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Trbovich AM, Mucha A, Zynda AJ, Farley T, Kegel N, Fazio V, Collins MW, Kontos AP. Multidomain Predictors of Protracted Recovery following Concussion among 5- to 9-Year-Old Patients: A Preliminary Study. J Pediatr 2024; 268:113927. [PMID: 38309522 DOI: 10.1016/j.jpeds.2024.113927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/09/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To determine which components from a multidomain assessment best predict protracted recovery in pediatric patients with a concussion. STUDY DESIGN A prospective cohort of patients aged 5-9 years who presented within 21 days of concussion to a specialty clinic were categorized into normal (≤30 days) and protracted (>30 days) recovery. Participants provided demographic and medical history information, and completed the Child Sport Concussion Assessment Tool-5 symptom report and balance assessment, the Vestibular/Ocular Motor Screen-Child (VOMS-C), and the Pediatric Immediate Post-concussion Assessment and Cognitive Testing. Univariate logistic regressions (LR) were used to inform a follow-up forward stepwise LR to identify the best predictors of protracted recovery. Receiver operating characteristic analysis of the area under the curve (AUC) was used to identify which predictors retained from the LR model best discriminated recovery. RESULTS The final sample included 68 patients (7.52 ± 2.3 years; 56% male), 36 (52.9%) with normal and 32 (47.1%) with protracted recovery. Results of the LR to identify protracted recovery were significant (P < .001) and accounted for 39% of the variance. The model accurately classified 78% of patients, with days to first clinic visit (OR, 1.2; 95% CI, 1.1-1.4; P = .003) and positive VOMS-C findings (OR, 8.32; 95% CI, 2.4-28.8; P < .001) as significant predictors. A receiver operating characteristic analysis of the AUC of this 2-factor model discriminated protracted from normal recovery (AUC, 0.82; 95% CI, 0.71-0.92; P < .001). CONCLUSIONS Days to first clinic visit and positive findings on the VOMS-C were the most robust predictors of protracted recovery after concussion in young pediatric patients.
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Affiliation(s)
- Alicia M Trbovich
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA.
| | - Anne Mucha
- University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA
| | - Aaron J Zynda
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Taylor Farley
- University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA
| | - Nathan Kegel
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Vanessa Fazio
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Michael W Collins
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
| | - Anthony P Kontos
- University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA
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2
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Gornall A, Takagi M, Morawakage T, Liu X, Anderson V. Mental health after paediatric concussion: a systematic review and meta-analysis. Br J Sports Med 2021; 55:1048-1058. [PMID: 33926965 DOI: 10.1136/bjsports-2020-103548] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis sought to rigorously examine mental health outcomes following paediatric concussion. To date, heterogeneous findings and methodologies have limited clinicians' and researchers' ability to meaningfully synthesise existing literature. In this context, there is a need to clarify mental health outcomes in a homogeneous sample, controlling for key methodological differences and applying a consistent definition of concussion across studies. DESIGN Systematic review and meta-analysis. DATA SOURCES We searched Medline, Embase, PsycINFO, CINAHL, SportDiscus, Scopus and PubMed. ELIGIBILITY Peer-reviewed studies published between 1980 and June 2020 that prospectively examined mental health outcomes after paediatric concussion, defined as per the Berlin Consensus Statement on Concussion in Sport. RESULTS Sixty-nine articles characterising 60 unique samples met inclusion criteria, representing 89 114 children with concussion. Forty articles (33 studies) contributed to a random effects meta-analysis of internalising (withdrawal, anxiety, depression, post-traumatic stress), externalising (conduct problems, aggression, attention, hyperactivity) and total mental health difficulties across three time points post-injury (acute, persisting and chronic). Overall, children with concussion (n=6819) experienced significantly higher levels of internalising (g=0.41-0.46), externalising (g=0.25-0.46) and overall mental health difficulties compared with controls (g=0.18-0.49; n=56 271), with effects decreasing over time. SUMMARY/CONCLUSIONS Our review highlights that mental health is central to concussion recovery. Assessment, prevention and intervention of mental health status should be integrated into standard follow-up procedures. Further research is needed to clarify the mechanisms underlying observed relationships between mental health, post-concussion symptoms and other psychosocial factors. Results suggest that concussion may both precipitate and exacerbate mental health difficulties, thus impacting delayed recovery and psychosocial outcomes.
