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Haider MN, Leddy JJ, Pavlesen S, Kluczynski M, Baker JG, Miecznikowski JC, Willer BS. A systematic review of criteria used to define recovery from sport-related concussion in youth athletes. Br J Sports Med 2018; 52:1179-1190. [PMID: 28735282 PMCID: PMC5818323 DOI: 10.1136/bjsports-2016-096551] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The Concussion in Sport Group guidelines recommend a multifaceted approach to help clinicians make return to sport decisions. The purpose of this study was to identify the most common multifaceted measures used to define clinical recovery from sport-related concussion in young athletes (high school and/or college level) and to summarise existing knowledge of criteria used to make return to sport decisions. DESIGN Systematic review. DATA SOURCES The PubMed (MEDLINE), SPORTDiscus and Embase electronic databases were searched from 1 January 2000 to 1 March 2017 by three independent reviewers. ELIGIBILITY CRITERIA Inclusion criteria: elementary, high school and college age groups, and a specific definition of clinical recovery that required two or more measures. EXCLUSION CRITERIA review articles, articles using the same sample population, case studies, non-English language and those that used one measure only or did not specify the recovery measures used. STUDY QUALITY Study quality was assessed using the Downs and Black Criteria. RESULTS Of 2023 publications, 43 met inclusion criteria. Included articles reported the following measures of recovery: somatic symptom resolution or return to baseline (100%), cognitive recovery or return to baseline (86%), no exacerbation of symptoms on physical exertion (49%), normalisation of balance (30%), normal special physical examination (12%), successful return to school (5%), no exacerbation of symptoms with cognitive exertion (2%) and normalisation of cerebral blood flow (2%). Follow-up to validate the return to sport decision was reported in eight (19%) articles. Most studies were case-control or cohort (level of evidence 4) and had significant risk of bias. CONCLUSION All studies of sport-related concussion use symptom reports to define recovery. A minority of studies used multiple measures of outcome or had clearly defined recovery criteria, the most common being a combination of a self-reported symptom checklist and a computerised neurocognitive test. Future studies ideally should define recovery a priori using objective physiological measures in addition to symptom reports.
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Affiliation(s)
- Mohammad N Haider
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Psychiatry
| | - John J Leddy
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
| | - Sonja Pavlesen
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
| | - Melissa Kluczynski
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
| | - John G Baker
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, UBMB Department of Orthopaedics and Sports Medicine
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Nuclear Medicine
| | | | - Barry S Willer
- SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Department of Psychiatry
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102
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Legarreta AD, Brett BL, Solomon GS, Zuckerman SL. The role of family and personal psychiatric history in postconcussion syndrome following sport-related concussion: a story of compounding risk. J Neurosurg Pediatr 2018; 22:238-243. [PMID: 29856298 DOI: 10.3171/2018.3.peds1850] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sport-related concussion (SRC) has become a major public health concern. Prolonged recovery after SRC, named postconcussion syndrome (PCS), has been associated with several biopsychosocial factors, yet the role of both family and personal psychiatric histories requires investigation. In a cohort of concussed high school athletes, the authors examined the role(s) of family and personal psychiatric histories in the risk of developing PCS. METHODS A retrospective cohort study of 154 high school athletes with complete documentation of postconcussion symptom resolution or persistence at 6 weeks was conducted. PCS was defined as 3 or more symptoms present 6 weeks after SRC. Three groups were defined: 1) positive family psychiatric history and personal psychiatric history (FPH/PPH), 2) positive FPH only, and 3) negative family and personal psychiatric histories (controls). Three bivariate regression analyses were conducted: FPH/PPH to controls, FPH only to controls, and FPH/PPH to FPH. Post hoc bivariate regression analyses examined specific FPH pathologies and PCS. RESULTS Athletes with FPH/PPH compared with controls had an increased risk of PCS (χ2 = 8.90, p = 0.018; OR 5.06, 95% CI 1.71-14.99). Athletes with FPH only compared with controls also had an increased risk of PCS (χ2 = 6.04, p = 0.03; OR 2.52, 95% CI 1.20-5.30). Comparing athletes with FPH/PPH to athletes with FPH only, no added PCS risk was noted (χ2 = 1.64, p = 0.247; OR 2.01, 95% CI 0.68-5.94). Among various FPH diagnoses, anxiety (χ2 = 7.48, p = 0.021; OR 2.99, 95% CI 1.36-6.49) and bipolar disorder (χ2 = 5.13, p = 0.036; OR 2.74, 95% CI 1.14-6.67) were significantly associated with the presence of PCS. CONCLUSIONS Concussed high school athletes with FPH/PPH were greater than 5 times more likely to develop PCS than controls. Athletes with only FPH were over 2.5 times more likely to develop PCS than controls. Those with an FPH of anxiety or bipolar disorder are specifically at increased risk of PCS. These results suggest that not only are athletes with FPH/PPH at risk for slower recovery after SRC, but those with an FPH only-especially anxiety or bipolar disorder-may also be at risk. Overall, this study supports taking a detailed FPH and PPH in the management of SRC.
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Affiliation(s)
- Andrew D Legarreta
- 1Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Benjamin L Brett
- 1Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee.,3Department of Counseling, Educational Psychology and Research, The University of Memphis, Tennessee; and
| | - Gary S Solomon
- 1Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee.,4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Zuckerman
- 1Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Nashville, Tennessee.,4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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103
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Joseph JR, Swallow JS, Willsey K, Lapointe AP, Khalatbari S, Korley FK, Oppenlander ME, Park P, Szerlip NJ, Broglio SP. Elevated markers of brain injury as a result of clinically asymptomatic high-acceleration head impacts in high-school football athletes. J Neurosurg 2018; 130:1642-1648. [PMID: 29966462 DOI: 10.3171/2017.12.jns172386] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This prospective observational cohort study of high-school football athletes was performed to determine if high-acceleration head impacts (HHIs) that do not result in clinically diagnosed concussion still lead to increases in serum levels of biomarkers indicating traumatic brain injury (TBI) in asymptomatic athletes and to determine the longitudinal profile of these biomarkers over the course of the football season. METHODS Sixteen varsity high-school football athletes underwent baseline neurocognitive testing and blood sampling for the biomarkers tau, ubiquitin C-terminal hydrolase L1 (UCH-L1), neurofilament light protein (NF-L), glial fibrillary acidic protein (GFAP), and spectrin breakdown products (SBDPs). All athletes wore helmet-based accelerometers to measure and record head impact data during all practices and games. At various time points during the season, 6 of these athletes met the criteria for HHI (linear acceleration > 95g and rotational acceleration > 3760 rad/sec2); in these athletes a second blood sample was drawn at the end of the athletic event during which the HHI occurred. Five athletes who did not meet the criteria for HHI underwent repeat blood sampling following the final game of the season. In a separate analysis, all athletes who did not receive a diagnosis of concussion during the season (n = 12) underwent repeat neurocognitive testing and blood sampling after the end of the season. RESULTS Total tau levels increased 492.6% ± 109.8% from baseline to postsession values in athletes who received an HHI, compared with 164% ± 35% in athletes who did not receive an HHI (p = 0.03). Similarly, UCH-L1 levels increased 738.2% ± 163.3% in athletes following an HHI, compared with 237.7% ± 71.9% in athletes in whom there was no HHI (p = 0.03). At the end of the season, researchers found that tau levels had increased 0.6 ± 0.2 pg/ml (p = 0.003) and UCH-L1 levels had increased 144.3 ± 56 pg/ml (p = 0.002). No significant elevations in serum NF-L, GFAP, or SBDPs were seen between baseline and end-of-athletic event or end-of-season sampling (for all, p > 0.05). CONCLUSIONS In this pilot study on asymptomatic football athletes, an HHI was associated with increased markers of neuronal (UCH-L1) and axonal (tau) injury when compared with values in control athletes. These same markers were also increased in nonconcussed athletes following the football season.
