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Wingerson MJ, Schmitz B, Smulligan KL, Walker GA, Magliato S, Wilson JC, Howell DR. Concussion symptom presentation and clinical recovery among pediatric athletes: comparing concussions sustained during school and summer months. Brain Inj 2024; 38:574-582. [PMID: 38511887 DOI: 10.1080/02699052.2024.2332770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE We examined post-concussion symptom presentation, exercise, and sleep among pediatric athletes who sustained concussion during the school year vs. summer months. METHODS We evaluated athletes 6-18 years old within 21-days of concussion. They reported symptoms (Health and Behavior Inventory), with cognitive/somatic domain sub-scores calculated, and indicated if they had exercised or experienced sleep problems since injury. We grouped patients by injury season: summer months (June-August) vs. school year (September-May). RESULTS 350 patients (14.4 ± 2.4 years old; 37% female; initial visit 8.8 ± 5.3 days post-concussion) were seen for care: 24% sustained a concussion during summer months, 76% during the school year. Lower cognitive (median = 7 [IQR = 1, 15] vs. 9.5 [4, 17]; p = 0.01), but not somatic (7 [2.5, 11] vs. 8 [4, 13]; p = 0.06), HBI scores were observed for patients injured during the summer. Groups were similar in proportion exercising (16% vs 17%) and endorsing sleep problems (29% vs 31%). After adjustments, sustaining a concussion during the summer predicted total (β=-3.43; 95%CI = -6.50, -0.36; p = 0.029) and cognitive (β = -2.29; 95%CI = -4.22, -0.36; p = 0.02), but not somatic (β=-1.46; 95%CI = -2.84, -0.08; p = 0.04), symptom severity. CONCLUSION Pediatric patients with concussion may present with greater cognitive symptoms during the school year, compared to summer months.
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Affiliation(s)
- Mathew J Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
| | - Baylie Schmitz
- Doctor of Occupational Therapy Program, Northern Arizona University, Phoenix, Arizona, USA
| | - Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
| | - Gregory A Walker
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
| | - Samantha Magliato
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine Denver, Colorado, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Denver Colorado, USA
- Sports Medicine Center, Children's Hospital Colorado Denver, Colorado, USA
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Biard A, Vaittinada Ayar P, Diallo A, Gatineau-Sailliant M, Lefevre C, Cogne M, Azouvi P, Faillot T, Decq P, Faillot M. Co-existence of depression and post-concussion syndrome one month after mild traumatic brain injury. Brain Inj 2024; 38:443-447. [PMID: 38385558 DOI: 10.1080/02699052.2024.2311338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Previous studies suggest an association between Post-concussion syndrome (PCS) and depression, both highly prevalent after mTBI. OBJECTIVE To assess the prevalence and risk-factors of depression among patients with PCS 1 month after mTBI. METHODS We prospectively screened 372 mTBI patients admitted in two academic Emergency Departments between 2017 and 2019. One month after mTBI, we administered the Rivermead Post-concussion symptoms Questionnaire (RPQ) and the Patient Health Questionnaire (PHQ-9) questionnaires over the telephone. PCS and depression were defined by RPQ ≥ 12 and PHQ-9 ≥ 10. Multivariate multinomial regression identified baseline factors associated with PCS and depression. RESULTS Two hundred and eight completed RPQ and PHQ-9. Forty-seven patients (22.5%) met criteria for PCS, among which 22 (46.8%) met criteria for depression (PCS+D+). Patients with PCS but without depression were less likely to present with an associated injury (Coefficient = -1.6, p = 0.047) and to report initial sadness (Coefficient = -2.5, p = 0.03). Initial sadness (Coefficient = -1.3, p = 0.047), associated injury (Coefficient = -1.9, p = 0.008), as well as initial nausea (Coefficient = -1.8, p = 0.002), and male sex (Coefficient = 1.8, p = 0.002), were associated with the absence of depression and PCS in comparison with PCS+D+ patients. CONCLUSION Among patients with PCS 1 month after mTBI, those with depression are more likely to present with initial sadness and with an associated injury.
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Affiliation(s)
- Adam Biard
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
| | - Prabakar Vaittinada Ayar
- Emergency Department, Beaujon University Hospital, Greater Paris Hospitals APHP, Clichy, France
- UMR-S 942, INSERM, MASCOT
| | - Alhassane Diallo
- Epidemiology Department, Biostatistics and Clinical Research, Greater Paris Hospitals (APHP), Bichat University Hospital, Paris, France
| | - Maryame Gatineau-Sailliant
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
| | - Clémence Lefevre
- Physical Medicine and Rehabilitation Department, Greater Paris Hospital (APHP), Raymond Poincare, Garches, France
| | - Mélanie Cogne
- Physical Medicine and Rehabilitation Department, Greater Paris Hospital (APHP), Raymond Poincare, Garches, France
| | - Philippe Azouvi
- Physical Medicine and Rehabilitation Department, Greater Paris Hospital (APHP), Raymond Poincare, Garches, France
| | - Thierry Faillot
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
| | - Philippe Decq
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
| | - Matthieu Faillot
- Neurosurgical Department, University of Paris, Greater Paris Hospitals (APHP), Beaujon University Hospital, Clichy, France
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Clarke GJB, Skandsen T, Zetterberg H, Follestad T, Einarsen CE, Vik A, Mollnes TE, Pischke SE, Blennow K, Håberg AK. Longitudinal Associations Between Persistent Post-Concussion Symptoms and Blood Biomarkers of Inflammation and CNS-Injury After Mild Traumatic Brain Injury. J Neurotrauma 2024; 41:862-878. [PMID: 38117157 DOI: 10.1089/neu.2023.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The aim of our study was to investigate the biological underpinnings of persistent post-concussion symptoms (PPCS) at 3 months following mild traumatic brain injury (mTBI). Patients (n = 192, age 16-60 years) with mTBI, defined as Glasgow Coma Scale (GCS) score between 13 and 15, loss of consciousness (LOC) <30 min, and post-traumatic amnesia (PTA) <24 h were included. Blood samples were collected at admission (within 72 h), 2 weeks, and 3 months. Concentrations of blood biomarkers associated with central nervous system (CNS) damage (glial fibrillary acidic protein [GFAP], neurofilament light [NFL], and tau) and inflammation (interferon gamma [IFNγ], interleukin [IL]-8, eotaxin, macrophage inflammatory protein-1-beta [MIP]-1β, monocyte chemoattractant protein [MCP]-1, interferon-gamma-inducible protein [IP]-10, IL-17A, IL-9, tumor necrosis factor [TNF], basic fibroblast growth factor [FGF]-basic platelet-derived growth factor [PDGF], and IL-1 receptor antagonist [IL-1ra]) were obtained. Demographic and injury-related factors investigated were age, sex, GCS score, LOC, PTA duration, traumatic intracranial finding on magnetic resonance imaging (MRI; within 72 h), and extracranial injuries. Delta values, that is, time-point differences in biomarker concentrations between 2 weeks minus admission and 3 months minus admission, were also calculated. PPCS was assessed with the British Columbia Post-Concussion Symptom Inventory (BC-PSI). In single variable analyses, longer PTA duration and a higher proportion of intracranial findings on MRI were found in the PPCS group, but no single biomarker differentiated those with PPCS from those without. In multi-variable models, female sex, longer PTA duration, MRI findings, and lower GCS scores were associated with increased risk of PPCS. Inflammation markers, but not GFAP, NFL, or tau, were associated with PPCS. At admission, higher concentrations of IL-8 and IL-9 and lower concentrations of TNF, IL-17a, and MCP-1 were associated with greater likelihood of PPCS; at 2 weeks, higher IL-8 and lower IFNγ were associated with PPCS; at 3 months, higher PDGF was associated with PPCS. Higher delta values of PDGF, IL-17A, and FGF-basic at 2 weeks compared with admission, MCP-1 at 3 months compared with admission, and TNF at 2 weeks and 3 months compared with admission were associated with greater likelihood of PPCS. Higher IL-9 delta values at both time-point comparisons were negatively associated with PPCS. Discriminability of individual CNS-injury and inflammation biomarkers for PPCS was around chance level, whereas the optimal combination of biomarkers yielded areas under the curve (AUCs) between 0.62 and 0.73. We demonstrate a role of biological factors on PPCS, including both positive and negative effects of inflammation biomarkers that differed based on sampling time-point after mTBI. PPCS was associated more with acute inflammatory processes, rather than ongoing inflammation or CNS-injury biomarkers. However, the modest discriminative ability of the models suggests other factors are more important in the development of PPCS.
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Affiliation(s)
- Gerard Janez Brett Clarke
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, Department of Clinical and Molecular Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Toril Skandsen
- Department of Neuromedicine and Movement Sciences, Department of Clinical and Molecular Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- UK Dementia Research Institute at UCL, University College London, London, United Kingdom
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Department of Clinical and Molecular Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Cathrine Elisabeth Einarsen
- Department of Neuromedicine and Movement Sciences, Department of Clinical and Molecular Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Anne Vik
- Department of Neuromedicine and Movement Sciences, Department of Clinical and Molecular Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tom Eirik Mollnes
- Department of Immunology, Department of Anesthesiology and Intensive Care Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
- Center of Molecular Inflammation Research, Department of Clinical and Molecular Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Søren Erik Pischke
- Department of Immunology, Department of Anesthesiology and Intensive Care Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
- Clinic for Emergencies and Critical Care, Department of Anesthesiology and Intensive Care Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Asta Kristine Håberg
- Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Sciences, Department of Clinical and Molecular Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Scimeca LM, Cothran T, Larson JE, Held P. Factor analysis of the neurobehavioral symptom inventory in veterans with PTSD and no history of mild TBI. Appl Neuropsychol Adult 2024; 31:173-180. [PMID: 34860619 DOI: 10.1080/23279095.2021.2007386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
It is well established that long-term postconcussive symptoms following a mild traumatic brain injury (mTBI) are associated with underlying physical, emotional, and behavioral conditions. The Neurobehavioral Symptom Inventory (NSI) is a measure used to assess neurobehavioral symptoms that can occur following a mTBI and has demonstrated a 3- or 4-factor structure in veterans. The present study aimed to investigate the factor structure of veterans with PTSD without a history of mTBI. A confirmatory factor analysis (CFA) was conducted on a sample of 221 treatment-seeking veterans and service members with PTSD and without a history of mTBI. Results supported a 4-factor structure comprised of vestibular, somatic, cognitive, and affective domains in veterans with PTSD. Subsequent, correlational analyses between the four NSI factors and the four subscales of the Posttraumatic Stress Disorder Checklist - Fifth Edition (PCL-5) revealed high correspondence between the cognitive and affective factors of the NSI and the negative alterations in mood and cognitions and hyperarousal symptom subscales of PTSD. Collectively, findings demonstrated that the NSI functions similarly in veterans with PTSD with or without a history of mTBI. Findings suggest that neurobehavioral symptoms assessed by the NSI appear to be nonspecific and not explicitly associated with mTBI.