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Affiliation(s)
- Alice Gornall
- Psychological Sciences, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia.,Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michael Takagi
- Psychological Sciences, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia.,Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Psychology, The University of Melbourne, Melbourne School of Psychological Sciences, Melbourne, Victoria, Australia
| | - Thilanka Morawakage
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Xiaomin Liu
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Vicki Anderson
- Brain and Mind Research, Clinical Sciences Theme, Murdoch Children's Research Institute, Parkville, Victoria, Australia .,Psychology, The University of Melbourne, Melbourne School of Psychological Sciences, Melbourne, Victoria, Australia.,Psychology Service, The Royal Children's Hospital, Mebourne, Victoria, Australia
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3
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Gornall A, Takagi M, Clarke C, Babl FE, Davis GA, Dunne K, Anderson N, Hearps SJ, Demaneuf T, Rausa V, Anderson V. Behavioral and Emotional Difficulties after Pediatric Concussion. J Neurotrauma 2020; 37:163-169. [DOI: 10.1089/neu.2018.6235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alice Gornall
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Cathriona Clarke
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E. Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
| | - Gavin A. Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kevin Dunne
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Department of Rehabilitation Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Nicholas Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Thibaut Demaneuf
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vanessa Rausa
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Victoria, Australia
- Psychology Service, Royal Children's Hospital, Melbourne, Victoria, Australia
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4
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Pediatric Intracranial Pseudoaneurysms: A Report of 15 Cases and Review of the Literature. World Neurosurg 2018; 116:e951-e959. [DOI: 10.1016/j.wneu.2018.05.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 01/04/2023]
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The Role of Physical Activity in Recovery From Concussion in Youth: A Neuroscience Perspective. J Neurol Phys Ther 2018; 42:155-162. [PMID: 29864097 DOI: 10.1097/npt.0000000000000226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Concussion is a major public health concern and one of the least understood neurological injuries. Children and youth are disproportionally affected by concussion, and once injured, take longer to recover. Current guidelines recommend a period of physical and cognitive rest with a gradual progressive return to activity. Although there is limited high-quality evidence (eg, randomized controlled trials) on the benefit of physical activity and exercise after concussion, most studies report a positive impact of exercise in facilitating recovery after concussion. In this article we characterize the complex and dynamic changes in the brain following concussion by reviewing recent results from neuroimaging studies and to inform physical activity participation guidelines for the management of a younger population (eg, 14-25 years of age) after concussion. SUMMARY OF KEY POINTS Novel imaging methods and tools are providing a picture of the changes in the structure and function of the brain following concussion. These emerging results will, in the future, assist in creating objective, evidence-based pathways for clinical decision-making. Until such time, physical therapists should be aware that current neuroimaging evidence supports participation in physical activity after an initial and brief period of rest, and consider how best to incorporate exercise into rehabilitation to enhance recovery following concussion. RECOMMENDATIONS FOR CLINICAL PRACTICE It is important that physical therapists understand the neurobiological impact of concussion injury and recovery, and be informed of the scientific rationale for the recommendations and guidelines for engagement in physical activity.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A205).
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Pastore V, Galbiati S, Recla M, Colombo K, Beretta E, Strazzer S. Psychological and behavioural difficulties following severe TBI in adolescence: a comparison with a sample of peers with brain lesions of other origin and with a control group. Brain Inj 2018; 32:1011-1020. [PMID: 29738269 DOI: 10.1080/02699052.2018.1469041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe behavioural and adjustment problems in a group of 57 adolescents with severe traumatic brain injury (TBI) and compare them with a clinical group of peers with brain lesions of other origin (N = 33) and a control group of healthy adolescents (N = 48). METHODS All subjects received an age-appropriate assessment, including the child behaviour checklist (CBCL) 4/18, the strengths and difficulties questionnaire (SDQ) and the vineland adaptive behaviour scales (VABS). RESULTS Compared with healthy peers, adolescents with TBI presented with more marked behavioural problems on most CBCL scales (Internalization and Externalization domains were both affected) and on the SDQ Hyperactivity and Peer problems scales. They also showed a more impaired functioning in most VABS domains. Compared with adolescents with brain lesions of other aetiology, patients with TBI showed more conduct problems on the SDQ scale, but no significant differences were found on the CBCL scales. Regarding the VABS, patients with other lesions presented with the worst outcome in the Motor and Daily Living Skills domains. CONCLUSIONS Adolescents with TBI are exposed at a very high risk to develop behavioural and psychological disturbances with the potential to severely affect their social re-entry. Further knowledge is needed to plan early and well-timed interventions.
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Affiliation(s)
- Valentina Pastore
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Susanna Galbiati
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Monica Recla
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Katia Colombo
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Elena Beretta
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
| | - Sandra Strazzer
- a Neurophysiatric Department , 'Eugenio Medea' Scientific Institute , Lecco , Bosisio Parini , Italy
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7
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Schmidt J, Hayward KS, Brown KE, Zwicker JG, Ponsford J, van Donkelaar P, Babul S, Boyd LA. Imaging in Pediatric Concussion: A Systematic Review. Pediatrics 2018; 141:peds.2017-3406. [PMID: 29678928 DOI: 10.1542/peds.2017-3406] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Pediatric mild traumatic brain injury (mTBI) is a common and poorly understood injury. Neuroimaging indexes brain injury and outcome after pediatric mTBI, but remains largely unexplored. OBJECTIVE To investigate the differences in neuroimaging findings in children/youth with mTBI. Measures of behavior, symptoms, time since injury, and age at injury were also considered. DATA SOURCES A systematic review was conducted up to July 6, 2016. STUDY SELECTION Studies were independently screened by 2 authors and included if they met predetermined eligibility criteria: (1) children/youth (5-18 years of age), (2) diagnosis of mTBI, and (3) use of neuroimaging. DATA EXTRACTION Two authors independently appraised study quality and extracted demographic and outcome data. RESULTS Twenty-two studies met the eligibility criteria, involving 448 participants with mTBI (mean age = 12.7 years ± 2.8). Time postinjury ranged from 1 day to 5 years. Seven different neuroimaging methods were investigated in included studies. The most frequently used method, diffusion tensor imaging (41%), had heterogeneous findings with respect to the specific regions and tracts that showed group differences. However, group differences were observed in many regions containing the corticospinal tract, portions of the corpus callosum, or frontal white-matter regions; fractional anisotropy was increased in 88% of the studies. LIMITATIONS This review included a heterogeneous sample with regard to participant ages, time since injury, symptoms, and imaging methods which prevented statistical pooling/modelling. CONCLUSIONS These data highlight essential priorities for future research (eg, common data elements) that are foundational to progress the understanding of pediatric concussion.