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Affiliation(s)
| | | | | | | | | | - Frederick K Korley
- 5Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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104
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Barden C, Stokes K. Epidemiology of Injury in Elite English Schoolboy Rugby Union: A 3-Year Study Comparing Different Competitions. J Athl Train 2018; 53:514-520. [PMID: 29878844 DOI: 10.4085/1062-6050-311-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Injury risks in professional and community rugby union have been extensively described; however, less is known about injury epidemiology at the schoolboy level. OBJECTIVE To investigate the injury risk in English schoolboy rugby union matches, comparing an elite competition (Achieving Academic and Sporting Excellence [AASE]) with subelite matches (non-AASE). DESIGN Retrospective cohort study. SETTING Rugby union academy, consisting of 16- to 19-year-old males, based at an elite sports college in England. PATIENTS OR OTHER PARTICIPANTS A total of 132 participants (mean age = 17.5 years) were included in the study; 64 athletes experienced a total of 103 time-loss injuries over a 3-season period (2012-2015). All injuries were assessed and recorded by the team therapist using consensus statement definitions. MAIN OUTCOME MEASURE(S) Injury characteristics were recorded and compared between groups. Primary outcome measures were injury incidence (per 1000 h match exposure) and injury burden (days absent/1000 h), and rate ratios and 95% confidence intervals are presented throughout. RESULTS A total of 131 matches were played (34 AASE, 97 non-AASE) and a total of 103 injuries were recorded (47 AASE, 56 non-AASE). The injury incidence in AASE matches (77/1000 h) was greater than in non-AASE matches (34/1000 h). The concussion incidence in AASE matches (20/1000 h) was 5 times that of non-AASE matches (4/1000 h). The head/face had the highest injury incidence for a specific location, followed by the shoulder region (AASE = 19/1000 h, non-AASE = 5/1000 h), which had the greatest injury burden (553/1000 h and 105/1000 h, respectively) for any specific body location. More than 50% of all injuries were associated with tackles. CONCLUSIONS A much greater incidence of all injuries occurred at the highest level of competition, and the concussion incidence was greater than that reported in any previously published study of youth rugby. Given the high incidence and burden of concussions and shoulder injuries, prevention and management deserve specific focus.
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Affiliation(s)
- Craig Barden
- Physiotherapy Department, South Gloucestershire and Stroud College, Bristol, United Kingdom.,University of Bath, United Kingdom
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105
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On-Field Signs Predict Future Acute Symptoms After Sport-Related Concussion: A Structural Equation Modeling Study. J Int Neuropsychol Soc 2018; 24:476-485. [PMID: 29307322 DOI: 10.1017/s1355617717001321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study investigated the relationship between on-field, objective signs immediately following sport-related concussion and self-reported symptom endorsement within 1 day post injury. METHODS A retrospective case series of 237 concussed high school athletes was performed. On-field signs were evaluated immediately post injury. Self-reported symptoms (2 clusters) were collected within 1 day post injury. A two-step structural equation model and follow-up bivariate regression analyses of significant on-field signs and symptom clusters were performed. RESULTS Signs of immediate memory, β=0.20, p=.04, and postural instability, β=0.19, p < .01, significantly predicted a greater likelihood of endorsing the cognitive-migraine-fatigue symptom cluster within 1 day post injury. Regarding signs correlated with specific symptoms, immediate memory was associated with symptoms of trouble remembering, χ 2 =37.92, p < .001, odds ratio (OR)=3.89 (95% confidence interval (CI) [2.47, 6.13]), and concentration difficulties, χ 2 =10.84, p=.001, OR=2.13 (95% CI [1.37, 3.30]). Postural instability was associated with symptom endorsement of trouble remembering, χ 2 =12.08, p < .001, OR=1.76 (95% CI [1.29, 2.40]). CONCLUSIONS Certain post-concussion on-field signs exhibited after injury were associated with specific symptom endorsement within 1 day post injury. Based on these associations, individualized education-based interventions and academic accommodations may help reduce unanticipated worry from parents, students, and teachers following a student-athlete's sport-related concussion, especially in cases of delayed onset symptoms. (JINS, 2018, 24, 476-485).
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106
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Kosoy J, Feinstein R. Evaluation and Management of Concussion in Young Athletes. Curr Probl Pediatr Adolesc Health Care 2018; 48:139-150. [PMID: 30017603 DOI: 10.1016/j.cppeds.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Learning about concussion diagnosis and management is important for all individuals who will be taking care of young athletes. There are about 1.7million reported concussions per year, and, of these, about 20% are sports related. There are risks in all sports, but the highest rates of concussions are from football, rugby, and hockey, with soccer being the highest cause for girls. An on-field assessment includes evaluating airway, breathing, and circulation, followed by cervical spine assessment. Then, concussion evaluation tools can be used to aid in making the diagnosis. While concussion symptoms for the majority of youth resolve within a few weeks, some individuals may have persistence of symptoms for 3 months or more, referred to as postconcussive syndrome. Providers should consider ongoing symptoms in assessing when an athlete may safely return to sports and to learning. A major concern that has become more apparent in recent years is the possibility that concussions may have a longitudinal effect on health, such as in the development of chronic traumatic encephalopathy. Research has shown that there is an increase in the number of patients presenting to their primary care physician with concussions. Knowing how best to prevent, diagnose, and manage concussions will help to minimize risks to young athletes.
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Affiliation(s)
- Jennifer Kosoy
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, New York 11042, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
| | - Ronald Feinstein
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, New York 11042, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
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107
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Linden MA, Glang AE, McKinlay A. A systematic review and meta-analysis of educational interventions for children and adolescents with acquired brain injury. NeuroRehabilitation 2018; 42:311-323. [DOI: 10.3233/nre-172357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mark A. Linden
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, UK
| | - Ann E. Glang
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, UK
- Center on Brain Injury Research and Training, University of Oregon, Eugene, OR, USA
| | - Audrey McKinlay
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland, UK
- Department of Psychology, University of Canterbury, Canterbury, New Zealand
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108
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Thompson EC, Krizman J, White-Schwoch T, Nicol T, LaBella CR, Kraus N. Difficulty hearing in noise: a sequela of concussion in children. Brain Inj 2018. [DOI: 10.1080/02699052.2018.1447686] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Elaine C Thompson
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Jennifer Krizman
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Travis White-Schwoch
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Trent Nicol
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
| | - Cynthia R LaBella
- Division of Pediatric Orthopaedics & Sports Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nina Kraus
- Auditory Neuroscience Laboratory, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences, Northwestern University, Chicago, IL, USA
- Institute for Neuroscience, Northwestern University, Evanston, IL, USA
- Department of Neurobiology, Northwestern University, Evanston, IL, USA
- Department of Otolaryngology, Northwestern University, Evanston, IL, USA
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109
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Purcell LK, Davis GA, Gioia GA. What factors must be considered in ‘return to school’ following concussion and what strategies or accommodations should be followed? A systematic review. Br J Sports Med 2018; 53:250. [DOI: 10.1136/bjsports-2017-097853] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 01/08/2018] [Accepted: 02/02/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveTo evaluate the evidence regarding (1) factors affecting return to school (RTS) and (2) strategies/accommodations for RTS following a sport-related concussion (SRC) in children and adolescents.DesignA systematic review of original studies specifically addressing RTS following concussion in the paediatric and sporting context.Data sourcesMEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid) electronic databases and the grey literature OpenGrey, ClinicalTrials.gov and Google Advanced.Eligibility criteriaStudies were included if they were original research on RTS following SRC in children aged 5–18 years published in English between 1985 and 2017.ResultsA total of 180 articles were identified; 17 articles met inclusion criteria. Several factors should be considered for RTS after concussion, including: symptomatology; rest following injury; age/grade; and course load. On RTS after concussion, 17%–73% of students were provided academic accommodations or experienced difficulty with RTS. Students were more likely to obtain academic accommodations in schools with a concussion policy if they had a medical RTS letter and had regular medical follow-up after concussion.ConclusionsSchools should have a concussion policy and offer individualised academic accommodations to students recovering from SRC on RTS; a medical letter should be provided to facilitate provision/receipt of academic accommodations; students should have early, regular medical follow-up following SRC to help with RTS and monitor recovery; students may require temporary absence from school after SRC; clinicians should assess risk factors/modifiers that may prolong recovery and require more intensive academic accommodations.PROSPERO registration numberCRD42016039184.
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110
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Concussion in Children and Adolescents: Application of Return to Learning Policies, Best Practices, and Special Education Law. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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111
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Glang A, Todis B, Ettel D, Wade SL, Yeates KO. Results from a randomized trial evaluating a hospital-school transition support model for students hospitalized with traumatic brain injury. Brain Inj 2018; 32:608-616. [PMID: 29388885 DOI: 10.1080/02699052.2018.1433329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the utility of the STEP model, a systematic hospital-school transition protocol for children hospitalized for TBI. SETTING Five children's hospitals in Colorado, Ohio, and Oregon. PARTICIPANTS Hundred families of children with mild, complicated mild, moderate, or severe TBI. DESIGN Randomized controlled trial (RCT); participants were randomized while hospitalized to the STEP (a standardized hospital-school transition protocol for children treated for TBI) or usual care condition. MAIN MEASURES Questionnaire about child's special education eligibility status, support services, and academic accommodations; Achenbach Child Behaviour Checklist (CBCL); Behaviour Rating Inventory of Executive Function (BRIEF); Child and Adolescent Scale of Participation (CASP); Child and Adolescent Scales of Environment (CASE) Results: There were no significant effects, indicating that STEP participants did not differ from usual care participants on any study outcome at one month post-discharge or at one-year follow-up. CONCLUSION The lack of significant findings in this study does not imply that effective hospital-to-school transition programming is unnecessary. Rather, the findings raise important questions regarding timing and dosage/intensity of intervention, appropriate measurement of outcomes, and fidelity of programme delivery. The study highlights difficulties involved in the conduct of community-based RCTs in the paediatric TBI population.