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Affiliation(s)
- Lauren M Scimeca
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Thomas Cothran
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
| | - Jon E Larson
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Philip Held
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
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Corwin DJ, Mandel F, McDonald CC, Barnett I, Arbogast KB, Master CL. Optimizing the Combination of Common Clinical Concussion Batteries to Predict Persistent Postconcussion Symptoms in a Prospective Cohort of Concussed Youth. Am J Sports Med 2024; 52:811-821. [PMID: 38305042 PMCID: PMC11033620 DOI: 10.1177/03635465231222936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Studies have evaluated individual factors associated with persistent postconcussion symptoms (PPCS) in youth concussion, but no study has combined individual elements of common concussion batteries with patient characteristics, comorbidities, and visio-vestibular deficits in assessing an optimal model to predict PPCS. PURPOSE To determine the combination of elements from 4 commonly used clinical concussion batteries and known patient characteristics and comorbid risk factors that maximize the ability to predict PPCS. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS We enrolled 198 concussed participants-87 developed PPCS and 111 did not-aged 8 to 19 years assessed within 14 days of injury from a suburban high school and the concussion program of a tertiary care academic medical center. We defined PPCS as a Post-Concussion Symptom Inventory (PCSI) score at 28 days from injury of ≥3 points compared with the preinjury PCSI score-scaled for younger children. Predictors included the individual elements of the visio-vestibular examination (VVE), Sport Concussion Assessment Tool, 5th Edition (SCAT-5), King-Devick test, and PCSI, in addition to age, sex, concussion history, and migraine headache history. The individual elements of these tests were grouped into interpretable factors using sparse principal component analysis. The 12 resultant factors were combined into a logistic regression and ranked by frequency of inclusion into the combined optimal model, whose predictive performance was compared with the VVE, initial PCSI, and the current existing predictive model (the Predicting and Prevention Postconcussive Problems in Pediatrics (5P) prediction rule) using the area under the receiver operating characteristic curve (AUC). RESULTS A cluster of 2 factors (SCAT-5/PCSI symptoms and VVE near point of convergence/accommodation) emerged. A model fit with these factors had an AUC of 0.805 (95% CI, 0.661-0.929). This was a higher AUC point estimate, with overlapping 95% CIs, compared with the PCSI (AUC, 0.773 [95% CI, 0.617-0.912]), VVE (AUC, 0.736 [95% CI, 0.569-0.878]), and 5P Prediction Rule (AUC, 0.728 [95% CI, 0.554-0.870]). CONCLUSION Among commonly used clinical assessments for youth concussion, a combination of symptom burden and the vision component of the VVE has the potential to augment predictive power for PPCS over either current risk models or individual batteries.
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Affiliation(s)
- Daniel J. Corwin
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Francesca Mandel
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ian Barnett
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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6
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Jannace KC, Pompeii L, Gimeno Ruiz de Porras D, Perkison WB, Yamal JM, Trone DW, Rull RP. Lifetime Traumatic Brain Injury and Risk of Post-Concussive Symptoms in the Millennium Cohort Study. J Neurotrauma 2024; 41:613-622. [PMID: 37358384 PMCID: PMC10902500 DOI: 10.1089/neu.2022.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Traumatic brain injury (TBI) is prevalent among active duty military service members, with studies reporting up to 23% experiencing at least one TBI, with 10-60% of service members reporting at least one subsequent repeat TBI. A TBI has been associated with an increased risk of cumulative effects and long-term neurobehavioral symptoms, impacting operational readiness in the short-term and overall health in the long term. The association between multiple TBI and post-concussive symptoms (PCS), however, defined as symptoms that follow a concussion or TBI, in the military has not been adequately examined. Previous studies in military populations are limited by methodological issues including small sample sizes, the use of non-probability sampling, or failure to include the total number of TBI. To overcome these limitations, we examined the association between the total lifetime number of TBI and total number of PCS among U.S. active duty military service members who participated in the Millennium Cohort Study. A secondary data analysis was conducted using the Millennium Cohort Study's 2014 survey (n = 28,263) responses on self-reported TBI and PCS (e.g., fatigue, restlessness, sleep disturbances, poor concentration, or memory loss). Zero-inflated negative binomial models calculated prevalence ratios (PRs) and 95% confidence intervals (CIs) for the unadjusted and adjusted associations between lifetime TBIs and PCS. A third of military participants reported experiencing one or more TBIs during their lifetime with 72% reporting at least one PCS. As the mean number of PCS increased, mean lifetime TBIs increased. The mean number of PCS by those with four or more TBI (4.63) was more than twice that of those with no lifetime TBI (2.28). One, two, three, and four or more TBI had 1.10 (95% CI: 1.06-1.15), 1.19 (95% CI: 1.14-1.25), 1.23 (95% CI: 1.17-1.30), and 1.30 times (95% CI: 1.24-1.37) higher prevalence of PCS, respectively. The prevalence of PCS was 2.4 (95% CI: 2.32-2.48) times higher in those with post-traumatic stress disorder than their counterparts. Active duty military service members with a history of TBI are more likely to have PCS than those with no history of TBI. These results suggest an elevated prevalence of PCS as the number of TBI increased. This highlights the need for robust, longitudinal studies that can establish a temporal relationship between repetitive TBI and incidence of PCS. These findings have practical relevance for designing both workplace safety prevention measures and treatment options regarding the effect on and from TBI among military personnel.
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Affiliation(s)
- Kalyn C. Jannace
- Southwest Center for Occupational and Environmental Health, UT Health School of Public Health, West Houston, Texas, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
- The Center for Rehabilitation Sciences Research, Uniformed Services University for the Health Sciences, Bethesda, Maryland, USA
| | - Lisa Pompeii
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - David Gimeno Ruiz de Porras
- Southwest Center for Occupational and Environmental Health, UT Health School of Public Health, West Houston, Texas, USA
| | - William Brett Perkison
- Southwest Center for Occupational and Environmental Health, UT Health School of Public Health, West Houston, Texas, USA
| | - Jose-Miguel Yamal
- Coordinating Center for Clinical Trials, UT Health School of Public Health, Houston, Texas, USA
| | - Daniel W. Trone
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
| | - Rudolph P. Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, USA
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Jawid MY, Williams KL, Jo J, Hill TM, Prosak OL, Amedy A, Anesi TJ, Terry DP, Zuckerman SL. Acute psychological symptom profiles in high school football players following sport-related concussion. J Neurosurg Pediatr 2024; 33:118-126. [PMID: 37976502 DOI: 10.3171/2023.9.peds23301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/15/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE In a cohort of high school football athletes, the authors sought to 1) describe the proportion of those with acute psychological symptoms postconcussion, 2) determine predictors of more acute psychological symptoms postconcussion, and 3) determine if acute psychological symptoms impact recovery. METHODS A retrospective cohort study of high school football athletes (14-18 years of age) who sustained a sport-related concussion between November 2017 and April 2022 and presented to a multidisciplinary concussion center was performed. Based on their Post-Concussion Symptom Scale (PCSS) scores at the initial clinic visit, their total psychological symptom cluster score was calculated by summing their scores for the four affective symptoms (irritability, sadness, nervousness, and feeling more emotional). The psychological symptom ratio was defined as the ratio of the psychological symptom cluster score to the total initial PCSS score. Primary outcomes included time to return to learn (RTL), symptom resolution, and return to play (RTP). Uni- and multivariable regression analyses were performed controlling for demographic factors, learning disabilities, attention-deficit/hyperactivity disorder, and personal and/or family history of psychological diagnoses and migraine. RESULTS A total of 195 male football players (mean age 16.2 ± 1.2 years) were included in the study. About one-third of the sample (n = 70, 35.9%) reported at least one psychological symptom. Of these 70 athletes, their psychological symptom scores were 1 (10.3%), 2 (7.7%), and ≥ 3 (17.9%). Irritability was the most endorsed psychological symptom (25.1%), followed by nervousness (15.9%), feeling more emotional (12.8%), and sadness (11.8%). The multivariable regression model showed that a positive psychological history (B = 2.66, 95% CI 0.74-4.58, p = 0.007) and family psychological history (B = 2.43, 95% CI 0.98-3.88, p = 0.001) were significant predictors of a higher psychological symptom cluster score. Multivariable linear regression analysis showed that a higher psychological symptom cluster score was associated with a longer time to RTP (B = 1.22, 95% CI 0.17-2.264, p = 0.023) but not with time to symptom resolution or RTL. The psychological symptom ratio was not a significant predictor. CONCLUSIONS In a cohort of male football players, 36% reported at least one psychological symptom, with irritability being most commonly reported. Athletes with a personal and/or family history of psychological disorders experienced more acute psychological symptoms following a sport-related concussion. A higher psychological symptom cluster score was associated with delayed time to RTP but not time to RTL or symptom resolution.