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Affiliation(s)
- Julia Schmidt
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada; .,School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Kathryn S Hayward
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,Florey Institute of Neuroscience and Mental Health, National Health and Medical Research Council and University of Melbourne, Parkville, Australia.,Centre for Research Excellence in Stroke Rehabilitation and Brain Recovery, Melbourne, Australia
| | - Katlyn E Brown
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Jill G Zwicker
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | | | - Paul van Donkelaar
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - Shelina Babul
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada; and
| | - Lara A Boyd
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
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8
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Guerriero RM, Kuemmerle K, Pepin MJ, Taylor AM, Wolff R, Meehan WP. The Association Between Premorbid Conditions in School-Aged Children With Prolonged Concussion Recovery. J Child Neurol 2018; 33:168-173. [PMID: 29334854 DOI: 10.1177/0883073817749655] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The association between preexisting anxiety, depression, and/or neurodevelopmental disorders and symptom duration among younger children who sustain concussions is not well known. The authors conducted a prospective cohort study of 569 patients presenting to a pediatric neurology clinic with the diagnosis of concussion. The authors measured associations between symptom duration and premorbid conditions, as well as gender, age, mechanism of injury, and other factors. Premorbid conditions were common in both age groups. On univariate modeling female gender, age >12 years, and premorbid conditions were associated with longer symptom duration. On multivariable modeling, females and patients ≤12 years old with a history of headaches, migraines, or a history of psychiatric conditions took significantly longer to recover than those without such conditions. Premorbid conditions are associated with a prolonged recovery from concussion among those patients ≤12 years old.
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Affiliation(s)
- Réjean M Guerriero
- 1 Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA.,2 Departments of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis, MO, USA.,3 The Brain Injury Center, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
| | - Karameh Kuemmerle
- 1 Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA.,3 The Brain Injury Center, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
| | - Michael J Pepin
- 4 Department of Pediatrics, Division of Sports Medicine, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
| | - Alex M Taylor
- 1 Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA.,3 The Brain Injury Center, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
| | - Robert Wolff
- 1 Department of Neurology, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA.,3 The Brain Injury Center, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA
| | - William P Meehan
- 3 The Brain Injury Center, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA.,4 Department of Pediatrics, Division of Sports Medicine, Boston Children's Hospital & Harvard Medical School, Boston, MA, USA.,5 Micheli Center for Sports Injury Prevention, Waltham, MA, USA
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9
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Nguyen R, Fiest KM, McChesney J, Kwon CS, Jette N, Frolkis AD, Atta C, Mah S, Dhaliwal H, Reid A, Pringsheim T, Dykeman J, Gallagher C. The International Incidence of Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Can J Neurol Sci 2016; 43:774-785. [PMID: 27670907 DOI: 10.1017/cjn.2016.290] [Citation(s) in RCA: 247] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Understanding the epidemiology of traumatic brain injury (TBI) is essential to shape public health policy, implement prevention strategies, and justify allocation of resources toward research, education, and rehabilitation in TBI. There is not, to our knowledge, a systematic review of population-based studies addressing the epidemiology of TBI that includes all subtypes. We performed a comprehensive systematic review and meta-analysis of the worldwide incidence of TBI. METHODS A search was conducted on May 23, 2014, in Medline and EMBASE according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Abstracts were screened independently and in duplicate to identify original research. Study quality and ascertainment bias were assessed in duplicate using a previously published tool. Demographic data and incidence estimates from each study were recorded, along with stratification by age, gender, year of data collection, and severity. RESULTS The search strategy yielded 4944 citations. Two hundred and sixteen articles met criteria for full-text review; 144 were excluded. Hand searching resulted in ten additional articles. Eighty-two studies met all eligibility criteria. The pooled annual incidence proportion for all ages was 295 per 100,000 (95% confidence interval: 274-317). The pooled incidence rate for all ages was 349 (95% confidence interval: 96.2-1266) per 100,000 person-years. Incidence proportion and incidence rate were examined to see if associated with age, sex, country, or severity. CONCLUSIONS We conclude that most TBIs are mild and most TBIs occur in males among the adult population. The incidence of TBI varies widely by ages and between countries. Despite being an important medical, economic, and social problem, the global epidemiology of TBI is still not well-characterized in the current literature. Understanding the incidence of TBI, particularly mild TBI, remains challenging because of nonstandardized reporting among neuroepidemiological studies.
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Affiliation(s)
- Rita Nguyen
- 1Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - Kirsten M Fiest
- 1Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - Jane McChesney
- 2Department of Community Health Sciences & O'Brien Institute for Public Health,University of Calgary,Calgary,Alberta,Canada
| | - Churl-Su Kwon
- 4Department of Neurosurgery,King's College Hospital,Denmark Hill,London,UK
| | - Nathalie Jette
- 1Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - Alexandra D Frolkis
- 2Department of Community Health Sciences & O'Brien Institute for Public Health,University of Calgary,Calgary,Alberta,Canada
| | - Callie Atta
- 1Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - Sarah Mah
- 1Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - Harinder Dhaliwal
- 1Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - Aylin Reid
- 5Department of Neurology,University of California Los Angeles,Los Angeles,California
| | - Tamara Pringsheim
- 1Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
| | - Jonathan Dykeman
- 2Department of Community Health Sciences & O'Brien Institute for Public Health,University of Calgary,Calgary,Alberta,Canada
| | - Clare Gallagher
- 1Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada
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10
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Holmes L, Tworig J, Casini J, Morgan I, O'Brien K, Oceanic P, Dabney K. Implication of Socio-Demographics on Cognitive-Related Symptoms in Sports Concussion Among Children. SPORTS MEDICINE-OPEN 2016; 2:38. [PMID: 27747794 PMCID: PMC5023651 DOI: 10.1186/s40798-016-0058-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/03/2016] [Indexed: 12/02/2022]
Abstract
Background Sports-related concussion remains a public health challenge due to its morbidity and mortality. One of the consequences of concussion is cognitive impairment (CI) and cognitive-related symptoms (CRS) which determine, to some extent, physical and behavioral functioning of children who sustain concussion. Despite the high prevalence of CI and CRS associated with concussion, the risk factors are not fully understood. We aimed to characterize CRS and to examine its relationship with race, ethnicity, age, insurance, and sex in a pediatric population. Methods A retrospective cohort (case-only) design was used to assess CRS prevalence and its relationship with race and sex using a pediatric hospital’s electronic medical records. A consecutive sample was used with 1429 cases between 2007 and 2014. Study characteristics were examined using chi-square and log binomial regression for hypothesis-specific testing. Results Of the 1429 cases, 872 (61.0 %) were boys and 557 (39.0 %) were girls. The racial distribution indicated 1146 (80.2 %) Whites, 170 (11.9 %) Blacks/African Americans, and 113 (7.9 %) others. The prevalence of CRS was 78.0 %. Whereas boys had sustained more concussions, girls were more likely to present with CRS; prevalence risk ratio = 1.07, 95 % CI 1.01–1.13, p = 0.02. The crude analysis indicated no racial disparities in CRS prevalence, but the multivariable analysis did, comparing White to Black/African American children; adjusted prevalence risk ratio (aPRR) = 1.77, 99 % CI 1.02–3.08, p = 0.008. Conclusions Racial disparities exist in CRS among children with sports-related concussion, and Black/African American children are more likely, relative to Whites, to suffer CRS. Due to uncertainty in causal inference, we caution the interpretation and application of these data in risk-adapted concussion prevention.