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Affiliation(s)
- Ann Glang
- a Center on Brain Injury Research and Training, University of Oregon , Eugene , OR , USA
| | - Bonnie Todis
- a Center on Brain Injury Research and Training, University of Oregon , Eugene , OR , USA
| | - Debbie Ettel
- b Springfield School District , Springfield , OR , USA
| | - Shari L Wade
- c Division of Physical Medicine and Rehabilitation , Cincinnati Children's Hospital , Cincinnati , OH , USA
| | - Keith Owen Yeates
- d Department of Psychology , University of Calgary , Calgary , AB , Canada
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113
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Bachynski KE, Goldberg DS. Time out: NFL conflicts of interest with public health efforts to prevent TBI. Inj Prev 2017; 24:180-184. [PMID: 29142020 DOI: 10.1136/injuryprev-2017-042404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/18/2017] [Accepted: 08/30/2017] [Indexed: 11/04/2022]
Affiliation(s)
| | - Daniel S Goldberg
- Department of Family Medicine, University of Colorado at Denver-Anschutz Medical Campus, Aurora, Colorado, USA
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114
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O'Brien MJ, Howell DR, Pepin MJ, Meehan WP. Sport-Related Concussions: Symptom Recurrence After Return to Exercise. Orthop J Sports Med 2017; 5:2325967117732516. [PMID: 29085846 PMCID: PMC5648095 DOI: 10.1177/2325967117732516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Current guidelines dictate a gradual exercise progression after a concussion; however, it is unclear what proportion of athletes experience a recurrence of symptoms once they are symptom free at rest. Estimating the proportion of athletes and predictors of symptom recurrence would help shape return-to-play protocols. Purpose: To determine the proportion and associated risk factors of athletes who have a recurrence of concussion symptoms with exercise after being symptom free at rest. Study Design: Case-control study; Level of evidence, 3. Methods: Between October 1, 2009 and July 31, 2011, we studied patients from a sport concussion clinic located within a tertiary care regional children’s hospital. Patients were queried at every visit using a standardized questionnaire. Our main outcome variable was recurrence of symptoms with exercise after being symptom free at rest at some point in their recovery. Cofactors included age, sex, loss of consciousness with injury, prior concussion (diagnosed and undiagnosed), Post-Concussion Symptom Scale (PCSS) score, time until clinical presentation, and duration of symptoms. Results: Of the 217 patients included, 25 (12%) experienced a return of symptoms. Losing consciousness at the time of injury and a longer duration between injury and clinical presentation were associated with a decreased risk of symptoms recurring with exercise. Conversely, athletes who had sustained previously undiagnosed concussions and had suffered a longer duration of symptoms at rest were at an increased risk of symptom recurrence with exercise. Conclusion: Relatively few athletes who are symptom free at rest after a concussion will have a recurrence of symptoms when they resume exercise. The risk of symptoms recurring with exercise may be greater among those athletes who sustained previously undiagnosed concussions and had a longer period of symptoms at rest. The early identification of athletes who may be at risk of symptom recurrence will help mold treatment guidelines and exercise progression protocols.
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Affiliation(s)
- Michael J O'Brien
- Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - David R Howell
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael J Pepin
- Program for Patient Safety and Quality, Boston Children's Hospital, Boston, Massachusetts, USA
| | - William P Meehan
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA.,Division of Sports Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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115
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Aggarwal SS, Ott SD, Padhye NS, Meininger JC, Armstrong TS. Clinical and demographic predictors of concussion resolution in adolescents: A retrospective study. APPLIED NEUROPSYCHOLOGY-CHILD 2017; 8:50-60. [DOI: 10.1080/21622965.2017.1381099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Seema S. Aggarwal
- Acute and Continuing Care, University of Texas Health Sciences Center at Houston School of Nursing, Houston, Texas, USA
| | - Summer D. Ott
- Department of Orthopedic Surgery, University of Texas Health Sciences Center at Houston Medical School, Houston, Texas, USA
| | - Nikhil S. Padhye
- Center for Nursing Research, University of Texas Health Sciences Center at Houston School of Nursing, Houston, Texas, USA
| | - Janet C. Meininger
- Nursing Systems, University of Texas Health Sciences Center at Houston School of Nursing, Houston, Texas, USA
| | - Terri S. Armstrong
- National Institute of Health (NIH), Neuro-Oncology Branch, NCI/CCR, Bethesda, MD, USA
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116
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Speirs JN, Lyons MI, Johansson BE. Emergency Medical Service Personnel Recognize Pediatric Concussions. Glob Pediatr Health 2017; 4:2333794X17719187. [PMID: 28812053 PMCID: PMC5528916 DOI: 10.1177/2333794x17719187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022] Open
Abstract
Concussions are a major cause of morbidity in pediatrics. Many concussions occur during activities with emergency medical service (EMS) providers present to determine if a higher level of care is needed. Data are limited on how capable these providers are. We assessed the ability of EMS providers to recognize pediatric concussions. Fifty-six total responses were included, 38 from EMS and 18 from our MD/RN (medical doctor/registered nurse) group. No statistical differences were found between the 2 groups when adjusted for age, gender, number of years in practice, and number of pediatric concussions managed. This first of its kind pilot study was designed to assess EMS personnel’s ability to recognize and triage pediatric concussions. Our findings show EMS providers are statistically identical in their ability to recognize and triage concussions to physicians. The performance of our MD participants was lower than expected. Larger studies are needed to further investigate EMS providers’ ability to recognize a concussion.
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Affiliation(s)
- Joshua N. Speirs
- Texas Tech University Health Sciences Center, El Paso, TX, USA
- Joshua Speirs, Department of Orthopaedic Surgery, Loma Linda University, 11406 Loma Linda Drive, Suite 213, Loma Linda, CA 92354, USA.
| | | | - Bert E. Johansson
- Texas Tech University Health Sciences Center, El Paso, TX, USA
- El Paso Children’s Hospital El Paso, TX, USA
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Rozbacher A, Selci E, Leiter J, Ellis M, Russell K. The Effect of Concussion or Mild Traumatic Brain Injury on School Grades, National Examination Scores, and School Attendance: A Systematic Review. J Neurotrauma 2017; 34:2195-2203. [PMID: 28084891 DOI: 10.1089/neu.2016.4765] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Concussion often results in symptoms, including difficulty concentrating, focusing, and remembering, that are typically managed with cognitive and physical rest. Often, the school environment is not conducive to cognitive rest and may lead to worsening or prolonged symptoms that can contribute to impaired academic performance. The objective of the review was to identify and summarize literature concerning the effects of concussion or mild traumatic brain injury (mTBI) on academic outcomes. MEDLINE, Embase, Scopus, and CINAHL were searched until June 1, 2016. Studies must have been primary literature examining students enrolled in primary, secondary, or post-secondary education, have received a physician diagnosis of concussion or mTBI, and have post-injury academic outcomes assessed in numeric or alphabet grade/grade point average (GPA), school attendance records, or national examination scores. Data were extracted and checked by a second reviewer for accuracy and completeness. Nine studies were included. Among four studies that examined grades, one found a significant difference in pre- and post-grades only in the subject Afrikaans. Three examined national test scores and no significant differences were found between cases and controls. Four examined school absenteeism and found that students who developed post-concussion syndrome missed significantly more school days and took longer to return to school than students with extremity injuries. Although mTBI or concussion is associated with missed school, the results demonstrate minimal impact on school grades and national examination scores at a group level. Further research is needed to identify risk factors for impaired school functioning following mTBI and concussion in individual patients.
