hospitals, during which parents rated children's pre-injury symptoms retrospectively. Children completed a post-acute (3-24 days post-injury) assessment, which included a 3 Tesla MRI, and 3- and 6-month post-injury assessments. Parents and children rated PCS at each assessment. Cortical thickness was estimated using FreeSurfer. Linear mixed effects and multi-variable negative binomial regression models were used to test study aims, with false discovery rate (FDR) correction for multiple comparisons. Groups differed significantly on left parietal cortical thickness (TBI > OI) after FDR correction. Cortical thickness also varied by brain subregion and age, but not sex. Groups differed significantly on PCS post-acutely (TBI > OI), but not at 3 or 6 months. Right frontal thickness was positively related to post-acute PCS in both groups. Right cingulum thickness predicted chronic PCS in the OI group only. Results highlight the complexity of predicting outcomes of pediatric mild TBI from post-acute neuroimaging biomarkers.
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Affiliation(s)
- Ashley L Ware
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Naomi J Goodrich-Hunsaker
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.,Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Catherine Lebel
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Ayushi Shukla
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Elisabeth A Wilde
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Tracy J Abildskov
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Erin D Bigler
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA.,Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Daniel M Cohen
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Leslie K Mihalov
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Barbara A Bangert
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - H Gerry Taylor
- Abigail Wexner Research Institute at Nationwide Children's Hospital, and Department of Pediatrics, Ohio State University, Columbus, Ohio, USA
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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16
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Harfmann EJ, deRoon-Cassini TA, McCrea MA, Nader AM, Nelson LD. Comparison of Four Quality of Life Inventories for Patients with Traumatic Brain Injuries and Orthopedic Injuries. J Neurotrauma 2020; 37:1408-1417. [PMID: 32000584 DOI: 10.1089/neu.2019.6746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The value of assessing health-related quality of life (HRQoL) in traumatic brain injury (TBI) patients has been increasingly recognized in recent years. Yet, research examining generic and TBI-specific quality of life (QOL) methodologies within this population has been limited, rendering decisions to use one alternative over another difficult and based largely on conceptual grounds. The current study compared widely used generic QoL/HRQOL measures (Satisfaction With Life Scale, 36-item Short Form Survey) and newer population-specific HRQoL measures (Quality of Life after Brain Injury [QOLIBRI], Trauma-Quality of Life [TQoL]) among 77 TBI and 23 orthopedically injured trauma control patients. The QOLIBRI Cognition and Physical Problems subscales were the only HRQoL scores across the four instruments administered that differentiated between patient groups: participants with TBI reported being significantly less satisfied with their cognitive abilities and more bothered by physical problems. Analyses of the unique population-specific QOLIBRI content revealed that 12.2-31.5% of TBI patients endorsed dissatisfaction and 28.8-51.4% endorsed being bothered by items unique to the QOLIBRI. Endorsement rates for unique TQoL items ranged from 1.4-75.7%. Overall, the QOLIBRI and TQoL appear to capture important information pertinent to patients with TBI and trauma. Inclusion of these disease-specific HRQoL measures is recommended over the use of only generic measures among TBI populations.
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Affiliation(s)
- Elisabeth J Harfmann
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.,Carl T. Hayden VA Medical Center, Phoenix, Arizona, USA
| | - Terri A deRoon-Cassini
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A McCrea
- Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.,Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amy M Nader
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lindsay D Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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17
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Bronner S, Urbano IR. Dance Functional Outcome Survey: Development and Preliminary Analyses. Sports Med Int Open 2018; 2:E191-E199. [PMID: 30539138 PMCID: PMC6277239 DOI: 10.1055/a-0729-3000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 07/22/2018] [Accepted: 08/26/2018] [Indexed: 11/17/2022] Open
Abstract
The Dance Functional Outcome Survey (DFOS) was developed as a self-report questionnaire for healthy and injured ballet and modern dancers, focusing on the low back and lower extremities. Our aim was to determine factor analysis and internal consistency of the 16 items and to investigate test-retest and equivalence reliability and validity of the DFOS compared to three orthopedic outcomes instruments. Data were collected from 80 healthy and injured adult ballet and modern pre-professional and professional dancers. DFOS Likert-type and visual analog scales were completed twice within 4-9 days to study test-retest reliability. The Cincinnati Knee Rating System, Olerud and Molander Foot-Ankle Questionnaire, and Oswestry Disability Index were used to assess concurrent validity using intraclass correlation coefficients in SPSS, p<0.05. To determine instrument dimensions and internal consistency of the items, we conducted exploratory factor analysis and calculated Cronbach's α in JASP. DFOS demonstrated single factor loading and high Cronbach's α; high test-retest repeatability and equivalence reliability ( r =0.74-0.99) and acceptable criterion validity compared to the orthopedic outcomes instruments (r≥0.67). These results support further study of a revised 14 item Likert-version DFOS for repeatability, validity and responsiveness.