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Affiliation(s)
- Laurens Holmes
- Nemours/Alfred I. DuPont Hospital for Children, Office of Health Equity and Inclusion, P.O. Box 269, Wilmington, DE, 19803, USA. .,University of Delaware, Newark, DE, 19716, USA.
| | | | | | - Isabel Morgan
- Nemours/Alfred I. DuPont Hospital for Children, Office of Health Equity and Inclusion, P.O. Box 269, Wilmington, DE, 19803, USA.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Kathleen O'Brien
- Orthopedic Department, Nemours/A. I. duPont Hospital for Children, Wilmington, DE, 19803, USA
| | - Patricia Oceanic
- Nemours/Alfred I. DuPont Hospital for Children, Office of Health Equity and Inclusion, P.O. Box 269, Wilmington, DE, 19803, USA
| | - Kirk Dabney
- Nemours/Alfred I. DuPont Hospital for Children, Office of Health Equity and Inclusion, P.O. Box 269, Wilmington, DE, 19803, USA.,Orthopedic Department, Nemours/A. I. duPont Hospital for Children, Wilmington, DE, 19803, USA
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11
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Weerdenburg K, Schneeweiss S, Koo E, Boutis K. Concussion and its management: What do parents know? Paediatr Child Health 2016; 21:e22-6. [PMID: 27398059 DOI: 10.1093/pch/21.3.e22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To determine the sensitivity of parental suspicion of concussion relative to paediatric emergency physicians in children who presented to an emergency department (ED) with a head injury. A secondary objective was to examine the variables associated with parental suspicion of concussion concordant with that of a physician. METHODS Parents of children five to 18 years of age presenting to an urban paediatric ED with a nonstructural head injury completed a 24-item questionnaire. RESULTS Of the 577 eligible parents, 495 (85.8%) consented to participate. The sensitivity of parental suspicion for concussion was 40.0% (95% CI 33.2% to 47.2%), while the specificity was 58.3% (95% CI 52.4% to 64.0%). The variable of child age ≥10 years was associated with an increased odds (OR 3.0) of a parental suspicion of concussion concordant with that of a physician; parent age, parent sex, mechanism of head injury and history of concussion in the child were not. Although 453 (91.5%) parents would stop activity if they believed their child sustained a concussion, only 159 (32.1%) were familiar with return-to-play guidelines. CONCLUSIONS Parents often did not suspect a concussion when it was ultimately diagnosed by a paediatric emergency physician, although they were more likely to do so in older children. Only approximately one-third were aware of return-to-play guidelines. To enhance the potential for parent-driven advocacy in the recognition and management of concussion, these data support the need for increased parental education on this injury.
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Affiliation(s)
- Kirstin Weerdenburg
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Suzan Schneeweiss
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Ellen Koo
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Kathy Boutis
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
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12
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Tran LTT, Divita G, Carter ME, Judd J, Samore MH, Gundlapalli AV. Exploiting the UMLS Metathesaurus for extracting and categorizing concepts representing signs and symptoms to anatomically related organ systems. J Biomed Inform 2015; 58:19-27. [PMID: 26362345 DOI: 10.1016/j.jbi.2015.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/25/2015] [Accepted: 08/31/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a method to exploit the UMLS Metathesaurus for extracting and categorizing concepts found in clinical text representing signs and symptoms to anatomically related organ systems. The overarching goal is to classify patient reported symptoms to organ systems for population health and epidemiological analyses. MATERIALS AND METHODS Using the concepts' semantic types and the inter-concept relationships as guidance, a selective portion of the concepts within the UMLS Metathesaurus was traversed starting from the concepts representing the highest level organ systems. The traversed concepts were chosen, filtered, and reviewed to obtain the concepts representing clinical signs and symptoms by blocking deviations, pruning superfluous concepts, and manual review. The mapping process was applied to signs and symptoms annotated in a corpus of 750 clinical notes. RESULTS The mapping process yielded a total of 91,000 UMLS concepts (with approximately 300,000 descriptions) possibly representing physical and mental signs and symptoms that were extracted and categorized to the anatomically related organ systems. Of 1864 distinct descriptions of signs and symptoms found in the 750 document corpus, 1635 of these (88%) were successfully mapped to the set of concepts extracted from the UMLS. Of 668 unique concepts mapped, 603 (90%) were correctly categorized to their organ systems. CONCLUSION We present a process that facilitates mapping of signs and symptoms to their organ systems. By providing a smaller set of UMLS concepts to use for comparing and matching patient records, this method has the potential to increase efficiency of information extraction pipelines.
