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Yumul JN, McKinlay A, Anderson V, Catroppa C. Behaviour outcomes three months after mild TBI in preschool children. Neuropsychol Rehabil 2024; 34:600-618. [PMID: 37354534 DOI: 10.1080/09602011.2023.2224030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
This study examined parents' report of behaviour in preschoolers after a mild traumatic brain injury (mTBI), compared the proportion of preschoolers with elevated behaviour ratings between the mTBI and limb injury (LI) groups, and explored injury, premorbid child, and parent variables that may be associated with parents' report of behaviour at three months post-injury. Children aged 2-5 years with a mTBI (n = 13) or mild LI (n = 6) were recruited from the emergency department. Behaviour was assessed using the Child Behaviour Checklist. Preliminary findings showed that post-injury behaviour ratings remained in the normal range. The mTBI group had higher scores than the LI group at three months post-injury in terms of sleep; however, this may have been pre-existing. Two children with mTBI received borderline-clinically significant ratings on diagnostic-level anxiety problems at the three-month follow-up, while none of the limb-injured controls obtained elevated behaviour ratings. Parent-rated post-injury behaviour was significantly associated with premorbid child functioning and parental stress, which needs to be explored in greater detail using larger preschool mTBI samples.
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Affiliation(s)
- Joy Noelle Yumul
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Audrey McKinlay
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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2
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Dupont D, Tang K, Beaudoin C, Dégeilh F, Gagnon I, Yeates KO, Rose SC, Gravel J, Burstein B, Stang AS, Stanley RM, Zemek RL, Beauchamp MH. Postconcussive Symptoms After Early Childhood Concussion. JAMA Netw Open 2024; 7:e243182. [PMID: 38512252 PMCID: PMC10958232 DOI: 10.1001/jamanetworkopen.2024.3182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/26/2024] [Indexed: 03/22/2024] Open
Abstract
Importance Research on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their evolution in young children. Objective To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure. Design, Setting, and Participants This cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids' Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024. Exposure Concussion sustained between ages 6 and 72 months. Main Outcomes and Measures Primary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations & Symptoms inventory. Group comparisons were analyzed using ordinal regression models. Results The study included 303 children (mean [SD] age, 35.8 [20.2] months; 152 [50.2%] male). Of these, 174 children had a concussion (mean [SD] age, 33.3 [19.9] months), 60 children had an OI (mean [SD] age, 38.4 [19.8] months) and 69 children were uninjured controls (mean [SD] age, 39.7 [20.8] months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio [OR], 4.33 [95% CI, 2.44-7.69]; concussion vs control: OR, 7.28 [95% CI, 3.80-13.93]), 10 days (concussion vs OI: OR, 4.44 [95% CI, 2.17-9.06]; concussion vs control: OR, 5.94 [95% CI, 3.22-10.94]), 1 month (concussion vs OI: OR, 2.70 [95% CI, 1.56-4.68]; concussion vs control: OR, 4.32 [95% CI, 2.36-7.92]), and 3 months (concussion vs OI: OR, 2.61 [95% CI, 1.30-5.25]; concussion vs control: OR, 2.40 [95% CI, 1.36-4.24]). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points. Conclusions and Relevance In this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.
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Affiliation(s)
- Dominique Dupont
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Ken Tang
- Independent Statistical Consultant, Richmond, British Columbia
| | - Cindy Beaudoin
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Fanny Dégeilh
- Univ Rennes, CNRS (Centre national de recherche scientifique), Inria, Inserm, IRISA (Institut de recherche en informatique et systèmes aléatoires) UMR (Unité mixte de recherche) 6074, EMPENN - ERL (Equipe de recherche labellisée) U1228, Rennes, France
| | - Isabelle Gagnon
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Keith Owen Yeates
- Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Sean C Rose
- Child Neurology, Nationwide Children's Hospital, Columbus, Ohio
- The Ohio State University College of Medicine Columbus, Columbus
| | - Jocelyn Gravel
- Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Brett Burstein
- Montreal Children's Hospital, Division of Pediatric Emergency Medicine, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Antonia S Stang
- Department of Pediatrics, University of Calgary, Calgary Alberta, Canada
| | - Rachel M Stanley
- The Ohio State University College of Medicine Columbus, Columbus
- Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Roger L Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ontario, Canada
| | - Miriam H Beauchamp
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche Azrieli du Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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3
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Dupont D, Larivière-Bastien D, Caron JG, Beaudoin C, Gravel J, Gagnon I, Burstein B, Beaudin M, Rose SC, Yeates KO, Beauchamp MH. "What If?": Caregivers' Experiences Following Early Childhood Concussion. J Pediatr Psychol 2023; 48:971-981. [PMID: 37579243 DOI: 10.1093/jpepsy/jsad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE Little is known about the symptoms, signs, and management guidelines for children under the age of 6 years after they sustain a concussion. Caregivers of such young children may have unique concerns and encounter different challenges from those of school-age children given the distinctive developmental characteristics of the early childhood period. This study aimed to explore the experience of caregivers through semistructured interviews to inform clinical practice. METHODS Fifty caregivers of children aged 6 months to 5.99 years were interviewed 3 months postinjury for this qualitative study to document their experience in relation to their child's accident, recovery, and healthcare provisions. RESULTS Four main themes were identified: (1) visible changes associated with caregiver concerns, (2) a roller-coaster of emotions after the injury, (3) healthcare providers' role in addressing the need for reassurance, and (4) the need for better information after the injury. CONCLUSION The findings provide critical insight into the unique experiences and information needs of caregivers of young children who sustain concussion. The challenges identified can inform healthcare professionals regarding the needs of caregivers after early concussion and contribute to building a knowledge base for the development of age-appropriate anticipatory guidance for caregiver mental health and child recovery.