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Affiliation(s)
- Adrian Rozbacher
- 1 Max Rady College of Medicine, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Erin Selci
- 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada
- 6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- 2 Department of Surgery, University of Manitoba , Winnipeg, Manitoba, Canada
- 5 Pan Am Concussion Program , Winnipeg, Manitoba, Canada
- 7 Canada North Concussion Network , Winnipeg, Manitoba, Canada
| | - Michael Ellis
- 1 Max Rady College of Medicine, University of Manitoba , Winnipeg, Manitoba, Canada
- 2 Department of Surgery, University of Manitoba , Winnipeg, Manitoba, Canada
- 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada
- 4 Section of Neurosurgery, University of Manitoba , Winnipeg, Manitoba, Canada
- 5 Pan Am Concussion Program , Winnipeg, Manitoba, Canada
- 6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
- 7 Canada North Concussion Network , Winnipeg, Manitoba, Canada
| | - Kelly Russell
- 3 Pediatrics and Child Health, University of Manitoba , Winnipeg, Manitoba, Canada
- 6 Children's Hospital Research Institute of Manitoba , Winnipeg, Manitoba, Canada
- 7 Canada North Concussion Network , Winnipeg, Manitoba, Canada
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118
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Klein TA, Graves JM, Graham JY. Driving After Adolescent Concussion: Advice From Nurse Practitioners in the Absence of Standardized Recommendations. J Pediatr Health Care 2017; 31:441-451. [PMID: 27955874 DOI: 10.1016/j.pedhc.2016.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Nurse practitioners (NPs) are authorized to manage concussion recovery. Common adolescent activities, like driving, are omitted from guidelines. We investigated NP driving guidance and its clinical basis for restriction or limitation following adolescent concussion. METHOD NPs completed a web-based questionnaire after viewing a scripted video scenario of an adolescent describing symptoms of concussion occurring 72 hours prior. Driving recommendations were collected using an open-ended query, then coded and categorized by type, characteristic, and basis. RESULTS 1,051 (20%) responded to the question of interest. The majority (93.8%) provided driving recommendations: 32.6% based on time, 49.8% based on symptoms, and 28.5% based on health care utilization. 5.3% mentioned fatigue and sleep symptoms. 1% advised use of a standardized assessment tool. DISCUSSION Symptomatology, examination, and time were key factors in clinical decision-making for post-concussion driving, rather than use of standardized tools. Persistent symptoms that can impact driving, such as sleep and visual disturbances, may warrant consideration.
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119
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Kajankova M, Oswald JM, Terranova LM, Kaplen MV, Ambrose AF, Spielman LA, Gordon WA. Response of School Districts to the New York State Concussion Awareness and Management Act: Review of Policies and Procedures. THE JOURNAL OF SCHOOL HEALTH 2017; 87:409-415. [PMID: 28463444 DOI: 10.1111/josh.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/26/2016] [Accepted: 10/10/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND By 2014, all states implemented concussion laws that schools must translate into daily practice; yet, limited knowledge exists regarding implementation of these laws. We examined the extent to which concussion management policies and procedure (P&P) documents of New York State school districts comply with the State's Concussion Awareness and Management Act (the Act). We also aimed to identify barriers to compliance. METHODS Forty-seven school districts provided P&P documents. We examined compliance with the Act and the relationship between compliance and each district's demographics. RESULTS Compliance varied across school districts, with higher overall compliance in large city school districts compared to county districts. However, there was low compliance for several critical items. We found no statistically significant relationship between compliance and demographics. CONCLUSIONS School districts need to increase compliance with concussion legislation to ensure the adequate implementation necessary for the law to impact health and educational outcomes. The results provide important information to individuals charged with the responsibility of implementation and ultimately reducing the negative outcomes associated with brain injuries in schools.
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Affiliation(s)
- Maria Kajankova
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, NY 10029
| | - Jennifer M Oswald
- University at Albany, State University of New York, Psychology Department - Clinical Psychology, 1400 Washington Avenue, Albany, NY 12222
| | - Lauren M Terranova
- Interventional Spine & Sports Medicine, Spine Center & Orthopedic Rehabilitation of Englewood, 106 Grand Avenue, Suite 220, Englewood, NJ 07631
| | - Michael V Kaplen
- De Caro & Kaplen, LLP, 427 Bedford Road, Pleasantville, NY 10570
| | - Anne F Ambrose
- Traumatic Brain Injury Program, Vice Chair of Education, Burke Rehabilitation Hospital, 785 Mamaroneck Avenue, White Plains, NY 10605
| | - Lisa A Spielman
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, NY 10029
| | - Wayne A Gordon
- Icahn School of Medicine at Mount Sinai, Department of Rehabilitation Medicine, One Gustave Levy Place, Box 1163, New York, NY 10029
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Lyons VH, Moore M, Guiney R, Ayyagari RC, Thompson L, Rivara FP, Fleming R, Crawley D, Harper D, Vavilala MS. Strategies to Address Unmet Needs and Facilitate Return to Learn Guideline Adoption Following Concussion. THE JOURNAL OF SCHOOL HEALTH 2017; 87:416-426. [PMID: 28463445 PMCID: PMC8570132 DOI: 10.1111/josh.12510] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/12/2016] [Accepted: 10/10/2016] [Indexed: 05/17/2023]
Abstract
BACKGROUND Many students do not receive return to learn (RTL) services upon return to academics following a concussion. METHODS Using a mixed-methods approach, we conducted a survey of RTL practices and experiences in Washington State schools between January 2015 and June 2015. We then held a statewide summit of RTL stakeholders and used a modified Delphi process to develop a consensus-based RTL implementation model and process. RESULTS Survey participants included 83 educators, 57 school nurses, 14 administrators, and 30 parents, representing 144 schools in rural and urban areas. Unmet need domains and recommendations identified were (1) a current lack of school policies; (2) barriers to providing or receiving accommodations; (3) wide variability in communication patterns; and (4) recommendations shared by all stakeholder groups (including desire for readily available best practices, development of a formal school RTL policy for easy adoption and more training). Using stakeholder input from RTL summit participants and survey responses, we developed an RTL implementation model and checklist for RTL guideline adoption. CONCLUSIONS Washington State children have unmet needs upon returning to public schools after concussion. The student-centered RTL model and checklist for implementing RTL guidelines can help schools provide timely RTL services following concussion.
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Affiliation(s)
- Vivian H Lyons
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, F-262, Box 357236, Seattle, WA 98195-7236
| | - Megan Moore
- School of Social Work, University of Washington, 4101 15th Avenue NE, Seattle, WA 98105-6250
| | - Roxanne Guiney
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, 325 9th Avenue, Box 359911, Seattle, WA 98104
| | - Rajiv C Ayyagari
- Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218
| | - Leah Thompson
- Seattle Pediatric Concussion Research Collaborative, 4800 Sand Point Way NE, Seattle, WA 98105
| | - Frederick P Rivara
- Pediatrics, School of Medicine, University of Washington, Box 359960, 325 9th Avenue, Seattle, WA 98104
| | - Robin Fleming
- Office of the Superintendent of Public Instruction, 600 Washington Street SE, Olympia, WA 98504-7200
| | - Deborah Crawley
- Brain Injury Alliance of Washington, 316 Broadway Suite 305, Seattle, WA 98122
| | - Dawn Harper
- Issaquah Valley Elementary School, 98927 555 Northwest Holly Street, Issaquah, WA 98027
| | - Monica S Vavilala
- Harborview Injury Prevention & Research Center, Seattle, WA 98122
- School of Medicine, University of Washington, 401 Broadway, Seattle, WA 98122
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121
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Ferrari LR, O’Brien MJ, Taylor AM, Matheney TH, Zurakowski D, Slogic K, Anderson M, Soriano S, Rockoff M, Tasker RC. Concussion in pediatric surgical patients scheduled for time-sensitive surgical procedures. JOURNAL OF CONCUSSION 2017. [DOI: 10.1177/2059700217704775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Each year in the United States approximately three million individuals sustain sport or recreation-related concussion which may occur in the setting of orthopedic trauma requiring surgical intervention under general anesthesia. The effects of surgery and general anesthesia on brain recovery are currently unknown. The objective of this study was to determine the prevalence of recent sport concussion, recognized or not, in a preoperative, pediatric, surgical population. Methods The study involved administering a questionnaire to all eligible, consented patients in one of the following settings: Preoperative Clinic, Day Surgery Unit, Trauma Clinic, or inpatient floor. The questionnaire was designed to determine the occurrence and symptoms of a concussion. This study was conducted at an urban 395-bed comprehensive center for pediatric health, between May 2014 and April 2015. Inclusion criteria for study were age 5–21 years, presentation for surgical repair of orthopedic traumatic injury or nasal fracture, and precipitating injurious event occurring within four weeks of surgery. Results The prevalence of concussion in the setting of orthopedic trauma, either known or unknown at the time of presentation for surgery was 6%. The interval between surgery and injury was between three and 13 days. Prior education for recognition of concussion was present in 66% of patients. Conclusions The impact of surgery with general anesthesia in pediatric patients with a recent concussion is unknown. No changes in post-op disposition were noted in this patient population. However, our findings support the need to measure neurocognitive function before and after administration of operative procedures in a larger population with a recent concussion compared with controls.