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Affiliation(s)
- Le-Thuy T Tran
- IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Guy Divita
- IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Marjorie E Carter
- IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Joshua Judd
- IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Matthew H Samore
- IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Adi V Gundlapalli
- IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States; Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States.
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Semple BD, Lee S, Sadjadi R, Fritz N, Carlson J, Griep C, Ho V, Jang P, Lamb A, Popolizio B, Saini S, Bazarian JJ, Prins ML, Ferriero DM, Basso DM, Noble-Haeusslein LJ. Repetitive concussions in adolescent athletes - translating clinical and experimental research into perspectives on rehabilitation strategies. Front Neurol 2015; 6:69. [PMID: 25883586 PMCID: PMC4382966 DOI: 10.3389/fneur.2015.00069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/13/2015] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions among professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical, and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management.
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Affiliation(s)
- Bridgette D. Semple
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Sangmi Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Raha Sadjadi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nora Fritz
- Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, USA
| | - Jaclyn Carlson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carrie Griep
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Vanessa Ho
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Patrice Jang
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Annick Lamb
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Beth Popolizio
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Sonia Saini
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey J. Bazarian
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Mayumi L. Prins
- Department of Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donna M. Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - D. Michele Basso
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - Linda J. Noble-Haeusslein
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Physical Therapy and Rehabilitation Sciences, University of California San Francisco, San Francisco, CA, USA
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Abstract
Background and Objectives:Concussion is a prevalent brain injury in the community. While primary prevention strategies need to be enhanced, it is also important to diagnose and treat concussions expertly and expeditiously to prevent serious complications that may be life-threatening or long lasting. Therefore, physicians should be knowledgeable about the diagnosis and management of concussions. The present study assesses Ontario medical students’ and residents’ knowledge of concussion management.Methods:A survey to assess the knowledge and awareness of the diagnosis and treatment of concussions was developed and administered to graduating medical students (n= 222) and neurology and neurosurgery residents (n = 80) at the University of Toronto.Results:Residents answered correctly significantly more of the questions regarding the diagnosis and management of concussions than the medical students (mean = 5.8 vs 4.1, t= 4.48, p<0.01). Gender, participation in sports, and personal concussion history were not predictive of the number of questions answered correctly. Several knowledge gaps were identified in the sample population as a whole. Approximately half of the medical students and residents did not recognize chronic traumatic encephalopathy (n = 36) or the second impact syndrome (n = 44) as possible consequences of repetitive concussions. Twenty-four percent of the medical students (n = 18) did not think that “every concussed individual should see a physician” as part of management.Conclusions:A significant number of medical students and residents have incomplete knowledge about concussion diagnosis and management. This should be addressed by targeting this population during undergraduate medical education.
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Macpherson A, Fridman L, Scolnik M, Corallo A, Guttmann A. A population-based study of paediatric emergency department and office visits for concussions from 2003 to 2010. Paediatr Child Health 2014; 19:543-6. [PMID: 25587234 PMCID: PMC4276389 DOI: 10.1093/pch/19.10.543] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is a paucity of information regarding descriptive epidemiology of paediatric concussions over time, and few studies include both emergency department (ED) and physician office visits. OBJECTIVE To describe trends in visits for paediatric concussions in both EDs and physician offices according to age and sex. A secondary objective was to describe the cause of concussion for children treated in EDs. METHODS A retrospective, population-based study using linked health administrative data from all concussion-related visits to the ED or a physician office by school-age children and youth (three to 18 years of age) in Ontario between April 1, 2003 and March 3, 2011 was conducted. RESULTS The number of children evaluated in both EDs and a physician offices increased between 2003 and 2010, and this linear trend was statistically significant (P=0.002 for ED visits and P=0.001 for office visits). The rate per 100,000 increased from 466.7 to 754.3 for boys and from 208.6 to 440.7 for girls during the study period. Falls accounted for approximately one-third of the paediatric concussions. Hockey/skating was the most common specific cause of paediatric sports-related concussions. CONCLUSIONS The increasing use of health care services for concussions is likely related to changes in incidence over time and increased awareness of concussion as a health issue. Evidence-based prevention initiatives to help reduce the incidence of concussion are warranted, particularly in sports and recreation programs.
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Affiliation(s)
- Alison Macpherson
- York University
- Institute for Clinical Evaluative Sciences, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | | | | | - Ashley Corallo
- Institute for Clinical Evaluative Sciences, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
- Division of Paediatric Medicine, The Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario
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Ilie G, Mann RE, Boak A, Adlaf EM, Hamilton H, Asbridge M, Rehm J, Cusimano MD. Suicidality, bullying and other conduct and mental health correlates of traumatic brain injury in adolescents. PLoS One 2014; 9:e94936. [PMID: 24736613 PMCID: PMC3988100 DOI: 10.1371/journal.pone.0094936] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 03/20/2014] [Indexed: 11/18/2022] Open
Abstract
Objective Our knowledge on the adverse correlates of traumatic brain injuries (TBI), including non-hospitalized cases, among adolescents is limited to case studies. We report lifetime TBI and adverse mental health and conduct behaviours associated with TBI among adolescents from a population-based sample in Ontario. Method and Findings Data were derived from 4,685 surveys administered to adolescents in grades 7 through 12 as part of the 2011 population-based cross-sectional Ontario Student Drug Use and Health Survey (OSDUHS). Lifetime TBI was defined as head injury that resulted in being unconscious for at least 5 minutes or being retained in the hospital for at least one night, and was reported by 19.5% (95%CI:17.3,21.9) of students. When holding constant sex, grade, and complex sample design, students with TBI had significantly greater odds of reporting elevated psychological distress (AOR = 1.52), attempting suicide (AOR = 3.39), seeking counselling through a crisis help-line (AOR = 2.10), and being prescribed medication for anxiety, depression, or both (AOR = 2.45). Moreover, students with TBI had higher odds of being victimized through bullying at school (AOR = 1.70), being cyber-bullied (AOR = 2.05), and being threatened with a weapon at school (AOR = 2.90), compared with students who did not report TBI. Students with TBI also had higher odds of victimizing others and engaging in numerous violent as well as nonviolent conduct behaviours. Conclusions Significant associations between TBI and adverse internalizing and externalizing behaviours were found in this large population-based study of adolescents. Those who reported lifetime TBI were at a high risk for experiencing mental and physical health harms in the past year than peers who never had a head injury. Primary physicians should be vigilant and screen for potential mental heath and behavioural harms in adolescent patients with TBI. Efforts to prevent TBI during adolescence and intervene at an early stage may reduce injuries and comorbid problems in this age group.