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18
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Posti JP, Hossain I, Takala RSK, Liedes H, Newcombe V, Outtrim J, Katila AJ, Frantzén J, Ala-Seppälä H, Coles JP, Kyllönen A, Maanpää HR, Tallus J, Hutchinson PJ, van Gils M, Menon DK, Tenovuo O. Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 Are Not Specific Biomarkers for Mild CT-Negative Traumatic Brain Injury. J Neurotrauma 2017; 34:1427-1438. [PMID: 27841729 DOI: 10.1089/neu.2016.4442] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) have been studied as potential biomarkers of mild traumatic brain injury (mTBI). We report the levels of GFAP and UCH-L1 in patients with acute orthopedic injuries without central nervous system involvement, and relate them to the type of extracranial injury, head magnetic resonance imaging (MRI) findings, and levels of GFAP and UCH-L1 in patients with CT-negative mTBI. Serum UCH-L1 and GFAP were longitudinally measured from 73 patients with acute orthopedic injury on arrival and on days 1, 2, 3, 7 after admission, and on the follow-up visit 3-10 months after the injury. The injury types were recorded, and 71% patients underwent also head MRI. The results were compared with those found in patients with CT-negative mTBI (n = 93). The levels of GFAP were higher in patients with acute orthopedic trauma than in patients with CT-negative mTBI (p = 0.026) on arrival; however, no differences were found on the following days. The levels of UCH-L1 were not significantly different between these two groups at any measured point of time. Levels of GFAP and UCH-L1 were not able to distinguish patients with CT-negative mTBI from patients with orthopedic trauma. Patients with orthopedic trauma and high levels of UCH-L1 or GFAP values may be falsely diagnosed as having a concomitant mTBI, predisposing them to unwarranted diagnostics and unnecessary brain imaging. This casts a significant doubt on the diagnostic value of GFAP and UCH-L1 in cases with mTBI.
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Affiliation(s)
- Jussi P Posti
- 1 Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital , Turku, Finland
- 2 Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital , Turku, Finland
- 3 Department of Neurology, University of Turku , Turku, Finland
| | | | - Riikka S K Takala
- 4 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku , Turku, Finland
| | - Hilkka Liedes
- 5 Systems Medicine, VTT Technical Research Centre of Finland Ltd , Tampere, Finland
| | - Virginia Newcombe
- 6 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Joanne Outtrim
- 6 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ari J Katila
- 4 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku , Turku, Finland
| | - Janek Frantzén
- 1 Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital , Turku, Finland
- 2 Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital , Turku, Finland
| | | | - Jonathan P Coles
- 7 Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Anna Kyllönen
- 3 Department of Neurology, University of Turku , Turku, Finland
| | | | - Jussi Tallus
- 3 Department of Neurology, University of Turku , Turku, Finland
| | - Peter J Hutchinson
- 7 Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Mark van Gils
- 5 Systems Medicine, VTT Technical Research Centre of Finland Ltd , Tampere, Finland
| | - David K Menon
- 6 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Olli Tenovuo
- 2 Division of Clinical Neurosciences, Department of Rehabilitation and Brain Trauma, Turku University Hospital , Turku, Finland
- 3 Department of Neurology, University of Turku , Turku, Finland
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19
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Govindarajan KA, Narayana PA, Hasan KM, Wilde EA, Levin HS, Hunter JV, Miller ER, Patel VKS, Robertson CS, McCarthy JJ. Cortical Thickness in Mild Traumatic Brain Injury. J Neurotrauma 2016; 33:1809-1817. [PMID: 26959810 DOI: 10.1089/neu.2015.4253] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Magnetic resonance imaging data were acquired at ∼24 h and ∼3 months post-injury on mild traumatic brain injury (mTBI; n = 75) and orthopedic injury (n = 60) cohorts. The mTBI subjects were randomly assigned to a treatment group with atorvastatin or a non-treatment mTBI group. The treatment group was further divided into drug and placebo subgroups. FreeSurfer software package was used to compute cortical thickness based on the three dimensional T1-weighted images at both time-points. Cross-sectional