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Affiliation(s)
- Lynne R Ferrari
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Michael J O’Brien
- Harvard Medical School, Boston, USA
- Sports Concussion Clinic, Orthopedic Center, Boston Children’s Hospital, Boston, USA
| | - Alex M Taylor
- Harvard Medical School, Boston, USA
- Brain Injury Center, Department of Neurology, Boston Children’s Hospital, Boston, USA
| | - Travis H Matheney
- Harvard Medical School, Boston, USA
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, USA
| | - David Zurakowski
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Katherine Slogic
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA
| | - Michelle Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA
| | - Sulpicio Soriano
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Mark Rockoff
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | - Robert C Tasker
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, USA
- Harvard Medical School, Boston, USA
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Davis GA, Anderson V, Babl FE, Gioia GA, Giza CC, Meehan W, Moser RS, Purcell L, Schatz P, Schneider KJ, Takagi M, Yeates KO, Zemek R. What is the difference in concussion management in children as compared with adults? A systematic review. Br J Sports Med 2017; 51:949-957. [PMID: 28455361 DOI: 10.1136/bjsports-2016-097415] [Citation(s) in RCA: 256] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the evidence regarding the management of sport-related concussion (SRC) in children and adolescents. The eight subquestions included the effects of age on symptoms and outcome, normal and prolonged duration, the role of computerised neuropsychological tests (CNTs), the role of rest, and strategies for return to school and return to sport (RTSp). DESIGN Systematic review. DATA SOURCES MEDLINE (OVID), Embase (OVID) and PsycInfo (OVID). ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were included if they were original research on SRC in children aged 5 years to 18 years, and excluded if they were review articles, or did not focus on childhood SRC. RESULTS A total of 5853 articles were identified, and 134 articles met the inclusion criteria. Some articles were common to multiple subquestions. Very few studies examined SRC in young children, aged 5-12 years. SUMMARY/CONCLUSIONS This systematic review recommends that in children: child and adolescent age-specific paradigms should be applied; child-validated symptom rating scales should be used; the widespread routine use of baseline CNT is not recommended; the expected duration of symptoms associated with SRC is less than 4 weeks; prolonged recovery be defined as symptomatic for greater than 4 weeks; a brief period of cognitive and physical rest should be followed with gradual symptom-limited physical and cognitive activity; all schools be encouraged to have a concussion policy and should offer appropriate academic accommodations and support to students recovering from SRC; and children and adolescents should not RTSp until they have successfully returned to school, however early introduction of symptom-limited physical activity is appropriate. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2016:CRD42016039184.
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Affiliation(s)
- Gavin A Davis
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Franz E Babl
- Murdoch Childrens Research Institute, Melbourne, Australia
| | | | | | - William Meehan
- Micheli Center for Sports Injury Prevention, Massachusetts, USA
| | | | - Laura Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, Cummings School of Medicine, University of Calgary, Calgary, Canada
| | - Michael Takagi
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Keith Owen Yeates
- Department of Psychology, Alberta Children's Research Institute & Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Roger Zemek
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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Abstract
The authors conducted a cross-sectional survey of Massachusetts school nurses examining return-to-learn practices for children recovering from concussion in prekindergarten through high school. Regardless of school setting, all students received academic accommodations to support learning during recovery. School nurses perceived less benefit to prolonged cognitive rest (>4 days) for high school students relative to students in elementary school, but provided academic accommodations to them for comparatively longer periods of time (10-14 days vs 6-10 days). In all settings, respondents indicated a need for improved communication among treating physicians, parents, and school personnel, as well as improved education and standardized management tools for younger children and those who sustain non-sport-related injuries. Despite serving children at different developmental stages, school return-to-learn practices are essentially the same in primary and secondary schools, highlighting the need for standardized, developmentally appropriate return-to-learn plans and additional education for the providers and school personnel who implement them.
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Affiliation(s)
- Laura S Blackwell
- 1 Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Anna F Robinson
- 1 Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Mark R Proctor
- 2 Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA
| | - Alex M Taylor
- 1 Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.,3 Department of Neurology, Boston Children's Hospital, Boston, MA, USA
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O’Brien AM, Casey JE, Salmon RM. Short-term test–retest reliability of the ImPACT in healthy young athletes. APPLIED NEUROPSYCHOLOGY-CHILD 2017. [DOI: 10.1080/21622965.2017.1290529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Joseph E. Casey
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Rachel M. Salmon
- Department of Psychology, University of Windsor, Windsor, Canada
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125
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Effgen GB, Morrison B. Electrophysiological and Pathological Characterization of the Period of Heightened Vulnerability to Repetitive Injury in an in Vitro Stretch Model. J Neurotrauma 2017; 34:914-924. [DOI: 10.1089/neu.2016.4477] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Gwen B. Effgen
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Barclay Morrison
- Department of Biomedical Engineering, Columbia University, New York, New York
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126
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Gänsslen A, Neubauer T, Hartl C, Moser N, Rickels E, Lüngen H, Nerlich M, Krutsch W. [School re-integration after child brain dislocation : The trauma surgeon's role]. Unfallchirurg 2017; 120:442-448. [PMID: 28130573 DOI: 10.1007/s00113-017-0317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Concussion injury of the brain is still a frequently underestimated injury, which can be associated with long-lasting consequences. Compared to adults, the recovery phase is often prolonged in childhood. Primary treatment consists of symptom-dependent physical and mental activities. Re-integration into daily life is crucial. In childhood, the primary focus is therefore on returning to school. New symptoms, or an increased presence of symptoms must be detected, to avoid prolonged recovery courses. School restrictions have to be minimized. Corresponding concepts are already implemented in North America. Comparable concepts are not established in Germany. In addition to well-known standard return-to-play protocols for sport re-integration, it is urgently recommended to integrate gradual return-to-learn protocols.Thus, academic adaptations and support must be established as well as symptom-oriented organizational and teaching modules.
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Affiliation(s)
- A Gänsslen
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland.
| | - T Neubauer
- Unfallchirurgie, Landesklinikum Horn, Spitalgasse 10, 3580, Horn, Österreich
| | - C Hartl
- Unfallchirurgie, Landeskrankenhaus Steyr, Sierninger Str. 170, 4400, Steyr, Österreich
| | - N Moser
- Verwaltungs-Berufsgenossenschaft, Bezirksverwaltung München, Postfach 20 20 42, 80020, München, Deutschland
| | - E Rickels
- Klink für Unfallchirurgie, Orthopädie und Neurotraumatologie, Allgemeines Krankenhaus Celle, Siemensplatz 4, 29223, Celle, Deutschland
| | - H Lüngen
- ZNS - Hannelore Kohl Stiftung, Rochusstr. 24, 53123, Bonn, Deutschland
| | - M Nerlich
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - W Krutsch
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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127
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Pabian PS, Oliveira L, Tucker J, Beato M, Gual C. Interprofessional management of concussion in sport. Phys Ther Sport 2017; 23:123-132. [DOI: 10.1016/j.ptsp.2016.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/12/2016] [Accepted: 09/07/2016] [Indexed: 12/14/2022]
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Collins MW, Kontos AP, Okonkwo DO, Almquist J, Bailes J, Barisa M, Bazarian J, Bloom OJ, Brody D, Cantu R, Cardenas J, Clugston J, Cohen R, Echemendia R, Elbin R, Ellenbogen R, Fonseca J, Gioia G, Guskiewicz K, Heyer R, Hotz G, Iverson GL, Jordan B, Manley G, Maroon J, McAllister T, McCrea M, Mucha A, Pieroth E, Podell K, Pombo M, Shetty T, Sills A, Solomon G, Thomas DG, Valovich McLeod TC, Yates T, Zafonte R. Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015. Neurosurgery 2016; 79:912-929. [PMID: 27741219 PMCID: PMC5119544 DOI: 10.1227/neu.0000000000001447] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. OBJECTIVE To describe the current landscape of treatment for concussion and to provide summary agreements related to treatment to assist clinicians in the treatment of concussion. METHODS On October 14 to 16, 2015, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting was convened in Pittsburgh, Pennsylvania. Thirty-seven concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. RESULTS A total of 16 statements of agreement were supported covering (1) Summary of the Current Approach to Treating Concussion, (2) Heterogeneity and Evolving Clinical Profiles of Concussion, (3) TEAM Approach to Concussion Treatment: Specific Strategies, and (4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97% to 100%. CONCLUSION Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies on the basis of modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery after concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments. ABBREVIATIONS ARS, audience response systemCDC, Centers for Disease Control and PreventionDoD, Department of DefensemTBI, mild traumatic brain injuryNCAA, National Collegiate Athletic AssociationNFL, National Football LeagueNIH, National Institutes of HealthRCT, randomized controlled trialRTP, return to playSRC, sport- and recreation-related concussionTBI, traumatic brain injuryTEAM, Targeted Evaluation and Active Management.