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Affiliation(s)
- Dominique Dupont
- Department of Psychology, University of Montreal, Canada
- CHU Sainte-Justine Research Center, Canada
| | - Danaë Larivière-Bastien
- Department of Psychology, University of Montreal, Canada
- CHU Sainte-Justine Research Center, Canada
| | - Jeffrey G Caron
- School of Kinesiology and Physical Activity Sciences, University of Montreal, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Canada
| | - Cindy Beaudoin
- Department of Psychology, University of Montreal, Canada
| | | | - Isabelle Gagnon
- Montreal Children's Hospital, McGill University Health Centre, Canada
- School of Physical and Occupational Therapy, McGill University, Canada
| | - Brett Burstein
- Montreal Children's Hospital, McGill University Health Centre, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Myriam Beaudin
- Department of Psychology, University of Quebec in Montreal, Canada
| | - Sean C Rose
- Department of Neurology, Nationwide Children's Hospital, USA
| | - Keith O Yeates
- Department of Psychology, Alberta Children's Hospital Research Institute, Canada
- Hotchkiss Brain Institute, University of Calgary, Canada
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Canada
- CHU Sainte-Justine Research Center, Canada
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4
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Yeates KO, Barlow KM, Wright B, Tang K, Barrett O, Berdusco E, Black AM, Clark B, Conradi A, Godfrey H, Kolstad AT, Ly A, Mikrogianakis A, Purser R, Schneider K, Stang AS, Zemek R, Zwicker JD, Johnson DW. Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial. CAN J EMERG MED 2023; 25:627-636. [PMID: 37351798 PMCID: PMC10333406 DOI: 10.1007/s43678-023-00530-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs. METHODS Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care. RESULTS A total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change - 23.76 min, 95% CI - 37.99, - 9.52). Total physician claims increased significantly at only 1 of 5 sites. CONCLUSIONS Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient. TRIAL REGISTRATION ClinicalTrials.gov NCT05095012.