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Affiliation(s)
- Gabriela Ilie
- Division of Neurosurgery and Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada
- * E-mail:
| | - Robert E. Mann
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Community Health and Epidemiology and Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Angela Boak
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Edward M. Adlaf
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hayley Hamilton
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology and Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jürgen Rehm
- Social and Epidemiological Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael D. Cusimano
- Division of Neurosurgery and Injury Prevention Research Office, St. Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Clinically-important brain injury and CT findings in pediatric mild traumatic brain injuries: a prospective study in a Chinese reference hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:3493-506. [PMID: 24675642 PMCID: PMC4025027 DOI: 10.3390/ijerph110403493] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/13/2014] [Accepted: 03/07/2014] [Indexed: 12/21/2022]
Abstract
This study investigated injury patterns and the use of computed tomography (CT) among Chinese children with mild traumatic brain injury (MTBI). We enrolled children with MTBI who were treated within 24 hours of head trauma in the emergency department of Wuhan Medical Care Center for Women and Children in Wuhan, China. Characteristics of MTBIs were analyzed by age and gender. Results of cranial CT scan and clinically-important brain injury (ciTBI) for children were obtained. The definition of ciTBI was: death from TBI, intubation for more than 24 h for TBI, neurosurgery, or hospital admission of 2 nights or more. Of 455 eligible patients with MTBI, ciTBI occurred in two, and no one underwent neurosurgical intervention. CT scans were performed for 441 TBI patients (96.9%), and abnormal findings were reported for 147 patients (33.3%, 95% CI 29.0–37.8). Falls were the leading cause of MTBI (61.5%), followed by blows (18.9%) and traffic collisions (14.1%) for children in the 0–2 group and 10–14 group. For children aged between 3 and 9, the top three causes of TBI were falls, traffic collisions and blows. Leisure activity was the most reported activity when injuries occurred for all age groups. Sleeping/resting and walking ranked in the second and third place for children between 0 and 2 years of age, and walking and riding for the other two groups. The places where the majority injuries occurred were the home for the 0–2 and 3–9 years of age groups, and school for the 10–14 years of age group. There was no statistical difference between boys and girls with regard to the activity that caused the MTBI. This study highlights the important roles that parents and school administrators in the development of preventive measures to reduce the risk of traumatic brain injury in children. Also, identifying children who had a head trauma at very low risk of clinically important TBI for whom CT might be unnecessary is a priority area of research in China.
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Tomei KL, Doe C, Prestigiacomo CJ, Gandhi CD. Comparative analysis of state-level concussion legislation and review of current practices in concussion. Neurosurg Focus 2012. [PMID: 23199423 DOI: 10.3171/2012.9.focus12280] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Forty-two states and the District of Columbia have passed legislation based on the Lystedt law of Washington state, enacted in 2009 to protect young athletes who have sustained a concussion. The aim of this study was to note the several similarities and differences among the various laws.
Methods
Concussion legislation was compared for 50 states and the District of Columbia. Evaluation parameters of this study included stipulations of concussion education, criteria for removal from play, requirements for evaluation and return to play after concussion, and individuals required to assess young athletes. Other parameters that were not consistent across states were also noted.
Results
Forty-three states and the District of Columbia have passed concussion legislation, and an additional 4 states have pending legislation. All states with existing legislation support concussion education for coaches; however, only 48% require coaches to undergo formal education. Athletes must be educated on concussion in 86% of states and parents in 88.7%. Suspicion of concussion is a criterion for removal from play in 75% of states; signs and symptoms of concussion are criteria for removal from play in 16% of states. The individuals allowed to evaluate and clear an athlete for return to play differ greatly among states.
Conclusions
Injury prevention legislation holds historical precedent, and given the increasing attention to long-term sequelae of repeated head trauma and concussion, concussion legislation has been rapidly passed in 43 states and the District of Columbia. Although the exact stipulations of these laws vary among states, the overall theme is to increase recognition of concussion in young athletes and ensure that they are appropriately cleared for return to play after concussion.
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Andersson EE, Sejdhage R, Wage V. Mild traumatic brain injuries in children between 0-16 years of age: a survey of activities and places when an accident occurs. Dev Neurorehabil 2012; 15:26-30. [PMID: 22256831 DOI: 10.3109/17518423.2011.633570] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to identify what activities cause most mild traumatic brain injury (MTBI) among boys and girls between 0-16 years of age. METHODS Based on a randomized controlled study, a retrospective analysis was conducted among 765 children. RESULT The most common causes of injury were falls from a height and falls from the same level. The most common place where the accident occurred was at 'home' followed by 'pre-school/school'. The highest incidence was 'play' followed by 'hit by another person', thereafter 'baby nursing'. Boys are more often injured than girls, but with no difference between boys and girls in terms of which activities that cause MTBI. CONCLUSION Supervision during play at home as well as better designed schoolyards and playgrounds are required to prevent accidents. Furthermore, well-documented medical records are necessary to identify activities causing MTBI among children.