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Affiliation(s)
- Maryam Y Jawid
- 3Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kristen L Williams
- 1Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
- 2Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Jacob Jo
- 1Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
- 2Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Tyler M Hill
- 1Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
- 2Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Olivia L Prosak
- 3Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Amad Amedy
- 3Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Trevor J Anesi
- 3Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Douglas P Terry
- 1Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
- 2Department of Neurological Surgery, Vanderbilt University Medical Center
| | - Scott L Zuckerman
- 1Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center
- 2Department of Neurological Surgery, Vanderbilt University Medical Center
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Karr JE, Logan T. Post-Concussion Symptoms in Women With Head Injury Due to Intimate Partner Violence. J Neurotrauma 2024; 41:447-463. [PMID: 37485628 PMCID: PMC10908327 DOI: 10.1089/neu.2023.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Limited research has examined the symptom sequelae of head injuries in women survivors of intimate partner violence (IPV), despite this community being at increased risk for neurotrauma due to partner abuse. The current study compared post-concussion symptom severity between women with and without IPV-related head injuries. Women were recruited from court jurisdictions in Kentucky, USA, after receiving a protective order for partner abuse. The sample included 268 women with no prior head injuries (age: M[standard deviation (SD)] = 31.8[9.8], 77.2% White) and 251 women with lifetime IPV-related head injuries (age: M[SD] = 31.8[9.8], 88.0% White). Women with IPV-related head injuries were slightly older (t = 2.46, p = 0.014) with lower education (χ2 = 5.81, p = 0.016), were more frequently unemployed (χ2 = 9.23, p = 0.002), and had a higher likelihood of residing in a rural setting (χ2 = 30.16, p < 0.001). Women with IPV-related head injuries were also more often White (χ2 = 10.47, p = 0.001), but this group difference was almost entirely related to rural versus urban residence. Women with IPV-related head injuries reported a higher severity of lifetime physical IPV (t = 7.27, p < 0.001, d = 0.64, 95% confidence interval [CI]: [.46, .82]) and sexual IPV (t = 4.65, p < 0.001, d = 0.41 [0.24, 0.59]). A three-factor model of post-concussion symptoms, inclusive of cognitive, physical, and emotional symptoms, fit well (χ2 = 368.99, p < 0.0001, comparative fit index [CFI] = 0.974, Tucker-Lewis index [TLI] = 0.968, root mean square error of approximation [RMSEA] = 0.079 [0.071, 0.087]), and showed evidence for strong measurement invariance across women with and without IPV-related head injuries. The subscale and total scores each had acceptable reliability: cognitive (ω = 0.88 [0.86, 0.90]), physical (ω = 0.74 [0.70, 0.77]), and emotional (ω = 0.88 [0.86, 0.89]), and total score (ω = 0.93 [0.92, 0.95]). Women with IPV-related head injuries reported all individual post-concussion symptoms at a significantly higher frequency, with medium group differences in cognitive (t = 7.57, p < 0.001, d = 0.67 [0.50, 0.85]) and physical symptoms (t = 7.73, p < 0.001, d = 0.68 [0.51, 0.86]) and large group differences in emotional (t = 8.51, p < 0.001, d = 0.75 [0.57, 0.93]) and total symptoms (t = 9.07, p < 0.001, d = 0.80 [0.62, 0.98]). All sociodemographic characteristics were independently associated with post-concussion symptoms, as were physical IPV (total score: r = 0.28 [0.19, 0.35], p < 0.001) and sexual IPV severity (total score: r = 0.22 [0.13, 0.30], p < 0.001). In hierarchical regression analyses, controlling for sociodemographic characteristics (i.e., age, race/ethnicity, education, unemployment, and rural/urban residence) and physical and sexual IPV severity, IPV-related head injury was independently significant and accounted for significant additional variance when predicting cognitive (ΔR2 = 0.05, p < 0.001), physical (ΔR2 = 0.03, p < 0.001), emotional (ΔR2 = 0.07, p < 0.001), and total symptoms (ΔR2 = 0.06, p < 0.001). Negative-binomial regression resulted in similar findings. This study demonstrates that multiple sociodemographic and IPV history variables are related to post-concussion symptom severity, but IPV-related head injury was independently associated with greater symptom severity. Women with IPV-related head injuries may be at increased risk for unaddressed health problems spanning cognitive, physical, and emotional domains. Future research is needed to psychometrically evaluate assessment instruments for this population and to assess efficacy of interventions to address their unique health care needs.
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Affiliation(s)
- Justin E. Karr
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - T.K. Logan
- Department of Behavioral Science, University of Kentucky, Lexington, Kentucky, USA
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Albrecht TJ, Makwana Mehmel B, Rossi EA, Trbovich AM, Eagle SR, Kontos AP. Temporal Changes in Fixational Eye Movements After Concussion in Adolescents and Adults: Preliminary Findings. J Neurotrauma 2024; 41:199-208. [PMID: 37565280 DOI: 10.1089/neu.2023.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Concussions often involve ocular impairment and symptoms such as convergence insufficiency, accommodative insufficiency, blurred vision, diplopia, eye strain, and pain. Current clinical assessments of ocular function and symptoms rely on subjective symptom reporting and/or involve lengthy administration time. More objective, brief assessments of ocular function following concussion are warranted. The purpose of this study was to evaluate changes in fixational eye movements (FEMs) and their association with clinical outcomes including recovery time, symptoms, cognitive and vestibular/ocular motor impairment. Thirty-three athletes (13-27 years of age; 54.5% female) within 21 days of a diagnosed concussion participated in the study. A tracking scanning laser ophthalmoscope (TSLO) evaluated FEMs metrics during fixation on a center and corner target. Participants completed symptom (Post-Concussion Symptom Scale [PCSS]), cognitive (Immediate Post-concussion Assessment and Cognitive Testing [ImPACT], and Vestibular/Ocular Motor Screening (VOMS) evaluations. All measures were administered at the initial visit and following medical clearance, which was defined as clinical recovery. Changes in FEMs were calculated using paired-samples t tests. Linear regression (LR) models were used to evaluate the association of FEMs with clinical recovery. Pearson product-moment correlations were used to evaluate the associations among FEMs and clinical outcomes. On the center task, changes across time were supported for average microsaccade amplitude (p = 0.005; Cohen's d = 0.53), peak velocity of microsaccades (p = 0.01; d = 0.48), peak acceleration of microsaccades (p = 0.02; d = 0.48), duration of microsaccade (p < 0.001; d = 0.72), and drift vertical (p = 0.017; d = -0.154). The LR model for clinical recovery was significant (R2 = 0.37; p = 0.023) and retained average instantaneous drift amplitude (β = 0.547) and peak acceleration of microsaccade (β = 0.414). On the corner task, changes across time were supported for drift proportion (p = 0.03; d = 0.43). The LR model to predict clinical recovery was significant (R2 = 0.85; p = 0.004) and retained average amplitude of microsaccades (β = 2.66), peak velocity of microsaccades (β = -15.11), peak acceleration of microsaccades (β = 12.56), drift horizontal (β = 7.95), drift vertical (β = 1.29), drift amplitude (β = -8.34), drift proportion (β = 0.584), instantaneous drift direction (β = -0.26), and instantaneous drift amplitude (β = 0.819). FEMs metrics were also associated with reports of nausea and performance within the domain of visual memory. The FEMs metric were also associated with PCSS, ImPACT, and VOMS clinical concussion outcomes, with the highest magnitude correlations between average saccade amplitude and VOMS symptoms of nausea and average instantaneous drift speed and ImPACT visual memory, respectively. FEMs metrics changed across time following concussion, were useful in predicting clinical recovery, and were correlated with clinical outcomes. FEMs measurements may provide objective data to augment clinical assessments and inform prognosis following this injury.
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Affiliation(s)
- Ted J Albrecht
- UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | | | - Ethan A Rossi
- UPMC Department of Ophthalmology, Vision Institute at Mercy Pavilion, Pittsburgh, Pennsylvania, USA
| | - Alicia M Trbovich
- UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania, USA
| | - Shawn R Eagle
- UPMC Department of Neurosurgery, Pittsburgh, Pennsylvania, USA
| | - Anthony P Kontos
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Stein A, Vinh To X, Nasrallah FA, Barlow KM. Evidence of Ongoing Cerebral Microstructural Reorganization in Children With Persisting Symptoms Following Mild Traumatic Brain Injury: A NODDI DTI Analysis. J Neurotrauma 2024; 41:41-58. [PMID: 37885245 DOI: 10.1089/neu.2023.0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Approximately 300-550 children per 100,000 sustain a mild traumatic brain injury (mTBI) each year, of whom ∼25-30% have long-term cognitive problems. Following mTBI, free water (FW) accumulation occurs in white matter (WM) tracts. Diffusion tensor imaging (DTI) can be used to investigate structural integrity following mTBI. Compared with conventional DTI, neurite orientation dispersion and density imaging (NODDI) orientation dispersion index (ODI) and fraction of isolated free water (FISO) metrics may allow a more advanced insight into microstructural damage following pediatric mTBI. In this longitudinal study, we used NODDI to explore whole-brain and tract-specific differences in ODI and FISO in children with persistent symptoms after mTBI (n = 80) and in children displaying clinical recovery (n = 32) at 1 and 2-3 months post-mTBI compared with healthy controls (HCs) (n = 21). Two-way repeated measures analysis of variance (ANOVA) and voxelwise two-sample t tests were conducted to compare whole-brain and tract-specific diffusion across groups. All results were corrected at positive false discovery rate (pFDR) <0.05. We also examined the association between NODDI metrics and clinical outcomes, using logistical regression to investigate the value of NODDI metrics in predicting future recovery from mTBI. Whole-brain ODI was significantly increased in symptomatic participants compared with HCs at both 1 and 2 months post-injury, where the uncinate fasciculus (UF) and inferior fronto-occipital fasciculus (IFOF) were particularly implicated. Using region of interest (ROI) analysis in significant WM, bilateral IFOF and UF voxels, symptomatic participants had the highest ODI in all ROIs. ODI was lower in asymptomatic participants, and HCs had the lowest ODI in all ROIs. No changes in FISO were found across groups or over time. WM ODI was moderately correlated with a higher youth-reported post-concussion symptom inventory (PCSI) score. With 87% predictive power, ODI (1 month post-injury) and clinical predictors (age, sex, PCSI score, attention scores) were a more sensitive predictor of recovery at 2-3 months post-injury than fractional anisotropy (FA) and clinical predictors, or clinical predictors alone. FISO could not predict recovery at 2-3 months post-injury. Therefore, we found that ODI was significantly increased in symptomatic children following mTBI compared with HCs at 1 month post-injury, and progressively decreased over time alongside clinical recovery. We found no significant differences in FISO between groups or over time. WM ODI at 1 month was a more sensitive predictor of clinical recovery at 2-3 months post-injury than FA, FISO, or clinical measures alone. Our results show evidence of ongoing microstructural reorganization or neuroinflammation between 1 and 2-3 months post-injury, further supporting delayed return to play in children who remain symptomatic. We recommend future research examining the clinical utility of NODDI following mTBI to predict recovery or persistence of post-concussion symptoms and thereby inform management of mTBI.