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Affiliation(s)
- Keith Owen Yeates
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N1N4, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| | - Karen M Barlow
- Child Health Research Centre, Queensland Children's Hospital, University of Queensland, South Brisbane, Australia
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
- Women's and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Ken Tang
- Independent Statistical Consulting, Vancouver, BC, Canada
| | | | - Edward Berdusco
- Departments of Emergency Medicine and Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Amanda M Black
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Brenda Clark
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Alf Conradi
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Heather Godfrey
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, Alberta Children's Hospital, Calgary, AB, Canada
| | - Ashley T Kolstad
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Anh Ly
- Department of Psychology, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N1N4, Canada
| | | | - Ross Purser
- Department of Emergency Medicine, Grey Nuns Hospital, Edmonton, AB, Canada
| | - Kathryn Schneider
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Antonia S Stang
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - David W Johnson
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
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5
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Yumul JN, Catroppa C, McKinlay A, Anderson V. Post-Concussive Symptoms in Preschool Children up to Three Months Post-Injury. Dev Neurorehabil 2023; 26:338-347. [PMID: 37548355 DOI: 10.1080/17518423.2023.2242945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/20/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS Post-concussive symptoms (PCS) are central to the assessment and management of mild traumatic brain injury (mTBI); however, this remains poorly understood in children aged ≤5 years. The study aimed to explore individual PCS, pattern of parents' PCS report over time, proportion of symptomatic children, and variables associated with parents' report of PCS in their preschool child after a mTBI. METHODS Children aged 2-5 years with either a mTBI (n=13) or limb injury (n=6) were recruited from the emergency department (ED). Parent ratings of child PCS were assessed at ED presentation, at one month, and at three months post-injury. Injury (e.g. injury group, pain), child (e.g. pre-existing behavior, symptoms), and parent (e.g. parental stress, education) characteristics were considered when investigating variables that may be relevant to parent report of PCS. RESULTS The number of total, physical, and sleep PCS were significantly higher after mTBI, with a significant decrease in physical and sleep PCS over time. The proportion of symptomatic children was comparable between injury groups at each time point. Acute pain and pre-injury symptoms were significantly associated with parents' acute PCS report in the mTBI group. Further research is needed on variables that may be relevant to parents' PCS report at follow-up. CONCLUSION Preliminary findings suggest a general trauma response after a mTBI or limb injury, but acute physical and sleep PCS may help differentiate the injury groups. Injury and premorbid child variables may be relevant to parents' report of acute PCS in their child. Additional research is needed to investigate PCS in preschoolers and variables that may predict parents' PCS report.
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Affiliation(s)
- Joy Noelle Yumul
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Cathy Catroppa
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
| | - Audrey McKinlay
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- University of Canterbury, Christchurch, New Zealand
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Melbourne, Australia
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Rose SC, Levine DA, Shi J, Wheeler K, Aungst T, Stanley RM, Beauchamp MH. Emergency department visits for mild traumatic brain injury in early childhood. Am J Emerg Med 2023; 65:36-42. [PMID: 36580699 DOI: 10.1016/j.ajem.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Brain injury during early childhood may disrupt key periods of neurodevelopment. Most research regarding mild traumatic brain injury (mTBI) has focused on school-age children. We sought to characterize the incidence and healthcare utilization for mTBI in young children presenting to U.S. emergency departments (ED). METHODS The Nationwide Emergency Department Sample was queried for children age 0-6 years with mTBI from 2016 to 2019. Patients were excluded for focal or diffuse TBI, drowning or abuse mechanism, death in the ED or hospital, Injury Severity Score > 15, neurosurgical intervention, intubation, or blood product transfusion. RESULTS National estimates included 1,372,291 patient visits: 63.5% were two years or younger, 57.5% were male, and 69.4% were injured in falls. The most common head injury diagnosis was "unspecified injury of head" (83%); this diagnosis decreased in frequency as age increased, in favor of a concussion diagnosis. Most patients were seen at low pediatric volume EDs (64.5%) and non-children's hospital EDs (86.2%), and 64.9% were seen at a non-teaching hospital. Over 98% were treated in the ED and discharged home. Computed tomography of the head and cervical spine were performed in 18.7% and 1.6% of patients, respectively, less often at children's hospitals (OR = 0.55, 95%CI = 0.41-0.76 for head and OR = 0.19, 95%CI = 0.11-0.34 for cervical spine). ED charges resulted in $540-681 million annually, and more than half of patients utilized Medicaid. CONCLUSIONS Early childhood mTBI is prevalent and results in high financial burden in the U.S. There is wide variation in diagnostic coding and computed tomography scanning amongst EDs. More focused research is needed to identify optimal diagnostic tools and management strategies.
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Affiliation(s)
- Sean C Rose
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Division of Pediatric Neurology, Columbus, OH 43205, United States.