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Affiliation(s)
- Michael W. Collins
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon Almquist
- Fairfax Family Practice Comprehensive Concussion Center, Fairfax, Virginia
| | - Julian Bailes
- Department of Neurosurgery, NorthShore University Health System, Chicago, Illinois
| | - Mark Barisa
- Baylor Institute for Rehabilitation, Frisco, Texas
| | - Jeffrey Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - O. Josh Bloom
- Carolina Sports Concussion Clinic, Cary, North Carolina
| | - David Brody
- Department of Neurology, Washington University, St. Louis, Missouri
| | - Robert Cantu
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital, Boston University, Concord, Massachusetts
| | - Javier Cardenas
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Jay Clugston
- Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Randall Cohen
- Athletics Department, University of Arizona, Tucson, Arizona
| | - Ruben Echemendia
- Psychological and Neurobehavioral Associates, State College, Pennsylvania
| | - R.J. Elbin
- Office for Sports Concussion Research, University of Arkansas, Fayetteville, Arkansas
| | - Richard Ellenbogen
- Department of Neurological Surgery University of Washington, Seattle, Washington
| | - Janna Fonseca
- Carolina Sports Concussion Clinic, Cary, North Carolina
| | - Gerard Gioia
- Division of Neuropsychology, Children’s National Health System, Washington, District of Columbia
| | - Kevin Guskiewicz
- College of Arts and Sciences, University of North Carolina, Chapel Hill, North Carolina
| | - Robert Heyer
- Carolinas Medical Center, Charlotte, North Carolina
| | - Gillian Hotz
- Neuroscience Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Grant L. Iverson
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Barry Jordan
- Neurorehabilitation, Burke Rehabilitation & Research, White Plains, New York
| | - Geoffrey Manley
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California
| | - Joseph Maroon
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Michael McCrea
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anne Mucha
- University of Pittsburgh Medical Center Centers for Rehabilitation Services, Pittsburgh, Pennsylvania
| | - Elizabeth Pieroth
- Neurological Institute, NorthShore University Health System, Chicago, Illinois
| | - Kenneth Podell
- Houston Methodist Concussion Center, Houston Methodist Hospital, Houston, Texas
| | - Matthew Pombo
- Department of Orthpoedics, Emory University Healthcare, Atlanta, Georgia
| | - Teena Shetty
- Department of Neurology, Hospital for Special Surgery, Weill Cornell Medical College, New York City, New York
| | - Allen Sills
- Department of Neurosurgery, Vanderbilt University, Vanderbilt Sports Concussion Center, Nashville, Tennessee
| | - Gary Solomon
- Department of Neurosurgery, Vanderbilt University, Vanderbilt Sports Concussion Center, Nashville, Tennessee
| | - Danny G. Thomas
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Pediatric Emergency Medicine, Children’s Hospital of Wisconsin, Wauwatosa, Wisconsin
| | | | - Tony Yates
- Pittsburgh Steelers, Pittsburgh, Pennsylvania
| | - Ross Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Thompson LL, Lyons VH, McCart M, Herring SA, Rivara FP, Vavilala MS. Variations in State Laws Governing School Reintegration Following Concussion. Pediatrics 2016; 138:peds.2016-2151. [PMID: 27940709 DOI: 10.1542/peds.2016-2151] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to examine the prevalence, scope, and specificity of provisions governing school reintegration in current state concussion laws. METHODS State concussion laws as of May 2016 were independently assessed and classified by 2 trained coders. Statutes were classified as "Return-to-Learn" (RTL) laws if they contained language mandating institutional action at the state, district, or school level related to academic reintegration of youth who have sustained a concussion. All statutes classified as RTL laws were further analyzed to determine scope, required actions, and delineation of responsibility. RESULTS RTL laws were uncommon, present in only 8 states. Most (75%) of these laws held schools responsible for RTL management but mandated RTL education for school personnel was less frequent, present in only one-quarter of the laws. None of the RTL laws provided guidance on support of students with persistent postconcussive symptoms, and only 1 recommended an evidence-based standard for RTL guidelines. CONCLUSIONS Our review of state concussion laws indicates scant and vague legal guidance regarding RTL. These findings suggest an opportunity for legislative action on the issue of RTL, and reveal the need for better integration of laws and research, so that laws reflect existing best-practice recommendations and remain current as the evidence base develops.
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Affiliation(s)
| | - Vivian H Lyons
- Harborview Injury Prevention and Research Center, Seattle, Washington.,Departments of Epidemiology
| | - Melissa McCart
- The Center on Brain Injury Research and Training, Eugene, Oregon
| | - Stanley A Herring
- Rehabilitation Medicine.,University of Washington Medicine Sports Health and Safety Institute, and.,University of Washington Medicine Sports Concussion Program, University of Washington, Seattle, Washington; and
| | - Frederick P Rivara
- Seattle Children's Research Institute, Seattle, Washington.,Harborview Injury Prevention and Research Center, Seattle, Washington.,Departments of Epidemiology.,Pediatrics, and
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Seattle, Washington; .,Pediatrics, and.,Anesthesiology
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130
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Applying an Evidence-Based Assessment Model to Identify Students at Risk for Perceived Academic Problems following Concussion. J Int Neuropsychol Soc 2016; 22:1038-1049. [PMID: 27903334 DOI: 10.1017/s1355617716000916] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to demonstrate the utility of an evidence-based assessment (EBA) model to establish a multimodal set of tools for identifying students at risk for perceived post-injury academic problems. METHODS Participants included 142 students diagnosed with concussion (age: M=14.95; SD=1.80; 59% male), evaluated within 4 weeks of injury (median=16 days). Demographics, pre-injury history, self- and parent-report measures assessing symptom severity and executive functions, and cognitive test performance were examined as predictors of self-reported post-injury academic problems. RESULTS Latent class analysis categorized participants into "high" (44%) and "low" (56%) levels of self-reported academic problems. Receiver operating characteristic analyses revealed significant discriminative validity for self- and parent-reported symptom severity and executive dysfunction and self-reported exertional response for identifying students reporting low versus high academic problems. Parent-reported symptom ratings [area under the receiver operating characteristic curve (AUC)=.79] and executive dysfunction (AUC=.74), and self-reported ratings of executive dysfunction (AUC=.84), symptoms (AUC=.80), and exertional response (AUC=.70) each classified students significantly better than chance (ps<.001). Hierarchical logistic regression indicated that, of the above, self-reported symptoms and executive dysfunction accounted for the most variance in the prediction of self-reported academic problems. CONCLUSIONS Post-concussion symptom severity and executive dysfunction significantly predict perceived post-injury academic problems. EBA modeling identified the strongest set of predictors of academic challenges, offering an important perspective in the management of concussion by applying traditional strengths of neuropsychological assessment to clinical decision making. (JINS, 2016, 22, 1038-1049).
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131
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Building Statewide Infrastructure for the Academic Support of Students With Mild Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:397-406. [DOI: 10.1097/htr.0000000000000205] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Russell K, Hutchison MG, Selci E, Leiter J, Chateau D, Ellis MJ. Academic Outcomes in High-School Students after a Concussion: A Retrospective Population-Based Analysis. PLoS One 2016; 11:e0165116. [PMID: 27764223 PMCID: PMC5072608 DOI: 10.1371/journal.pone.0165116] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 10/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many concussion symptoms, such as headaches, vision problems, or difficulty remembering or concentrating may deleteriously affect school functioning. Our objective was to determine if academic performance was lower in the academic calendar year that students sustain a concussion compared to the previous year when they did not sustain a concussion. METHODS Using Manitoba Health and Manitoba Education data, we conducted a population-based, controlled before-after study from 2005-2006 to 2010-2011 academic years. Grade 9-12 students with an ICD9/10 code for concussion were matched to non-concussed controls. Overall changes in grade point average (GPA) were compared for the academic year prior to the concussion to the academic year the concussion occurred (or could have occurred among non-concussed matched students). RESULTS Overall, 8240 students (1709 concussed, 6531 non-concussed students) were included. Both concussed and non-concussed students exhibited a lower overall GPA from one year to the next. Having sustained a concussion resulted in a -0.90% (95% CI: -1.88, 0.08) reduction in GPA. Over the same period, non-concussed matched students' GPA reduced by -0.57% (95% CI: -1.32, 0.19). Students who sustained a concussion during high school were just as likely to graduate within four years as their non-concussed peers (ORadj: 0.84; 95% CI: 0.73, 1.02). CONCLUSIONS We found that, at a population level, a concussion had minimal long-term effects on academic performance during high school. While academic accommodations and Return-to-Learn programs are an important component of pediatric concussion management, research is needed to identify risk factors for poor academic performance after a concussion and who should receive these programs.