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Affiliation(s)
- Athena Stein
- Acquired Brain Injury in Children Research Group, The University of Queensland, South Brisbane, Queensland, Australia
| | - Xuan Vinh To
- Queensland Brain Institute, The University of Queensland, South Brisbane, Queensland, Australia
| | - Fatima A Nasrallah
- Queensland Brain Institute, The University of Queensland, South Brisbane, Queensland, Australia
| | - Karen M Barlow
- Acquired Brain Injury in Children Research Group, The University of Queensland, South Brisbane, Queensland, Australia
- Queensland Pediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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Zargari M, Williams K, Jo J, Anesi TJ, Prosak OL, Amedy A, Bishay AE, Zuckerman SL, Terry DP. Does earlier vestibular therapy after sport-related concussion lead to faster recovery? J Neurosurg Pediatr 2023; 32:657-664. [PMID: 37724838 DOI: 10.3171/2023.7.peds23172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/18/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Many patients experience vestibular dysfunction following a sport-related concussion (SRC). Vestibular rehabilitation therapy has recently become more well established. In a cohort of athletes with SRC, the authors sought to 1) assess the relationship between symptoms at the initial clinic visit and time to referral for vestibular therapy, and 2) evaluate whether earlier referral to vestibular therapy was associated with faster recovery, as defined as days to return to learn (RTL), symptom resolution (SR), and return to play (RTP). METHODS A retrospective cohort study was conducted using a regional multidisciplinary concussion center's database. Patients aged 12-23 years diagnosed with SRC who received vestibular rehabilitation therapy between October 2017 and October 2021 were included. Demographics and Post-Concussion Symptom Scale (PCSS) scores were extracted. The independent variable of interest was time to vestibular therapy referral. The three outcome variables were RTL, SR, and RTP. Spearman's rho correlation (rho) was used to evaluate the relationship between total PCSS score and individual symptoms (balance problems, blurred vision, and dizziness) and time to referral for vestibular therapy. Multivariable linear regression was performed to determine the impact of time to vestibular therapy on the three outcomes of RTL, SR, and RTP. Covariates included initial symptom burden, age, and prior concussions. RESULTS Forty-two concussed athletes were referred for vestibular therapy (mean age 16.8 ± 2.7 years; 54.8% female). The mean time from concussion to the initial clinic visit was 22.4 ± 20.2 days, and the mean time from the initial clinic visit to vestibular therapy referral was 4.9 ± 11.3 days. Initial total PCSS scores (rho[37] = 0.05, p = 0.78) and individual symptoms, including balance problems (rho[33] = -0.004, p = 0.98), blurred vision (rho[34] = -0.17, p = 0.33), and dizziness (rho[33] = 0.07, p = 0.67), were not correlated with time to referral for vestibular therapy. Multivariable linear regression analysis found that earlier vestibular therapy referral was predictive of shorter days to SR (p = 0.002) and RTP (p = 0.02) but not RTL (p = 0.59). CONCLUSIONS In athletes with SRC referred for vestibular therapy, earlier vestibular therapy referral was significantly associated with faster time to RTP and SR. Future investigations should focus on identifying common postconcussive signs and symptoms that serve as indications for referral to vestibular therapy.
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Affiliation(s)
- Michael Zargari
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Kristen Williams
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacob Jo
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Trevor J Anesi
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Olivia L Prosak
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Amad Amedy
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Anthony E Bishay
- 1Vanderbilt University School of Medicine, Nashville
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
| | - Scott L Zuckerman
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas P Terry
- 2Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Boucher V, Frenette J, Neveu X, Tardif PA, Mercier É, Chauny JM, Berthelot S, Archambault P, Lee J, Perry JJ, McRae A, Lang E, Moore L, Cameron P, Ouellet MC, de Guise E, Swaine B, Émond M, Le Sage N. Lack of association between four biomarkers and persistent post-concussion symptoms after a mild traumatic brain injury. J Clin Neurosci 2023; 118:34-43. [PMID: 37857062 DOI: 10.1016/j.jocn.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/07/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
Approximately 15 % of individuals who sustained a mild Traumatic Brain Injury (TBI) develop persistent post-concussion symptoms (PPCS). We hypothesized that blood biomarkers drawn in the Emergency Department (ED) could help predict PPCS. The main objective of this project was to measure the association between four biomarkers and PPCS at 90 days post mild TBI. We conducted a prospective cohort study in seven Canadian EDs. Patients aged ≥ 14 years presenting to the ED within 24 h of a mild TBI who were discharged were eligible. Clinical data and blood samples were collected in the ED, and a standardized questionnaire was administered 90 days later to assess the presence of symptoms. The following biomarkers were analyzed: S100B protein, Neuron Specific Enolase (NSE), cleaved-Tau (c-Tau) and Glial Fibrillary Acidic Protein (GFAP). The primary outcome measure was the presence of PPCS at 90 days after trauma. Relative risks and Areas Under the Curve (AUC) were computed. A total of 595 patients were included, and 13.8 % suffered from PPCS at 90 days. The relative risk of PPCS was 0.9 (95 % CI: 0.5-1.8) for S100B ≥ 20 pg/mL, 1.0 (95 % CI: 0.6-1.5) for NSE ≥ 200 pg/mL, 3.4 (95 % CI: 0.5-23.4) for GFAP ≥ 100 pg/mL, and 1.0 (95 % CI: 0.6-1.8) for C-Tau ≥ 1500 pg/mL. AUC were 0.50, 0.50, 0.51 and 0.54, respectively. Among mild TBI patients, S100B protein, NSE, c-Tau or GFAP do not seem to predict PPCS. Future research testing of other biomarkers is needed to determine their usefulness in predicting PPCS.
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Affiliation(s)
- Valérie Boucher
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Jérôme Frenette
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada
| | - Xavier Neveu
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Pier-Alexandre Tardif
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Éric Mercier
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada
| | - Jean-Marc Chauny
- Faculté de médecine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montréal, Québec H3T 1J4, Canada
| | - Simon Berthelot
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada
| | - Patrick Archambault
- Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada; Centre de recherche du CISSS de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, Québec, QC G6V 3Z1, Canada
| | - Jacques Lee
- Sunnybrook Health Science Center, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario M5G 1X5, Canada
| | - Jeffrey J Perry
- The Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, Ontario K1H 8L6, Canada; Department of Emergency Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario K1N 6N5, Canada
| | - Andrew McRae
- Department of Emergency Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada; Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta T2N 2T9, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada; Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta T2N 2T9, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada
| | - Peter Cameron
- Alfred Emergency and Trauma Centre, Monash University, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Marie-Christine Ouellet
- Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), 525 Bd Wilfrid-Hamel, Québec, Québec G1M 2S8, Canada
| | - Elaine de Guise
- Département de psychologie, Université de Montréal, 2900, boul. Édouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR) du Montréal métropolitain, 6363, chemin Hudson, Montréal, Québec H3S 1M9, Canada
| | - Bonnie Swaine
- Faculté de médecine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montréal, Québec H3T 1J4, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR) du Montréal métropolitain, 6363, chemin Hudson, Montréal, Québec H3S 1M9, Canada
| | - Marcel Émond
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada
| | - Natalie Le Sage
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada.
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Oyekan AA, Eagle S, Trbovich AM, Shaw JD, Schneider M, Collins M, Lee JY, Kontos AP. Neck Symptoms and Associated Clinical Outcomes in Patients Following Concussion. J Head Trauma Rehabil 2023; 38:417-424. [PMID: 36854136 PMCID: PMC10619635 DOI: 10.1097/htr.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To examine the frequency and association of neck pain symptoms in patients with a concussion. STUDY SETTING AND PARTICIPANTS Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021. DESIGN Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes. RESULTS Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms. CONCLUSION Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.
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Affiliation(s)
- Anthony A Oyekan
- Departments of Orthopaedic Surgery (Drs Oyekan, Trbovich, Shaw, Collins, Lee, and Kontos) and Physical Therapy (Dr Schneider), University of Pittsburgh, Pittsburgh, Pennsylvania; Pittsburgh Ortho Spine Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Oyekan, Shaw, and Lee); Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Eagle); and UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania (Drs Trbovich, Collins, and Kontos)
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Sullivan K, Caltabiano E. A - 165 A Pilot Study of an Online Screening Assessment of Lifetime Exposure to Traumatic Brain Injury (TBI). Arch Clin Neuropsychol 2023; 38:1337. [PMID: 37807271 DOI: 10.1093/arclin/acad067.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE To conduct a pilot test of the feasibility and validity of administering an online screening measure of lifetime TBI exposure (LTE) and determine associations between LTE and health status. METHOD 156 adults were recruited from the general community (Age = 18-65 years; 73% women) most of whom (~70%) were at-risk for TBI, primarily from playing contact-sport (62.2%). TBI exposure was assessed using the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) short form. Health status was assessed using the Rivermead Post-concussion Symptoms Questionnaire, the Depression, Anxiety and Stress Scales, and items from the 2014 Ohio Behavioral Risk Factor Surveillance Study. All measures were administered via cross-sectional survey. RESULTS Online OSU TBI-ID feasibility was high (e.g., minimal missing data/attrition). With covariates controlled (e.g., TBI risk), there were positive associations between LTE [Worst TBI, Multiple TBIs] and health status (post-concussion symptoms; p's < 0.05. CONCLUSION Initial support was found for the feasibility and validity of the online OSU TBI-ID. The patterns of associations between online LTE measures and health status were consistent with those reported for non-online methods (e.g., interview). While validation of the online LTE record against clinical records would be ideal, this study suggests that a structured method of assessing LTE can be validly administered online.
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Winstone-Weide LK, Gettig K, Mooney K, Austin CA. H - 23 Post-Concussive Symptom Severity and Mental Health Status in Hispanic or Latine Youth: Implications for Generalizability. Arch Clin Neuropsychol 2023; 38:1506. [PMID: 37807566 DOI: 10.1093/arclin/acad067.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Previous analysis in a pediatric sample demonstrated that pre-injury anxiety/depression significantly predicted post-concussive symptom severity and longer time to recovery. The current study investigated the reproducibility of results using a sample who identified as Hispanic or Latine (H/L). METHOD Participants were a subsample of H/L youths (n = 443) from an outpatient mild traumatic brain injury (mTBI)/concussion program (June 2017 - present). Eligibility criteria included: 1) mTBI (GCS ≥ 13) and 2) 5-17 years of age. Families self-reported on youth's pre-injury anxiety/depression symptoms and history of psychotherapy. Concussion symptoms were measured via the Post-Concussive Symptom Inventory (PCSI) at each visit. Regression analysis controlled for baseline symptoms, days since injury, and age. RESULTS Youths (M age = 13.13; SD = 3.21) with pre-injury anxiety/depression reported significantly higher PCSI scores at baseline (t(98) = -6.90, p < 0.001) and visit 1 (t(123) = -6.39, p = 0.002). They also took significantly longer to receive clearance for high risk activities (t(85) = -3.71, p < 0.001) than those without pre-injury anxiety/depression. Results of multiple regression analyses indicated that history of psychotherapy significantly predicted higher PCSI scores at visit 1 after controlling for aforementioned covariates (ꞵ = 9.95, S.E. = 3.25, p = 0.002). CONCLUSIONS Consistent with previous findings, H/L youth with pre-concussion anxiety/depression reported higher symptoms and longer recovery time. However, the strongest predictor of symptoms for H/L youth was history of therapy, instead of anxiety/depression in the general sample. Variability in the strength of predictors warrants additional investigation and clinical attention to race/ethnicity to avoid overgeneralization.