analysis was carried out to compare cortical thickness between the mTBI and control groups. Longitudinal unbiased templates were generated for all subjects and cortical thickness measurements were compared between baseline and follow-up scans in the mTBI group. At baseline, significant reduction in cortical thickness was observed in the left middle temporal and the right superior parietal regions in the mTBI group, relative to the control group (p = 0.01). At follow-up, significant cortical thinning was again observed in the left middle temporal cortex in the mTBI group. Further analysis revealed significant cortical thinning only in the non-treatment group relative to the control group. In the follow-up, small regions with significant but subtle cortical thinning and thickening were seen in the frontal, temporal, and parietal lobes in the left hemisphere in the non-treatment group only. Our results indicate that cortical thickness could serve as a useful measure in identifying subtle changes in mTBI patients.
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Affiliation(s)
- Koushik A Govindarajan
- 1 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston , Houston, Texas
| | - Ponnada A Narayana
- 1 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston , Houston, Texas
| | - Khader M Hasan
- 1 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston , Houston, Texas
| | - Elisabeth A Wilde
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,3 Department of Radiology, Baylor College of Medicine , Houston, Texas
| | - Harvey S Levin
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine , Houston, Texas.,4 Michael E. DeBakey Veterans Affairs Medical Center , Houston, Texas
| | - Jill V Hunter
- 3 Department of Radiology, Baylor College of Medicine , Houston, Texas
| | - Emmy R Miller
- 5 Department of Neurosurgery, Virginia Commonwealth University , Richmond, Virginia
| | - Vipul Kumar S Patel
- 1 Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston , Houston, Texas
| | | | - James J McCarthy
- 7 Department of Emergency Medicine, University of Texas Health Science Center at Houston , Houston, Texas
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20
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Ewing-Cobbs L, Bloom DR, Prasad MR, Waugh JK, Cox CS, Swank PR. Assessing recovery and disability after physical trauma: the Pediatric Injury Functional Outcome Scale. J Pediatr Psychol 2014; 39:653-65. [PMID: 24748647 PMCID: PMC4061599 DOI: 10.1093/jpepsy/jsu018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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] [Received: 10/18/2013] [Revised: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To establish reliability and validity of the Pediatric Injury Functional Outcome Scale (PIFOS), a brief injury-specific rating scale covering motor, self-care, communication, social-emotional, cognition, physical, and academic areas. METHODS In a prospective longitudinal study, the PIFOS structured interview was administered to parents of children 3-15 years of age at 3 and 12 months after hospitalization for traumatic brain injury (TBI) or orthopedic injury (OI). RESULTS The total score had good internal consistency (α = .90-.93) and inter-rater reliability (α = .90) and correlated significantly with injury severity and neurodevelopmental outcomes. Generalized linear modeling showed the PIFOS was sensitive to the type and severity of injury, showed specific initial and persisting difficulties following TBI and OI, and was responsive to change during the first year after injury. Both groups had residual difficulties with coordination, emotionality, social participation, and discomfort. CONCLUSION The PIFOS is useful in examining recovery in natural history and intervention studies.
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Affiliation(s)
- Linda Ewing-Cobbs
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at HoustonDepartment of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Douglas R Bloom
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Mary R Prasad
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Jane K Waugh
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Charles S Cox
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
| | - Paul R Swank
- Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Department of Pediatrics, Baylor College of Medicine, and Department of Pediatric Surgery, University of Texas Health Science Center at Houston
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