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Affiliation(s)
- Kelly Russell
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
- Canada North Concussion Network, Winnipeg, Canada
| | - Michael G. Hutchison
- Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada
| | - Erin Selci
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Jeff Leiter
- Canada North Concussion Network, Winnipeg, Canada
- Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Daniel Chateau
- Manitoba Center for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Michael J. Ellis
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
- Canada North Concussion Network, Winnipeg, Canada
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Canada
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McCarty CA, Zatzick D, Stein E, Wang J, Hilt R, Rivara FP. Collaborative Care for Adolescents With Persistent Postconcussive Symptoms: A Randomized Trial. Pediatrics 2016; 138:peds.2016-0459. [PMID: 27624513 PMCID: PMC5051206 DOI: 10.1542/peds.2016-0459] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postconcussive and co-occurring psychological symptoms are not uncommon after sports-related concussion and are associated with functional impairment and societal costs. There is no evidence-based treatment targeting postconcussive symptoms in children and adolescents. The goal of this study was to test a collaborative care intervention model with embedded cognitive-behavioral therapy, care management, and psychopharmacological consultation. We hypothesized that patients in collaborative care would demonstrate greater reductions in postconcussive, depressive, and anxiety symptoms and improvement in functioning over the course of 6 months, compared with usual care control. METHODS Patients aged 11 to 17 years with persistent symptoms ≥1 month after sports-related concussion were randomly assigned to receive collaborative care (n = 25) or care as usual (n = 24). Patients were assessed before randomization and after 1, 3, and 6 months. Groups were compared over time via linear mixed effects regression models. RESULTS Adolescents assigned to collaborative care experienced clinically and statistically significant improvements in postconcussive symptoms in addition to functional gains at 6 months compared with controls. Six months after the baseline assessment, 13.0% of intervention patients and 41.7% of control patients reported high levels of postconcussive symptoms (P = .03), and 78% of intervention patients and 45.8% of control patients reported ≥50% reduction in depression symptoms (P = .02). No changes between groups were demonstrated in anxiety symptoms. CONCLUSIONS Orchestrated efforts to systematically implement collaborative care treatment approaches for slow-to-recover adolescents may be useful given the reductions in postconcussive and co-occurring psychological symptoms in addition to improved quality of life.
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Affiliation(s)
- Carolyn A. McCarty
- Research Institute, Center for Child Health, Behavior and Development, and,Departments of Pediatrics, and
| | - Douglas Zatzick
- Psychiatry and Behavioral Sciences, and,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Elizabeth Stein
- Research Institute, Center for Child Health, Behavior and Development, and
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
| | - Robert Hilt
- Department of Psychiatry and Behavioral Medicine, Seattle Children’s Hospital, Seattle, Washington; and,Psychiatry and Behavioral Sciences, and
| | - Frederick P. Rivara
- Research Institute, Center for Child Health, Behavior and Development, and,Departments of Pediatrics, and,Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington
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135
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Affiliation(s)
- Katerina Lin
- Medical Acupuncture Service, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Cynthia Tung
- Medical Acupuncture Service, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Arbogast KB, Curry AE, Pfeiffer MR, Zonfrillo MR, Haarbauer-Krupa J, Breiding MJ, Coronado VG, Master CL. Point of Health Care Entry for Youth With Concussion Within a Large Pediatric Care Network. JAMA Pediatr 2016; 170:e160294. [PMID: 27244368 PMCID: PMC6025897 DOI: 10.1001/jamapediatrics.2016.0294] [Citation(s) in RCA: 207] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Previous epidemiologic research on concussions has primarily been limited to patient populations presenting to sport concussion clinics or to emergency departments (EDs) and to those high school age or older. By examining concussion visits across an entire pediatric health care network, a better estimate of the scope of the problem can be obtained. OBJECTIVE To comprehensively describe point of entry for children with concussion, overall and by relevant factors including age, sex, race/ethnicity, and payor, to quantify where children initially seek care for this injury. DESIGN, SETTING, AND PARTICIPANTS In this descriptive epidemiologic study, data were collected from primary care, specialty care, ED, urgent care, and inpatient settings. The initial concussion-related visit was selected and variation in the initial health care location (primary care, specialty care, ED, or hospital) was examined in relation to relevant variables. All patients aged 0 to 17 years who received their primary care from The Children's Hospital of Philadelphia's (CHOP) network and had 1 or more in-person clinical visits for concussion in the CHOP unified electronic health record (EHR) system (July 1, 2010, to June 30, 2014) were selected. MAIN OUTCOMES AND MEASURES Frequency of initial concussion visits at each type of health care location. Concussion visits in the EHR were defined based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes indicative of concussion. RESULTS A total of 8083 patients were included (median age, 13 years; interquartile range, 10-15 years). Overall, 81.9% (95% CI, 81.1%-82.8%; n = 6624) had their first visit at CHOP within primary care, 5.2% (95% CI, 4.7%-5.7%; n = 418) within specialty care, and 11.7% (95% CI, 11.0%-12.4%; n = 947) within the ED. Health care entry varied by age: 52% (191/368) of children aged 0 to 4 years entered CHOP via the ED, whereas more than three-quarters of those aged 5 to 17 years entered via primary care (5-11 years: 1995/2492; 12-14 years: 2415/2820; and 15-17 years: 2056/2403). Insurance status also influenced the pattern of health care use, with more Medicaid patients using the ED for concussion care (478/1290 Medicaid patients [37%] used the ED vs 435/6652 private patients [7%] and 34/141 self-pay patients [24%]). CONCLUSIONS AND RELEVANCE The findings suggest estimates of concussion incidence based solely on ED visits underestimate the burden of injury, highlight the importance of the primary care setting in concussion care management, and demonstrate the potential for EHR systems to advance research in this area.
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Affiliation(s)
- Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania2University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Allison E. Curry
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Melissa R. Pfeiffer
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mark R. Zonfrillo
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania2University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Juliet Haarbauer-Krupa
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew J. Breiding
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Victor G. Coronado
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina L. Master
- University of Pennsylvania Perelman School of Medicine, Philadelphia4Sports Medicine and Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Wasserman EB, Bazarian JJ, Mapstone M, Block R, van Wijngaarden E. Academic Dysfunction After a Concussion Among US High School and College Students. Am J Public Health 2016; 106:1247-53. [PMID: 27196651 DOI: 10.2105/ajph.2016.303154] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To determine whether concussed students experience greater academic dysfunction than students who sustain other injuries. METHODS We conducted a prospective cohort study from September 2013 through January 2015 involving high school and college students who visited 3 emergency departments in the Rochester, New York, area. Using telephone surveys, we compared self-reported academic dysfunction between 70 students with concussions and a comparison group of 108 students with extremity injuries at 1 week and 1 month after injury. RESULTS At 1 week after injury, academic dysfunction scores were approximately 16 points higher (b = 16.20; 95% confidence interval = 6.39, 26.00) on a 174-point scale in the concussed group than in the extremity injury group. Although there were no differences overall at 1-month after injury, female students in the concussion group and those with a history of 2 or more prior concussions were more likely to report academic dysfunction. CONCLUSIONS Our results showed academic dysfunction among concussed students, especially female students and those with multiple prior concussions, 1 week after their injury. Such effects appeared to largely resolve after 1 month. Our findings support the need for academic adjustments for concussed students.
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Affiliation(s)
- Erin B Wasserman
- At the time of this study, the authors were with the University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jeffrey J Bazarian
- At the time of this study, the authors were with the University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Mark Mapstone
- At the time of this study, the authors were with the University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Robert Block
- At the time of this study, the authors were with the University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Edwin van Wijngaarden
- At the time of this study, the authors were with the University of Rochester School of Medicine and Dentistry, Rochester, NY
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138
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Kasamatsu T, Cleary M, Bennett J, Howard K, McLeod TV. Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer. J Athl Train 2016; 51:153-61. [PMID: 26942658 DOI: 10.4085/1062-6050-51.4.02] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools. OBJECTIVE To examine ATs' perspectives on return to learn, cognitive rest, and communication with school professionals after concussion. DESIGN Cross-sectional study. SETTING Web-based survey. PATIENTS OR OTHER PARTICIPANTS A total of 1124 secondary school ATs completed the survey (28.5% response rate). The majority of participants were employed full time (752/1114 [67.5%]) in public schools (911/1117 [81.6%]). MAIN OUTCOME MEASURE(S) School and AT employment characteristics, demographics, number of concussions evaluated annually, and perceptions of school professionals' familiarity with ATs' responsibilities were independent variables. RESULTS Of the ATs, 44% reported having an existing return-to-learn policy. The strongest predictor of a return-to-learn policy was frequent communication with teachers after concussion (odds ratio = 1.5; 95% confidence interval = 1.2, 1.7). Most ATs recommended complete cognitive rest (eg, no reading, television; 492/1087 [45.3%]) or limited cognitive activity based upon symptoms (391/1087 [36.0%]). Common academic accommodations were postponed due dates (789/954 [82.7%]), rest breaks (765/954 [80.2%]), and partial attendance (740/954 [77.6%]). Athletic trainers self-reported as primary monitors of health (764/1037 [73.7%]) and academic progression (359/1011 [35.5%]). The strongest predictor of ATs' communication with school professionals was their perception of school professionals' understanding of ATs' roles. CONCLUSIONS Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes' physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes.