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Duarte A, Rios Guevara LV, Alcina J, Gonzalez D, Perez-Haddock Y, Villafana ML. H - 36 Identification and Management of Post-Concussion Syndrome within the Hispanic Population. Arch Clin Neuropsychol 2023; 38:1520. [PMID: 37807543 DOI: 10.1093/arclin/acad067.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE This systematic literature review sought to investigate Post-Concussion Syndrome (PCS) considerations within Hispanic populations. METHOD A systematic review of the literature was conducted from 2001 to 2023. We conducted a bibliographical search of peer-reviewed articles through databases PubMed and Google Scholar using keywords Post-Concussion Syndrome, Hispanic Populations, and Traumatic Brain Injury. Included in the review were articles designated as literature reviews published in English examining PCS within the Hispanic population. From the initial search results, 10 articles were extracted for review. After this search, 4 articles were retained. Articles that were excluded were not in English, did not contain samples of Hispanic individuals, and/or did not include PCS. RESULTS The literature highlighted clinical features, diagnosis, and management of PCS in athletes, and in individuals who had been admitted to an inpatient unit. Patients who reported higher levels of pre-injury depression and anxiety were more likely to develop PCS. Additionally, the severity of the initial injury was not a significant predictor of PCS. CONCLUSIONS The current literature suggests a lower incidence of PCS in Hispanic individuals may exist. However, more research is needed to confirm this relationship and explore potential underlying factors. A possible mediator for this relationship may be increased levels of familial social support. Limitations of the present review include scarce empirical literature in this area of study and small sample sizes of some of the available studies.
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Ingram EO, Karr JE. A - 145 Using a Multidimensional Symptom Model to Identify Persistent Post-Concussion Symptoms in Collegiate Athletes. Arch Clin Neuropsychol 2023; 38:1317. [PMID: 37807281 DOI: 10.1093/arclin/acad067.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Determine if a multidimensional (i.e., four-factor model) approach to post-concussion symptoms identifies more participants with persistent post-concussion symptoms after a sport-related concussion than a standard total score approach. METHOD Student-athletes (N = 1097; 61% Male; 59% White; 35% Freshmen; 14% Football athletes) from the Concussion Assessment, Research, and Education consortium completed the Sport Concussion Assessment Tool-3 Symptom Evaluation six months after a concussion. Scores ≥84th percentile compared to normative data were considered elevated. Elevation rates for total and subscale scores were compared to examine the utility of a multidimensional interpretation in identifying persistent symptoms. RESULTS Six months after injury, 9.9% of athletes had symptom elevations on the total or subscale score. Overall, 8.1% of athletes were elevated on a subscale (i.e., physical = 3.9%, cognitive = 1.9%, affective = 2.3%, sleep-arousal = 1.7%) but not the total score, whereas just 1.8% were elevated on both a subscale and the total score. No athletes were elevated on the total score without being concurrently elevated on a subscale. CONCLUSION(S) Multidimensional symptom interpretations may aid in identifying cases of persistent post-concussion symptoms, detecting up to 8.1% of athletes with elevated symptoms that would not be detected by focusing on a total score alone. This study did not assess for daily symptoms, which is one of the consensus criteria for persistent post-concussion symptoms. Future research should evaluate whether specific subscale elevations correspond to functional deficits or adverse health outcomes in these athletes.
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Glisky ML, Caughie C, Chu Z, Hayden A. A - 142 The Somatic Factor Drives Elevations on the Beck Depression Inventory-2 in Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2023; 38:1314. [PMID: 37807290 DOI: 10.1093/arclin/acad067.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE The Beck Depression Inventory-2 (BDI-2) is used to identify depression, which is common following a mild traumatic brain injury (mTBI). This study explored the specific type of symptom cluster (Affective, Cognitive and Somatic) most commonly endorsed in mTBI. METHOD A sample of 138 individuals diagnosed with an mTBI completed the BDI-2 during a clinical neuropsychological evaluation. A one-way repeated measures Analysis of Variance (ANOVA) was conducted to examine whether the type of symptoms reported on the BDI-2 differed in our mTBI sample. RESULTS The sample included 63% females, with mean age of 46.93 (SD = 13.28) and a mean education level of 15.08 (SD = 2.65).There was a significant main effect of BDI-2 factors, F (1.74, 238.5) = 199.211, p < 0.001, partial η2 = 0.25. Post-hoc pairwise comparisons (with Bonferroni correction) revealed differences between all three clusters, with significantly more somatic symptoms endorsed (M = 11.07, SD = 4.77, p < 0.001) compared to cognitive symptoms (M = 6.51, SD = 5.44, p < 0.001) and affective symptoms (M = 5.01, SD = 2.81, p < 0.001). CONCLUSION High scores on the BDI-2 were driven primarily by somatic symptoms, followed by cognitive symptoms, and lastly affective symptoms in our mTBI sample. The overlap between the BDI-2 somatic symptoms and post-concussive symptoms raises the question as to whether mTBI patients have higher rates of depression or just higher physical mTBI symptoms elevating the BDI-2. The implications for rates of depression in mTBI, and appropriate treatments will be discussed.
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Sakamoto MS, Thomas GA, Bradson ML, Merritt VC, Arnett PA. A - 161 Acute Injury Characteristics and Cognitive Post-Concussion Symptom Reporting in Collegiate Athletes with Sports-Related Concussion. Arch Clin Neuropsychol 2023; 38:1333. [PMID: 37807276 DOI: 10.1093/arclin/acad067.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Surprisingly little is known about how acute injury characteristics (i.e., loss of consciousness [LOC], retrograde amnesia [RA], and anterograde amnesia [AA]) predict cognitive symptom reporting after sports-related concussion (SRC). This study examined this relationship in collegiate athletes who sustained an SRC. We predicted that athletes who endorsed LOC, RA, and AA would report more cognitive symptoms. METHOD 141 collegiate athletes who recently sustained an SRC were grouped based on whether they experienced LOC, RA, or AA. Cognitive symptoms were assessed by the cognitive cluster of the Post Concussion Symptoms Scale (PCSS-Cog) both categorically (i.e., presence of symptoms) and continuously (i.e., total score). Chi-square tests investigated group differences on the presence of cognitive symptoms, and independent samples t-tests examined group differences on PCSS-Cog scores. RESULTS Athletes who experienced RA were significantly more likely to report cognitive symptoms than those without RA (RA+/PCSS-Cog+ = 62.50%; RA-/PCSS-Cog+ = 40.17%), X2 (1, N = 141) = 4.03, p = 0.045. Similar results were observed for athletes who endorsed AA (AA+/PCSS-Cog+ = 58.82%; AA-/PCSS-Cog+ = 35.56%), X2 (1, N = 141) = 7.15, p = 0.007. There was not a significant relationship between cognitive symptom endorsement and LOC. Athletes who experienced AA had significantly higher PCSS-Cog scores (M = 3.27, SD = 4.60) than those without AA (M = 1.39, SD = 3.04), t(75.22) = 2.62, p = 0.011, 95% CI[0.45, 3.32]. However, there was not a significant relationship between PCSS-Cog scores and LOC or RA. CONCLUSIONS Results suggest that athletes who experience amnesia during SRC are more likely to report cognitive symptoms post-concussion. Moreover, amnesia may be a risk factor for increased self-reported cognitive dysfunction, and athletes who experience RA and especially AA may require more careful SRC management.
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Marschall KP, O'Reilly M, Barros K, Hammond J, Lichtenstein J. A - 152 Won't Get Fooled Again: Factors in Persistent Complaints Following Youth Concussion. Arch Clin Neuropsychol 2023; 38:1324. [PMID: 37807293 DOI: 10.1093/arclin/acad067.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE While symptoms following youth concussion typically resolve within one month of injury, some patients report persistent post-concussive symptoms (PPCS). The current project aims to characterize a sample of sports neuropsychology patients, examine clinical outcomes, and determine relevant factors. METHODS Sports neuropsychology evaluated 38 consecutively referred patients at a rural academic medical center. The sample was 50% female, mostly White (91.9%), and ranged from 7-22 years of age (M = 16.45, SD = 2.92). Most had pre-existing conditions (medical/psychiatric; 78.9%), and 63% had at least one previous concussion. Months-from-injury varied (median = 4; range = 1-29). FSIQ was average (M = 107, SD = 15.45). We analyzed relationships between factors and outcomes using correlations (Spearman's rho or Pearson's r) and stepwise linear regression to determine prediction. RESULTS Only nine patients' persistent complaints were due to concussion, while medical or psychiatric etiologies explained PPCS in the majority of the sample (76.3%). Outcomes were uncorrelated with gender, age, race, IQ, or months-since-injury. Pre-existing depression (rs(37) = -0.40, p = 0.01) and migraines (rs(37) = -0.35, p = 0.02) both showed significant moderate correlations with outcome. Stepwise regression indicated that only pre-existing depression (β = -0.360, p = 0.01) significantly predicted the non-concussion clinical outcome. CONCLUSIONS In our sample, the etiology of PPCS was something other than concussion in over 76% of youth seen by sports neuropsychology. Pre-existing depression and migraines were significantly correlated with this outcome, and depression was a significant predictor. These results add to the literature on PPCS in children. Neuropsychologist involvement earlier in concussion care may help prevent PPCS by rapidly connecting patients to the proper interventions, thereby reducing families' economic burden and improving patients' quality of life.
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Krch D, Lequerica A, Arango-Lasprilla JC, Corrigan J. H - 32 Elevated Neurobehavioral Symptoms Detected in Greater Lifetime Subconcussive Exposure Frequency in Spanish-Speakers. Arch Clin Neuropsychol 2023; 38:1516. [PMID: 37807516 DOI: 10.1093/arclin/acad067.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE To examine whether individuals who have had one exposure to lifetime subconcussive impacts differ from those who have had multiple subconcussive exposures or those who have never had any injury to the head or neck in their report of neurobehavioral symptoms. METHOD 458 adults from the continental U.S., Spain, and Latin America participated in an online survey that included the Ohio State University Traumatic Brain Injury Identification Method Self- Administered-Brief (OSU TBI-ID SAB), which assesses lifetime exposure to Traumatic Brain Injury, and the Neurobehavioral Symptom Inventory (NSI), a measure of symptoms commonly observed after head injury. Questions from the OSU TBI-ID SAB allow for categorization of a No Exposure group, and Single and Multiple Subconcussive Exposure groups. General linear models were fitted with NSI scores as the dependent variable and the exposure groups as the independent variable. Sex, current age, and other central nervous system compromise were covariates. RESULTS A significant Group difference with small effect size was found F(2,452) = 9.3, p < 0.001, ηp2 = 0.40. The Multiple Exposure group scored significantly higher on the NSI versus the Single Exposure (p = 0.004) and No Exposure (p < 0.001) groups. The Single Exposure group did not differ significantly from the No Exposure group (p = 0.084). CONCLUSIONS The Spanish OSU TBI-ID SAB is sensitive to differentiating cumulative subconcussive exposures from those with only one subconcussive exposure and those with none. These data support the feasibility of deriving a subconcussive exposure index from the OSU TBI-ID SAB, and also provide preliminary justification for inclusion of a neurobehavioral symptom measure in subconcussive research and clinical practice.