| | - Deborah A Levine
- New York Presbyterian Hospital and Weill Cornell Medicine, Department of Emergency Medicine, New York, NY 10021, United States
| | - Junxin Shi
- Nationwide Children's Hospital, Division of Emergency Medicine, Columbus, OH 43205, United States
| | - Krista Wheeler
- Nationwide Children's Hospital, Division of Emergency Medicine, Columbus, OH 43205, United States
| | - Taylour Aungst
- Nationwide Children's Hospital, Division of Neurology, Columbus, OH 43205, United States
| | - Rachel M Stanley
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Division of Emergency Medicine, Columbus, OH 43205, United States
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal and Ste-Justine Hospital Research Center, Montreal, Quebec, Canada
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7
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Djukic S, Phillips NL, Lah S. Sleep outcomes in pediatric mild traumatic brain injury: a systematic review and meta-analysis of prevalence and contributing factors. Brain Inj 2022; 36:1289-1322. [PMID: 36413091 DOI: 10.1080/02699052.2022.2140198] [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: 11/24/2022]
Abstract
OBJECTIVE The aim was to determine the prevalence of disturbed sleep in children who sustained mild traumatic brain injury (mTBI). METHODS We conducted electronic searches of three databases MEDLINE, PsychINFO and EMBASE against pre-determined inclusion/exclusion criteria. We used the Newcastle-Ottawa Scale to assess the risk of bias. RESULTS Forty-four articles met the inclusion criteria. The risk of bias was mainly rated as moderate to high. Meta-analysis revealed that prevalence of sleep disturbances decreased as the time since injury increased: 51%, 40% and 9% within 1 week, between 1 week and 1 month, and between 1 and 3 months, respectively, but increased to 21% after 3 months. The sleep symptom drowsiness followed a similar temporal pattern. Other sleep symptoms of hypersomnia (sleeping more than usual) and insomnia (trouble falling asleep and sleeping less than usual) remained stable over time. The prevalence of sleep disturbances in children with mTBI was higher than in the general population. Pre-injury sleep and older age at injury were related to worse sleep outcomes. CONCLUSIONS Sleep disturbances are highly prevalent in the acute phase post-mTBI. Given that disturbed sleep can impact daily functioning and recovery, routine screening and management of sleep disturbances in children who sustain mTBI is important.
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Affiliation(s)
- Suzana Djukic
- School of Psychology, The University of Sydney, Sydney, Australia
| | | | - Suncica Lah
- School of Psychology, The University of Sydney, Sydney, Australia
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Wittevrongel K, Barrett O, Couloigner I, Bertazzon S, Hagel B, Schneider KJ, Johnson D, Yeates KO, Zwicker JD. Longitudinal trends in incidence and health care use for pediatric concussion in Alberta, Canada. Pediatr Res 2022; 93:1752-1764. [PMID: 36085365 PMCID: PMC10172117 DOI: 10.1038/s41390-022-02214-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 06/24/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND We described longitudinal trends in the incidence of episodes of care (EOC) and follow-up care for pediatric concussion in relation to age, sex, rurality of patient residence, point of care, and area-based socioeconomic status (SES) in Alberta, Canada. METHODS A retrospective population-based cohort study was conducted using linked, province-wide administrative health data for all patients <18 years of age who received a diagnosis of concussion, other specified injuries of head, unspecified injury of head, or post-concussion syndrome between April 1, 2004 and March 31, 2018. Data were geospatially mapped. RESULTS Concussion EOCs increased 2.2-fold over the study period, follow-up visits 5.1-fold. Care was increasingly received in physician office (PO) settings. Concussion diagnoses in rural and remote areas occurred in emergency department (ED) settings more often than in metro centres or urban areas (76%/75% vs. 52%/60%). Proportion of concussion diagnoses was positively related to SES and age. Diagnosis and point of care varied geographically. CONCLUSIONS The shift in care to PO settings, increased incidence of all diagnoses, and the higher use of the ED by some segments of the population all have important implications for appropriate clinical management and the efficient provision of health care for pediatric concussion. IMPACT This is the first study to use EOC to describe longitudinal trends in incidence and follow-up care for pediatric concussion in relation to age, sex, rurality, point of care, and area-based SES. We report increased incidence of concussion in both emergency and outpatient settings and the proportion of diagnoses was positively related to SES and age. Patients increasingly received care for concussion in PO over time. Geospatial mapping indicated that the incidence of concussion and unspecified injury of head varied geographically and temporally. Results have important implications for appropriate clinical management and efficient provision of health care following pediatric concussion.
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Affiliation(s)
| | | | | | - Stefania Bertazzon
- Department of Geography, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Brent Hagel
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Kathryn J Schneider
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - David Johnson
- Alberta Health Services, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Keith O Yeates
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jennifer D Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. .,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada. .,Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
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9
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Beauchamp MH, Séguin M, Gagner C, Lalonde G, Bernier A. The PARENT model: a pathway approach for understanding parents’ role after early childhood mild traumatic brain injury. Clin Neuropsychol 2020; 35:846-867. [DOI: 10.1080/13854046.2020.1834621] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- M. H. Beauchamp
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - M. Séguin
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - C. Gagner
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - G. Lalonde
- Department of Psychology, University of Montreal, Canada
- Sainte-Justine Hospital Research Center, Montreal, Canada
| | - A. Bernier
- Department of Psychology, University of Montreal, Canada
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