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Diduch BK, Hudson K, Resch JE, Shen F, Broshek DK, Brady W, Cole SL, Courson R, Castens T, Shimer A, Miller MD. Treatment of Head and Neck Injuries in the Helmeted Athlete. JBJS Rev 2016; 4:01874474-201603000-00002. [PMID: 27500432 DOI: 10.2106/jbjs.rvw.15.00077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Sport-related concussion treatment includes three major phases: initial evaluation at the time of the injury, treatment while the patient is symptomatic, and evaluation of the readiness for a gradual return to participation. Each concussion evaluation should include similar elements: assessment of symptoms, assessment of cognitive ability, assessment of coordination (of the eyes, upper extremities, and lower extremities), and assessment for additional injuries. The spine-boarding recommendations from the American College of Emergency Physicians, National Association of EMS Physicians, and National Athletic Trainers' Association have changed. These recommendations include both decreased use of spinal immobilization and removal of the helmet and shoulder pads prior to securing the athlete to the board when sufficient numbers of trained providers are present. Preseason training and pregame meetings or "medical time outs" should become standard practice for the sidelines medical team (including the athletic trainer, team physician, emergency response personnel, and possibly others).
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Affiliation(s)
- B Kent Diduch
- Department of Health Sciences, James Madison University, Harrisonburg, Virginia
| | - Korin Hudson
- Department of Emergency Medicine, MedStar Georgetown University Hospital & Washington Hospital Center, Washington, DC
| | - Jacob E Resch
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - Francis Shen
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - Donna K Broshek
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - William Brady
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | | | | | - Titus Castens
- Albemarle County Fire Rescue, Charlottesville, Virginia
| | - Adam Shimer
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
| | - Mark D Miller
- Department of Kinesiology (J.E.R.), Spine Division, Spine Center, Department of Orthopaedic Surgery (F.S.), Department of Psychiatry and Neurobehavioral Sciences (D.K.B.), Department of Emergency Medicine, University of Virginia School of Medicine (W.B.), Orthopedic Inpatient Unit, Department of Orthopaedic Surgery (A.S.), Division of Sports Medicine (M.D.M.), University of Virginia, Charlottesville, Virginia
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Chong SL, Chew SY, Feng JXY, Teo PYL, Chin ST, Liu N, Ong MEH. A prospective surveillance of paediatric head injuries in Singapore: a dual-centre study. BMJ Open 2016; 6:e010618. [PMID: 26908533 PMCID: PMC4769425 DOI: 10.1136/bmjopen-2015-010618] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study the causes of head injuries among the paediatric population in Singapore, and the association between causes and mortality, as well as the need for airway or neurosurgical intervention. DESIGN This is a prospective observational study utilising data from the trauma surveillance system from January 2011 to March 2015. SETTING Paediatric emergency departments (EDs) of KK Women's and Children's Hospital and the National University Health System. PARTICIPANTS We included children aged <16 years presenting to the paediatric EDs with head injuries who required a CT scan, admission for monitoring of persistent symptoms, or who died from the head injury. We excluded children who presented with minor mechanisms and those whose symptoms had spontaneously resolved. PRIMARY AND SECONDARY OUTCOME MEASURES Primary composite outcome was defined as death or the need for intubation or neurosurgical intervention. Secondary outcomes included length of hospital stay and type of neurosurgical intervention. RESULTS We analysed 1049 children who met the inclusion criteria. The mean age was 6.7 (SD 5.2) years. 260 (24.8%) had a positive finding on CT. 17 (1.6%) children died, 52 (5.0%) required emergency intubation in the ED and 58 (5.5%) underwent neurosurgery. The main causes associated with severe outcomes were motor vehicle crashes (OR 7.2, 95% CI 4.3 to 12.0) and non-accidental trauma (OR 5.8, 95% CI 1.8 to 18.6). This remained statistically significant when we stratified to children aged <2 years and performed a multivariable analysis adjusting for age and location of injury. For motor vehicle crashes, less than half of the children were using restraints. CONCLUSIONS Motor vehicle crashes and non-accidental trauma causes are particularly associated with poor outcomes among children with paediatric head injury. Continued vigilance and compliance with injury prevention initiatives and legislature are vital.
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Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
| | - Su Yah Chew
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Jasmine Xun Yi Feng
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Penny Yun Lin Teo
- Department of Emergency Medicine, National University Health System, Singapore
| | - Sock Teng Chin
- Department of Emergency Medicine, National University Health System, Singapore
| | - Nan Liu
- Department of Emergency Medicine, Singapore General Hospital, Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore
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Bressan S, Takagi M, Anderson V, Davis GA, Oakley E, Dunne K, Clarke C, Doyle M, Hearps S, Ignjatovic V, Seal M, Babl FE. Protocol for a prospective, longitudinal, cohort study of postconcussive symptoms in children: the Take C.A.Re (Concussion Assessment and Recovery Research) study. BMJ Open 2016; 6:e009427. [PMID: 26758260 PMCID: PMC4716210 DOI: 10.1136/bmjopen-2015-009427] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION A substantial minority of children who sustain a concussion suffer prolonged postconcussive symptoms. These symptoms can persist for more than 1 month postinjury and include physical, cognitive, behavioural and emotional changes. Those affected can develop significant disability, diminishing their quality of life. The precise prevalence of postconcussive symptoms following child concussion is unclear, with heterogeneous and at times conflicting results published regarding factors that predict children at risk for developing long-lasting postconcussive symptoms. The aim of the Take C.A.Re (Concussion Assessment and Recovery Research) study is to provide an in-depth multidimensional description of the postconcussive recovery trajectories from a physical, neurocognitive and psychosocial perspective in the 3 months following concussion, with a focus on the early postconcussive period, and identification of factors associated with prolonged recovery. METHODS AND ANALYSIS Take C.A.Re is a prospective, longitudinal study at a tertiary children's hospital, recruiting and assessing patients aged 5-<18 years who present to the emergency department with a concussion and following them at 1-4 days, 2 weeks, 1 month and 3 months postinjury. Multiple domains are assessed: postconcussive symptoms, balance and coordination, neurocognition, behaviour, quality of life, fatigue, post-traumatic stress symptoms, parental distress and family burden. 'Delayed recovery' is operationalised as the presence of ≥ 3 symptoms on the Post Concussive Symptoms Inventory rated as worse compared with baseline. Main analyses comprise analysis of variance (recovery trajectories, delayed vs normal recovery groups) and regression analyses of predictors of recovery (preinjury, acute and family factors). ETHICS AND DISSEMINATION Ethical approval has been obtained through the Royal Children's Hospital Melbourne Human Research Ethics Committee (33122). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER ACTRN12615000316505.
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Affiliation(s)
- Silvia Bressan
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Michael Takagi
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Psychology Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Ed Oakley
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital Melbourne, Victoria, Australia
| | - Kevin Dunne
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Melissa Doyle
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Vera Ignjatovic
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Marc Seal
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital Melbourne, Victoria, Australia
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142
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Rose SC, McNally KA, Heyer GL. Returning the student to school after concussion: what do clinicians need to know? ACTA ACUST UNITED AC 2015; 1:CNC4. [PMID: 30202549 PMCID: PMC6114019 DOI: 10.2217/cnc.15.4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 04/10/2015] [Indexed: 11/21/2022]
Abstract
Participation in school is vital to a child's academic and social development. Following concussion, returning the student to school can pose several challenges for families, healthcare providers and school personnel. The complex constellation of postconcussion symptoms can impair learning and can make the school environment intolerable. Research evidence to guide the return to school process is lacking, but protocols have been proposed that outline a gradual reintroduction to school with academic accommodations tailored to the student's specific symptoms. Key medical and school personnel must understand their respective roles to optimize the process. This review of the current literature examines the available data and expert recommendations that can support a student's successful return to school following concussion.
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Affiliation(s)
- Sean C Rose
- Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Kelly A McNally
- Division of Pediatric Psychology & Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Psychology & Neuropsychology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Geoffrey L Heyer
- Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA.,Division of Pediatric Neurology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.,Department of Neurology, The Ohio State University, Columbus, OH, USA
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