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Burley C, Patel S, Kegel N, Collins M, Kontos A. A - 136 Association of Pre-Injury Anxiety and Oculomotor Symptoms Following Concussion among Adolescents. Arch Clin Neuropsychol 2023; 38:1308. [PMID: 37807285 DOI: 10.1093/arclin/acad067.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE To investigate the utility of demographic risk factors and post-concussion oculomotor symptoms to identify adolescents with anxiety panic disorder symptoms. METHOD Participants included 124 patients (63 male) aged 10 to 18 (M = 14.4, SD = 2.3) within 2-30 days of injury (M = 9.3, SD = 6.3) who presented to a concussion specialty clinic between 2017-2018. All participants completed the Screening for Child Anxiety Related Disorders (SCARED-C) to evaluate pre-injury anxiety as well as the Vestibular/Ocular Motor Screening (VOMS) as part of standard clinical care. A backward logistic regression (LR) was employed to determine the utility of symptom provocation on oculomotor components of the VOMS (i.e., smooth pursuits, horizontal saccades, vertical saccades, and near point of convergence) and demographic risk factors (i.e., history of anxiety or depression and gender) to identify adolescents with panic disorder symptoms on the SCARED-C. RESULTS The LR model was statistically significant (χ2 (6) = 26.8, p < 0.001) and explained 32.0% of the variance. The model correctly classified 84.7% of cases with high specificity = 0.97 but low sensitivity = 0.27. Variables retained in the model included provocation of dizziness during vertical saccades (OR = 1.85, p = 0.016), self-reported history of depression (OR = 7.34, p = 0.032), and sex (i.e., female; OR = 5.45, p = 0.009). CONCLUSION The results indicate that symptom provocation on oculomotor components of the VOMS (i.e., dizziness during vertical saccades), sex, and self-reported history of depression diagnosis are modest predictors of panic disorder symptoms in adolescents. Clinicians should consider these symptoms when interpreting symptoms post-injury.
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Scott OFT, Bubna M, Boyko E, Hunt C, Kristman VL, Gargaro J, Khodadadi M, Chandra T, Kabir US, Kenrick-Rochon S, Cowle S, Burke MJ, Zabjek KF, Dosaj A, Mushtaque A, Baker AJ, Bayley MT, Tartaglia MC. Characterizing the profiles of patients with acute concussion versus prolonged post-concussion symptoms in Ontario. Sci Rep 2023; 13:17955. [PMID: 37863954 PMCID: PMC10589269 DOI: 10.1038/s41598-023-44095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023] Open
Abstract
Identifying vulnerability factors for developing persisting concussion symptoms is imperative for determining which patients may require specialized treatment. Using cross-sectional questionnaire data from an Ontario-wide observational concussion study, we compared patients with acute concussion (≤ 14 days) and prolonged post-concussion symptoms (PPCS) (≥ 90 days) on four factors of interest: sex, history of mental health disorders, history of headaches/migraines, and past concussions. Differences in profile between the two groups were also explored. 110 patients with acute concussion and 96 patients with PPCS were included in our study. The groups did not differ on the four factors of interest. Interestingly, both groups had greater proportions of females (acute concussion: 61.1% F; PPCS: 66.3% F). Patient profiles, however, differed wherein patients with PPCS were significantly older, more symptomatic, more likely to have been injured in a transportation-related incident, and more likely to live outside a Metropolitan city. These novel risk factors for persisting concussion symptoms require replication and highlight the need to re-evaluate previously identified risk factors as more and more concussions occur in non-athletes and different risk factors may be at play.
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Affiliation(s)
- Olivia F T Scott
- Canadian Concussion Centre, University Health Network, Toronto, ON, Canada
| | | | - Emily Boyko
- EPID@Work Research Institute, Lakehead University, Thunder Bay, ON, Canada
| | - Cindy Hunt
- Head Injury Clinic, Department of Trauma and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Concussion Ontario Network: Neuroinformatics to Enhance Clinical Care and Translation, Toronto, ON, Canada
| | - Vicki L Kristman
- EPID@Work Research Institute, Lakehead University, Thunder Bay, ON, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Judith Gargaro
- Neurotrauma Care Pathways Project, KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Mozhgan Khodadadi
- Canadian Concussion Centre, University Health Network, Toronto, ON, Canada
| | - Tharshini Chandra
- Hull-Ellis Concussion Clinic, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Umme Saika Kabir
- EPID@Work Research Institute, Lakehead University, Thunder Bay, ON, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Shannon Kenrick-Rochon
- Northern Ontario School of Medicine University, Thunder Bay, ON, Canada
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | | | - Matthew J Burke
- Neuropsychiatry Program, Division of Neurology, Department of Psychiatry, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Karl F Zabjek
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Anil Dosaj
- Head Injury Clinic, Department of Trauma and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Asma Mushtaque
- Canadian Concussion Centre, University Health Network, Toronto, ON, Canada
| | - Andrew J Baker
- Brain Health and Wellness Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia, University of Toronto, Toronto, ON, Canada
| | - Mark T Bayley
- Hull-Ellis Concussion Clinic, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Temerty Medicine, University of Toronto, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Canadian Concussion Centre, University Health Network, Toronto, ON, Canada.
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.
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Nguyen JVK, McKay A, Ponsford J, Davies K, Makdissi M, Drummond SPA, Reyes J, Makovec Knight J, Peverill T, Brennan JH, Willmott C. Interdisciplinary rehabilitation for persisting post-concussion symptoms after mTBI: N=15 single case experimental design. Ann Phys Rehabil Med 2023; 66:101777. [PMID: 37890339 DOI: 10.1016/j.rehab.2023.101777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Despite clinical guidelines recommending an interdisciplinary approach to persisting post-concussion symptom (PPCS) management, evaluations of interdisciplinary interventions remain scant. OBJECTIVES This pilot study aimed to explore the feasibility and preliminary efficacy of an interdisciplinary intervention for PPCSs. METHOD A single-case experimental design with randomisation to multiple baselines (2, 4, or 6 weeks) was repeated across 15 participants (53% female) with mild traumatic brain injury (mean age 38.3 years, SD 15.7). The 12-week treatment incorporated psychology, physiotherapy, and medical interventions. Feasibility outcomes included recruitment and retention rates, adverse events, treatment adherence and fidelity. Patient-centred secondary outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), assessed 3 times per week during the baseline and treatment phases, and at the 1- and 3-month follow-ups. Other secondary outcomes included measures of mood, sleep and fatigue, physical functioning, health-related quality of life, illness perceptions, and goal attainment. Changes in PPCSs were evaluated using systematic visual analysis and Tau-U. Clinically significant changes in secondary outcomes were explored descriptively. RESULTS 16/26 individuals assessed for eligibility were enroled (61% recruitment rate); 15 completed the post-treatment follow-ups, and 13 completed the 1- and 3-month follow-up assessments (81% retention rate). High treatment adherence and competence in delivering treatments was observed. Moderate-large effect sizes for reducing PPCSs were observed in 12/15 cases, with 7/15 reaching statistical significance. Improvements were maintained at the 1- and 3-month follow-ups and were accompanied by reductions in fatigue, sleep difficulties, and mood symptoms, and changes in illness perceptions. All participants had clinically significant improvements in at least 1 outcome, with 81% of individual therapy goals achieved. CONCLUSIONS This pilot study provided preliminary support for a subsequent randomised controlled trial (RCT), with satisfactory recruitment, retention, treatment compliance, and treatment fidelity. Improvement was evident on participant outcomes including symptom reduction and goal attainment, suggesting that progressing to a phase-II RCT is worthwhile. Findings highlight the potential benefit of individualized interdisciplinary treatments.
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Affiliation(s)
- Jack V K Nguyen
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia.
| | - Adam McKay
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Jennie Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Katie Davies
- Neurological Rehabilitation Group, Melbourne, Australia
| | - Michael Makdissi
- Olympic Park Sports Medicine Centre, Melbourne, Australia; Australian Football League, Melbourne, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jonathan Reyes
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia; Australian Football League, Melbourne, Australia
| | - Jennifer Makovec Knight
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Tess Peverill
- Neurological Rehabilitation Group, Melbourne, Australia
| | - James H Brennan
- Australian Football League, Melbourne, Australia; Epworth Sports and Exercise Medicine Group, Melbourne, Australia
| | - Catherine Willmott
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia; Australian Football League, Melbourne, Australia
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Bunt SC, LoBue C, Hynan LS, Didehbani N, Stokes M, Miller SM, Bell K, Cullum CM. Early vs. delayed evaluation and persisting concussion symptoms during recovery in adults. Clin Neuropsychol 2023; 37:1410-1427. [PMID: 36083237 DOI: 10.1080/13854046.2022.2119165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 11/03/2022]
Abstract
Objective: Persisting concussion symptoms may adversely affect return to work and functioning in daily activities. This study compared adults who were initially evaluated < 30 days versus those evaluated ≥ 30 days following a concussion at a specialty concussion clinic to determine if delayed initial evaluation is associated with persisting symptoms during recovery. Method: Participants (N = 205) 18 years of age and older who sustained a concussion and presented to a North Texas Concussion Registry (ConTex) clinic were evaluated at two time points: initial clinical visit and three-month follow-up. Participants provided medical history, injury related information, and completed the Sport Concussion Assessment Tool-5 Symptom Evaluation, Generalized Anxiety Disorder 7-item scale (GAD-7), and Patient Health Questionnaire (PHQ-8). Participants were divided into two groups: early and delayed evaluation (±30 days post injury). Results: Number and severity of concussion symptoms were similar between both groups at their initial clinical visit. However, linear regression models showed that a delayed clinical evaluation was associated with a greater number and severity of concussion symptoms along with greater aggravation of symptoms from physical and cognitive activity at three-month follow-up. Conclusions: Individuals who sought care at specialty concussion clinics regardless of previous care 30 or more days following their injury reported more serious persisting concussion symptoms at three month follow-up than those who sought care sooner. Education to improve adults' recognition of concussions when they occur and obtaining earlier clinical evaluation may represent important opportunities in promoting better recovery and reducing persisting concussion symptoms.