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Karlin AM. Concussion in the Pediatric and Adolescent Population: “Different Population, Different Concerns”. PM R 2011; 3:S369-79. [DOI: 10.1016/j.pmrj.2011.07.015] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 11/16/2022]
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Scherwath A, Sommerfeldt DW, Bindt C, Nolte A, Boiger A, Koch U, Petersen-Ewert C. Identifying children and adolescents with cognitive dysfunction following mild traumatic brain injury—Preliminary findings on abbreviated neuropsychological testing. Brain Inj 2011; 25:401-8. [DOI: 10.3109/02699052.2011.557351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Salminen S, Lounamaa A, Kurenniemi M. Gender and injury in Finnish comprehensive schools. ACCIDENT; ANALYSIS AND PREVENTION 2008; 40:1267-1272. [PMID: 18606255 DOI: 10.1016/j.aap.2008.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 12/21/2007] [Accepted: 01/29/2008] [Indexed: 05/26/2023]
Abstract
The aim of this study is to analyze the gender differences in injuries at Finnish comprehensive schools. Nine schools reported a total of 1135 injuries to the injury register over two school years. Boys (56%) were injured more often than girls, their injuries happened more often during breaks at school yard, whereas girls hurt themselves during sport lectures in the gymnastic halls. The proportion of boys' injuries also increased with age. More often, boys' injuries were caused by intentional actions by other pupils. Girls injured their lower extremities more often, whereas boys injured their faces and head. Boys also suffered concussion more often than girls, and were also referred for further care to health care centres or hospitals more often than girls. The higher injury frequency among boys at school corresponds to the higher injury rate of males in general, which is true for work, traffic, and leisure-time injuries. Increased adult supervisor control especially during breaks can prevent most of school injuries.
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Affiliation(s)
- Simo Salminen
- Finnish Institute of Occupational Health, Occupational Safety, Topeliuksenkatu 41a A, Helsinki, Finland.
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Chau N, Predine R, Benamghar L, Michaely JP, Choquet M, Predine E. Determinants of school injury proneness in adolescents: a prospective study. Public Health 2008; 122:801-8. [PMID: 18295288 DOI: 10.1016/j.puhe.2007.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 06/19/2007] [Accepted: 08/15/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Injury proneness is common in adolescents, but the role of individual factors has received little attention. This study assessed the relationships of a number of individual characteristics with frequency of school injuries. METHODS This prospective study was conducted on 2396 students from middle schools and high schools in an urban area in France over one school year. A questionnaire was completed by each student at the beginning of the school year, and an injury questionnaire was completed for all injuries that occurred at school during the year. Data were analysed using the chi2 independence test and logistic models. RESULTS Over the study year, 10.6% of the students had a single injury. Frequent injuries (two or more) were common (2.3%) and were strongly related to younger age [adjusted odds ratio (aOR) 1.52, 95% confidence interval (95%CI) 1.28-1.79], frequent use of psychotropic drugs (aOR 2.03, 95%CI 1.06-3.86) and a poorer average school mark (<10/20, aOR 2.58, 95%CI 1.30-5.12). The occurrence of a single injury was less strongly related to younger age (aOR 1.20, 95%CI 1.11-1.30) and frequent use of psychotropic drugs (aOR 1.43, 95%CI 1.04-1.96), and was also associated with parental absence (aOR 1.33, 95%CI 1.00-1.77), not being calm (aOR 1.41, 95%CI 1.03-1.89) and not being easily irritated (aOR 1.56, 95%CI 1.14-2.13). CONCLUSIONS This study identified a number of factors associated with injury frequency. This information could be useful for injury prevention. Physicians could help students, parents, teachers and school staff to be more aware of the risks and to find remedial measures.
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Affiliation(s)
- N Chau
- INSERM, U669, IFR25-IFRH, Paris, F-75014, France.
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Arbeau RP, Gordon KE, McCurdie G. Mayhem on the ice: do players' injuries put team staff at risk of injury? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2007; 53:1488-92. [PMID: 17872877 PMCID: PMC2234628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To investigate the potential for serious injury and the nature of injuries incurred as team staff or support personnel cross ice surfaces to get to players' benches or to attend to injured players. DESIGN Hybrid study, case series with survey. MAIN OUTCOME MEASURES Circumstances and nature of reported injuries. RESULTS Over 4 seasons, 988 injuries to team staff or support personnel were reported, including 94 concussions, 5 injuries to internal organs, 226 fractures, and 86 separations or dislocations. Most of the injuries were incurred by team staff or support personnel responsible for the welfare of players (managers, trainers, therapists, and emergency medical staff). CONCLUSION Team staff and support personnel incur serious injuries as a result of falls on the ice. Several preventive strategies can be put in place: changes in rink design, policies restricting access to the ice surface, and encouraging team staff and support personnel who must cross the ice surface to attend to injured players to wear gait-stabilizing devices.
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Chau N, Prédine R, Aptel E, d'Houtaud A, Choquet M. School injury and gender differentials: a prospective cohort study. Eur J Epidemiol 2007; 22:327-34. [PMID: 17484032 DOI: 10.1007/s10654-007-9118-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Accepted: 02/27/2007] [Indexed: 11/28/2022]
Abstract
This study assessed the role of certain individual characteristics in school injury among male and female adolescents. The sample included 2,398 subjects attending middle schools and high schools. Respondents completed a self-administered questionnaire at the beginning of the school year. School nurse completed a questionnaire on injury for each school injury occurred during the school year. The data was analyzed with the adjusted odds ratios (ORa) computed via the logistic models. The school injury was common (13% for both sexes). Sports/physical training injury was more frequent among girls (8.8% vs. 6.6%, P < 0.05) contrarily to the other types of injury (4.6% vs. 8.8%, P = 0.001). Sports/physical training injury was strongly associated with age <15 years (ORa 3.42) and presence of previous injury (2.63) among boys, and with age <15 years (2.02), presence of previous injury (2.94), not easily irritated (1.89), and irresponsible (1.59) among girls. The other types of injury were highly related to age <15 years (ORa 4.18), frequent use of psychotropic drugs (1.76), not living with both parents (1.65), being not calm (2.03), and presence of previous injury (1.82) among boys, and to age <15 years (2.59), obesity (3.24), and being not calm (1.84) among girls. The present study identified a number of potential risk factors for school injury among male and female adolescents. Preventive measures should be taken to make adolescents, their parents and teachers more aware of the risks and to find remedial measures.