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Affiliation(s)
- Stephen C Bunt
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
| | - Christian LoBue
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, UT Southwestern Medical Center Dallas, TX, USA
| | - Linda S Hynan
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nyaz Didehbani
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Mathew Stokes
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Shane M Miller
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Sports Medicine, Scottish Rite for Children, Dallas, TX, USA
| | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, UT Southwestern Medical Center Dallas, TX, USA
- Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA
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Aviv I, Shorer M, Fennig S, Aviezer H, Singer-Harel D, Apter A, Pilowsky Peleg T. From acute stress to persistent post-concussion symptoms: The role of parental accommodation and child's coping strategies. Clin Neuropsychol 2023; 37:1389-1409. [PMID: 36416168 DOI: 10.1080/13854046.2022.2145578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022]
Abstract
Background: Acute stress following mild Traumatic Brain Injury (mTBI) is highly prevalent and associated with Persistent Post-Concussion symptoms (PPCS). However, the mechanism mediating this relationship is understudied. Objective: To examine whether parental accommodation (i.e. parents' attempts to adjust the environment to the child's difficulties) and child's coping strategies mediate the association between acute stress and PPCS in children following mTBI. Method: Participants were 58 children aged 8-16 who sustained a mTBI and their parents. Children's acute stress (one-week post-injury) and coping strategies (three weeks post-injury), and parental accommodation (three weeks and four months post-injury) were assessed. Outcome measures included PPCS (four months post-injury) and neuropsychological tests of cognitive functioning (attention and memory). A baseline for PPCS was obtained by a retrospective report of pre-injury symptoms immediately after the injury. Results: Children's acute stress and negative coping strategies (escape-oriented coping strategies) and four-months parental accommodation were significantly related to PPCS. Acute stress predicted PPCS and attention and memory performance. Parental accommodation significantly mediated the association between acute stress and PPCS. Conclusions: Stress plays an important role in children's recovery from mTBI and PPCS. Parental accommodation mediates this relationship, and thus, clinical attention to parental reactions during recovery is needed.
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Affiliation(s)
- Irit Aviv
- Department of Psychology, The Hebrew University, Jerusalem, Israel
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Maayan Shorer
- Department of Psychology, Ruppin Academic Center, Emek-Hefer, Israel
| | - Silvana Fennig
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Hillel Aviezer
- Department of Psychology, The Hebrew University, Jerusalem, Israel
| | - Dana Singer-Harel
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Alan Apter
- Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Tammy Pilowsky Peleg
- Department of Psychology, The Hebrew University, Jerusalem, Israel
- The Neuropsychological Unit, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
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Neely LM, Smulligan KL, Wingerson MJ, Seehusen CN, Simon SL, Wilson JC, Howell DR. The association between sleep and physical activity with persisting postconcussion symptoms among adolescent athletes. PM R 2023; 15:1122-1129. [PMID: 36580488 PMCID: PMC10875599 DOI: 10.1002/pmrj.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 11/09/2022] [Accepted: 12/11/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Both sleep duration and physical activity following concussion may influence subsequent recovery. Objective measurement of sleep and physical activity behavior via wearable technology may provide insights into their association with concussion recovery. OBJECTIVE To determine whether sleep behavior (eg, duration, timing) and/or physical activity (steps/day, or exercise frequency, duration, intensity) in the first month after adolescent sports-related concussion are associated with developing persisting postconcussion symptoms (PPCS). DESIGN Case-control. SETTING Outpatient sports medicine clinic. PARTICIPANTS The study prospectively enrolled adolescent athletes who sustained a concussion (N = 49, age = 14.8 ± 1.8 years; 51% female) who were evaluated within 14 days of concussion (mean = 6.7 ± 2.7 days) and followed uvia sleep/physical activity monitoring for the subsequent 2 weeks. MAIN OUTCOME MEASURES Participants wore a monitor to track sleep (sleep time, wake time, and time spent awake in bed at night) and physical activity (average steps/day, exercise frequency, exercise duration) behavior for 2 weeks after initial assessment. Participants were followed until symptom resolution, and the main outcome of interest was development of PPCS (symptom duration >28 days). A multivariable logistic regression model was used to examine associations between physical activity and sleep behavior with PPCS. RESULTS Of the 49 participants, 47% (n = 23, mean symptom resolution = 57 ± 23 days post injury) developed PPCS and 53% (n = 26, mean symptom resolution = 15 ± 7 days post injury) did not. Univariable analysis showed that the PPCS group took fewer steps/day (7526 ± 2975 vs. 9803 ± 3786 steps/day; p = .02), exercised less frequently (2.5 ± 2.2 vs. 4.4 ± 2.1 days/week; p = .005), and spent more time in bed awake (1.2 ± 0.3 vs. 0.8 ± 0.3 h/night; p = .03) than the no PPCS group. Multivariable results indicated the odds of developing PPCS significantly increased with fewer exercise session/week (adjusted odds ratio = 1.96, 95% confidence interval = 1.09, 3.51, p = .024). CONCLUSIONS More exercise sessions that were longer than 15 minutes during concussion recovery was associated with a lower risk of developing PPCS, whereas sleep and other physical activity measures were not. Further studies regarding exercise duration and intensity are needed. Clinicians may consider advising patients to optimize sleep and physical activity during concussion recovery.
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Affiliation(s)
- Linda M Neely
- Modern Human Anatomy Program, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Sports Medicine Center, Children’s Hospital of Colorado, Aurora, CO, USA
| | - Mathew J Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Sports Medicine Center, Children’s Hospital of Colorado, Aurora, CO, USA
| | - Corrine N Seehusen
- University of New England School of Osteopathic Medicine, Biddeford, ME, USA
| | - Stacey L Simon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
- Pediatric Sleep Center, Children’s Hospital of Colorado, Aurora, CO, USA
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Sports Medicine Center, Children’s Hospital of Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
- Sports Medicine Center, Children’s Hospital of Colorado, Aurora, CO, USA
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Du Q, Liu C, Liu Y, Li J, Gong X, Zhang Q, Li K. Investigation of long-term symptoms and influencing factors in patients with mild traumatic brain injury: A cross-sectional study. Int Emerg Nurs 2023; 69:101313. [PMID: 37348243 DOI: 10.1016/j.ienj.2023.101313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Traumatic brain injury is the leading cause of death and disability in individuals under the age of 45, which places a heavy disease burden on patients and society. However, the prevalence of long-term symptoms in individuals who suffered from mild traumatic brain injury and how psychosocial factors affect their long-term symptoms remain unclear. OBJECTIVE To determine howpsychosocial factors influence long-term symptomsin individuals who suffered from mild traumatic brain injury as well as the prevalence of long-term symptoms. METHODS A demographic characteristics questionnaire, adapted self-report questionnaire of family relationship quality, revised Chinese version of the disease perception questionnaire, Rivermead postconcussion syndrome symptom questionnaire, Glasgow Outcome Scale-Extended, and Brief Symptoms Inventory 18 were used to collect data anonymously. Psychosocial factors associated with long-term symptoms in individuals who suffered from mild traumatic brain injury weremeasuredusingmultiple linear regression. RESULTS More than half of individuals who suffered from mild traumatic brain injury showed at least 1 long-term symptom after injury. Our results indicated that family relationship quality, disease perception, and demographic characteristics were related to the long-term symptoms of individuals who suffered from mild traumatic brain injury. CONCLUSIONS Our study shows that theprevalence of long-term symptomsfollowingmild traumatic brain injuryishigh. Psychosocial factors are related to patients' long-term symptoms. The findings indicate that healthcare administrators ought to adopt a robust health promotion strategy that prioritizes familial support and health education of diseases to ameliorate long-term symptoms in individuals who suffered from mild traumatic brain injury.
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Affiliation(s)
- Qiujing Du
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Changqing Liu
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Yuwei Liu
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Jiafei Li
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Xiaotong Gong
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Qi Zhang
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China
| | - Ka Li
- West China Hospital, Sichuan University/ West China School of Nursing, Sichuan University, Chengdu 610041, China.
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Engel J, van Ierssel JJ, Osmond MH, Tsampalieros A, Webster R, Zemek R. Return to the Emergency Department Within 3 Months Following Pediatric Acute Concussion. J Head Trauma Rehabil 2023; 38:319-328. [PMID: 36854112 DOI: 10.1097/htr.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To determine the proportion of concussed children returning to the emergency department (ED) for a concussion-related reason within 3 months of initial presentation and to determine which clinical composite score (5P or Post-Concussion Symptom Inventory) best predicts a return visit. SETTING, DESIGN, AND PARTICIPANTS We combined a secondary analysis of data from the prospectively collected 5P study with a retrospective medical record review of children aged 5 to 18 years who returned to the Children's Hospital of Eastern Ontario (CHEO) ED for a concussion-related reason within 3 months of an acutely diagnosed concussion. Among 770 eligible participants, 632 children (median age: 11.8 [interquartile range (IQR), 9.0-14.5] years; 58.9% male) were included in the study. MAIN MEASURES The primary outcome was the number of patients who returned to CHEO ED for a concussion-related reason within 3 months of an acute concussion diagnosed at CHEO ED. The secondary outcome was number of patients who returned within 14 days. RESULTS Forty-seven children (7.4%; 95% confidence interval [CI]: 5.6-9.7) had a concussion-related return to the ED within 3 months, the majority of which occurred in the first 14 days (29/47; 61.7%; 95% CI: 47.4-74.2). History of migraines (21.3% vs 9.7%; P = .03) were more common in those with a return visit. Headache was the most frequently reported symptom (87.2%) on revisit. Females aged 13 to 18 years had the highest return rate (survival rate: 85.8% [95% CI: 79.8-92.3]) compared with males and younger age groups. In multivariable Cox hazards regression modeling, inclusion of risk scores improved prognostication (pseudo R2 = 8%). The difference in pseudo R2 between 5P and Post-Concussion Symptom Inventory is small. CONCLUSION Most children and adolescents do not return to the ED following an acute concussion. Female youth with medium to high 5P scores at the index concussion visit may benefit from early referral to interdisciplinary specialty concussion care to guide treatment in anticipation of prolonged symptoms. By identifying these risk factors at the initial ED visit, healthcare and patient burden may be reduced.