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Abstract
The literature surrounding minor traumatic brain injury is complex, methodologically challenging, and controversial. Although we lack a consistent standardized definition, the annual rate is likely in excess of 200 per 100,000 children. The proportion of children with minor traumatic brain injury who will require neurosurgery is certainly <1%. Several studies are underway that have the potential to significantly advance our understanding of the specific risk factors for intracranial injury and more specifically neurosurgical injury. The mortality within children is very low, with estimates of 0% to 0.25%. Virtually all studies of the prognosis of minor brain injury in children have reported no long-term behavioral or cognitive sequelae as a specific result of the brain injury. Symptoms fall in 4 domains: somatic, cognitive, sleep/fatigue, and affective. Limited pediatric studies are available to assist clinicians in the prognosis or in optimizing recovery. Until further studies are available, a conservative approach is recommended. Children with suspected concussions should be removed from activity and observed. Children with symptomatic concussions must be limited to no physical activity. Adolescents and families need to self-monitor symptoms and limit environments or circumstances that exacerbate any symptoms. When symptoms resolve, a gradual progressive return to play is currently recommended. The recurrence risk for subsequent concussions is elevated, but there is limited documentation of the effectiveness of preventative efforts. Much remains to be learned.
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Affiliation(s)
- Kevin E Gordon
- Department of Pediatrics, Division of Pediatric Neurology, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada.
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Keenan HT, Bratton SL. Epidemiology and outcomes of pediatric traumatic brain injury. Dev Neurosci 2006; 28:256-63. [PMID: 16943649 DOI: 10.1159/000094152] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 02/07/2006] [Indexed: 11/19/2022] Open
Abstract
Traumatic brain injury is a leading cause of death and disability in the pediatric age group. Causes of injury vary with child developmental age, with more inflicted injuries in infants, fall-related injuries among toddlers, sports-related injuries among middle-school-aged children and motor vehicle crashes in older children. Prevention strategies exist for some pediatric traumatic brain injury; however, all suffer from lack of compliance and enforcement. Neuropsychological and behavioral outcomes for injured children vary with the severity of injury, child age at injury, premorbid child characteristics, family factors and the families' socioeconomic status. Each of these factors needs to be taken into account when designing rehabilitation strategies and assessing factors related to outcome.
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Affiliation(s)
- Heather T Keenan
- Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, Utah 84158-0189, USA.
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Gordon KE, Dooley JM, Wood EP. Descriptive epidemiology of concussion. Pediatr Neurol 2006; 34:376-8. [PMID: 16647998 DOI: 10.1016/j.pediatrneurol.2005.09.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 07/21/2005] [Accepted: 09/14/2005] [Indexed: 11/26/2022]
Abstract
To describe the epidemiology of reported concussion derived from a large, nationally representative health survey, the microdata files of the Canadian National Population Health Survey (1996-1997) were analyzed. Respondents reported whether they had "any injuries that were serious enough to limit their normal activities" in the preceding 12 months and the nature of the most serious injury. A total of 99.8% of 81,804 eligible respondents, representing 28,606,100 Canadians, reported their injury experience within the preceding year, with 89 reporting a concussion. The annual prevalence of Canadians reporting a concussion as their most serious injury was 110 per 100,000 population (95% confidence interval: 80, 140). Those reporting concussion were more likely to be younger (P < 0.001) and male (P = 0.02). Males were significantly overrepresented in the 16-34 year-old group (P = 0.004). More than 54% of all concussions were sport-related (95% confidence interval: 39%, 67%), occurring at a place for recreation or sport, with sport having a role in >85% of concussions in the 16-34 year-old group. This study presents annual prevalence estimates of reported concussion, derived from a sizeable, nationally representative population survey.
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Affiliation(s)
- Kevin E Gordon
- Division of Pediatric Neurology, Department of Pediatrics, Dalhousie University, and IWK Health Centre, Halifax, Nova Scotia, Canada.
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Langlois JA, Rutland-Brown W, Thomas KE. The incidence of traumatic brain injury among children in the United States: differences by race. J Head Trauma Rehabil 2005; 20:229-38. [PMID: 15908823 DOI: 10.1097/00001199-200505000-00006] [Citation(s) in RCA: 300] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This report summarizes the epidemiology of traumatic brain injury (TBI) deaths, hospitalizations, and emergency department (ED) visits by race among children aged 0-14 years in the United States. Few other studies have reported the incidence of TBI in this population by race. METHODS Data from 3 nationally representative sources maintained by the National Center for Health Statistics were used to report the annual numbers and rates of TBI-related deaths, hospitalizations, and ED visits during 1995-2001 by race, age, and external cause of injury. RESULTS An estimated 475,000 TBIs occurred among children aged 0-14 each year. Rates were highest among children aged 0-4. For children aged 0-9 years, both death and hospitalization rates were significantly higher for blacks than whites for motor vehicle-traffic-related TBIs. CONCLUSION With nearly half a million children affected each year, TBI is a serious public health problem. Variation in rates by race suggest the need to more closely examine the factors that contribute to these differences, such as the external causes of the injury and associated modifiable factors (e.g., the use of seatbelts and child safety seats).
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Affiliation(s)
- Jean A Langlois
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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