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Affiliation(s)
- Jake Engel
- University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada (Mr Engel and Drs Osmond and Zemek); Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada (Drs van Ierssel, Osmond, Tsampalieros, Webster, and Zemek); and Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada (Drs Osmond and Zemek)
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Faulkner JW, Snell DL, Theadom A, Mahon S, Barker-Collo S. The influence of psychological flexibility on persistent post concussion symptoms and functional status after mild traumatic brain injury. Disabil Rehabil 2023; 45:1192-1201. [PMID: 35382660 DOI: 10.1080/09638288.2022.2055167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE This study investigated the predictive role of psychological flexibility on long-term mTBI outcomes. METHOD Adults with mTBI (N = 147) completed a context specific measure of psychological flexibility, (AAQ-ABI), psychological distress, and mTBI outcomes at less than three months post injury (M = 6.02 weeks after injury) and 6 months later (N = 102). Structural equation modelling examined the mediating effects of psychological flexibility on psychological distress and mTBI outcomes at six months. The direct effect of psychological flexibility at less than three months on mTBI outcomes at six months was entered into the model, plus pre-injury and injury risk factors. RESULTS The theoretically derived model had good overall fit (χ2 = 1.42; p = 0.09; NFI = 0.95; TLI = 0.95; CFI = 0.98 and RMSEA = 0.06). Psychological flexibility at less than 3 months was directly significantly related to psychological distress and post-concussion symptoms at six months. Psychological flexibility at 6 months significantly mediated the relationship between psychological distress and functional disability but not post-concussion symptoms at six months post injury. CONCLUSION The exploratory findings suggest that a context specific measure of psychological flexibility assessed acutely and in the chronic phase of recovery may predict longer-term mTBI outcomes.Implications for RehabilitationPersistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI) can have a significant impact on wellbeing, functional status, and quality of life.In this study, psychological flexibility early in recovery, was associated with higher levels of psychological distress and more severe post-concussion symptoms six months later.Psychological flexibility at six months post-injury also mediated the relationship between psychological distress and functional disability.A context specific measure of psychological flexibility may predict poorer long-term outcomes following mTBI.
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Affiliation(s)
| | - Deborah L Snell
- Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
| | - Susan Mahon
- TBI Network, Auckland University of Technology, Northcote, Auckland, New Zealand
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Alim-Marvasti A, Kuleindiren N, Tiersen F, Johal M, Lin A, Selim H, Rifkin-Zybutz R, Mahmud M. Hierarchical clustering of prolonged post-concussive symptoms after 12 months: symptom-centric analysis and association with functional impairments. Brain Inj 2023; 37:317-328. [PMID: 36529935 PMCID: PMC10635586 DOI: 10.1080/02699052.2022.2158229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 09/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Following a concussion, approximately 15% of individuals experience persistent symptoms that can lead to functional deficits. However, underlying symptom-clusters that persist beyond 12 months have not been adequately characterized, and their relevance to functional deficits are unclear. The aim of this study was to characterize the underlying clusters of prolonged post-concussive symptoms lasting more than 12 months, and to investigate their association with functional impairments. METHODS Although hierarchical clustering is ideally suited in evaluating subjective symptom severities, it has not been applied to the Rivermead Post-Concussion Questionnaire (RPQ). The RPQ and functional impairments questions were administered via a smartphone application to 445 individuals who self-reported prolonged post-concussive symptoms. Symptom-clusters were obtained using agglomerative hierarchical clustering, and their association with functional deficits were investigated with sensitivity analyses, and corrected for multiple comparisons. RESULTS Five symptom-clusters were identified: headache-related, sensitivity to light and sound, cognitive, mood-related, and sleep-fatigue. Individuals with more severe RPQ symptoms were more likely to report functional deficits (p < 0.0001). Whereas the headache and sensitivity clusters were associated with at most one impairment, at-least-mild sleeping difficulties and fatigue were associated with four, and moderate-to-severe cognitive difficulties with five (all p < 0.01). CONCLUSIONS Symptom-clusters may be clinically useful for functional outcome stratification for targeted rehabilitation therapies. Further studies are required to replicate these findings in other cohorts and questionnaires, and to ascertain the effects of symptomatic intervention on functional outcomes.
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Affiliation(s)
- Ali Alim-Marvasti
- Research Division, Mindset Technologies Ltd, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, London, UK
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), London, UK
| | | | | | - Monika Johal
- Research Division, Mindset Technologies Ltd, London, UK
- School of Medicine, Imperial College London, London, UK
| | - Aaron Lin
- Research Division, Mindset Technologies Ltd, London, UK
- University of Birmingham Medical School, Birmingham, UK
| | - Hamzah Selim
- Research Division, Mindset Technologies Ltd, London, UK
| | | | - Mohammad Mahmud
- Research Division, Mindset Technologies Ltd, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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32
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Terpstra AR, Louie DR, Iverson GL, Yeates KO, Picon E, Leddy JJ, Silverberg ND. Psychological Contributions to Symptom Provocation Testing After Concussion. J Head Trauma Rehabil 2023; 38:E146-E155. [PMID: 35687896 DOI: 10.1097/htr.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Following concussion, symptoms such as headache, dizziness, and fatigue may transiently worsen or reemerge with increased exertion or activity. Standardized tests have been developed to assess symptom increases following aerobic, cognitive, or vestibular/oculomotor challenge. Although neurophysiological mechanisms are proposed to underlie symptom increases following exertion, psychological factors such as anxiety and misinterpretation of normal bodily sensations may also play a role. In this study, we examined the contribution of psychological factors to symptom provocation testing outcomes. SETTING Two outpatient concussion clinics in British Columbia, Canada. PARTICIPANTS Adults with persistent symptoms following concussion ( N = 79; 62% women). DESIGN In a single session, participants completed self-report questionnaires measuring the psychological factors of interest and underwent symptom provocation testing including aerobic (Buffalo Concussion Bike Test; BCBT), cognitive (National Institutes of Health Toolbox-Cognition Battery; NIHTB-CB), and vestibular/oculomotor (Vestibular/Ocular Motor Screening for Concussion; VOMS) challenge. MAIN MEASURES Psychological factors of interest included premorbid and current anxiety (Generalized Anxiety Disorder-7; GAD-7), catastrophizing (Pain Catastrophizing Scale-Adapted; PCS-A), fear avoidance behavior (Fear Avoidance Behavior after Traumatic Brain Injury; FAB-TBI), and somatization (Patient Health Questionnaire-15; PHQ-15). Our primary outcome variables were self-reported symptom change during each symptom provocation test. RESULTS We found that current anxiety ( B = 0.034; 95% CI = 0.003, 0.065), symptom catastrophizing ( B = 0.013; 95% CI = 0.000, 0.026), fear avoidance behavior ( B = 0.029; 95% CI = 0.008, 0.050), and somatization ( B = 0.041; 95% CI = 0.007, 0.075) were associated with increased symptoms during the VOMS in univariate models adjusted for time postinjury but not in a multivariable model that included all covariates. The psychological variables of interest were not significantly related to symptom change during the BCBT or NIHTB-CB. CONCLUSION Our findings suggest that symptom provocation test failure should be interpreted with caution because it might indicate psychological maladjustment rather than lingering brain injury or incomplete neurophysiological recovery.
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Affiliation(s)
- Alex R Terpstra
- Departments of Psychology (Mr Terpstra, Ms Picon, and Dr Silverberg) and Physical Therapy (Dr Louie), University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada (Drs Louie and Silverberg); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Iverson); Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts (Dr Iverson); MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts (Dr Iverson); and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts (Dr Iverson); Department of Psychology, University of Calgary (Dr Yeates), Alberta Children's Hospital Research Institute (Dr Yeates), and Hotchkiss Brain Institute (Dr Yeates), Calgary, Alberta, Canada; and UBMD Orthopaedics and Sports Medicine, SUNY Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York (Dr Leddy)
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Jobin K, Wang M, du Plessis S, Silverberg ND, Debert CT. The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms. NeuroRehabilitation 2023; 53:199-208. [PMID: 37638460 DOI: 10.3233/nre-237002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion. OBJECTIVE To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS. METHODS Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates. RESULTS We found that total RPQ score (βˆ= 0.27; 95% CI = [0.16, 0.38]), GAD-7 score (βˆ= 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score (βˆ= 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]). CONCLUSION The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions.
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Affiliation(s)
- Kaiden Jobin
- Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sané du Plessis
- Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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Broshek DK, Pardini JE, Herring SA. Persisting symptoms after concussion: Time for a paradigm shift. PM R 2022; 14:1509-1513. [PMID: 36152344 PMCID: PMC10087676 DOI: 10.1002/pmrj.12884] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Donna K. Broshek
- Department of Psychiatry and Neurobehavioral SciencesUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | | | - Stanley A. Herring
- Department of Rehabilitation MedicineUniversity of WashingtonSeattleWashingtonUSA
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35
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Thomas DG, Erpenbach H, Hickey RW, Waltzman D, Haarbauer-Krupa J, Nelson LD, Patterson CG, McCrea MA, Collins MW, Kontos AP. Implementation of active injury management (AIM) in youth with acute concussion: A randomized controlled trial. Contemp Clin Trials 2022; 123:106965. [PMID: 36252936 PMCID: PMC10924688 DOI: 10.1016/j.cct.2022.106965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/10/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Nearly 2 million youth seek acute medical care following concussion in the U.S. each year. Current standard of care recommends rest for the first 48 h after a concussion. However, research suggests that prolonged rest may lengthen recovery time especially for patients with certain risk profiles. Research indicates that physical activity and behavioral management interventions (sleep, stress management) may enhance recovery. To date, there is limited empirical evidence to inform acute (<72 h) concussion recommendations for physical activity and behavioral management in adolescents. OBJECTIVE To determine the effectiveness of physical activity and behavioral management for acute concussion in adolescents and young adults, and to evaluate the role of patient characteristics on treatment response. METHODS This multicenter prospective randomized controlled trial will determine which combination of physical activity and behavioral management is most effective for patients 11-24 years old who present to the emergency department or concussion clinic within 72 h of injury. Participants are randomized into: 1) rest, 2) physical activity, 3) mobile health application (mHealth) behavioral management, or 4) physical activity and mHealth app conditions. Assessments at enrollment, 3-5 days, 14 days, 1 month, and 2 months include: concussion symptoms, balance, vestibular-ocular and cognitive assessments, quality of life, and recovery time. Somatic symptoms and other risk factors are evaluated at enrollment. Compliance with treatment and symptoms are assessed daily using actigraph and daily self-report. The primary study outcome is symptoms at 14 days. CONCLUSION Prescribed physical activity and behavioral management may improve outcomes in youth following acute concussion.
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Affiliation(s)
- D G Thomas
- Medical College of Wisconsin, Department of Pediatrics, United States of America.
| | - H Erpenbach
- Medical College of Wisconsin, Department of Pediatrics, United States of America
| | - R W Hickey
- University of Pittsburgh, Department of Pediatrics, United States of America
| | - D Waltzman
- Centers for Disease Control and Prevention, United States of America
| | - J Haarbauer-Krupa
- Centers for Disease Control and Prevention, United States of America
| | - L D Nelson
- Medical College of Wisconsin, Department of Neurosurgery, United States of America
| | - C G Patterson
- University of Pittsburgh, Department of Physical Therapy, United States of America
| | - M A McCrea
- Medical College of Wisconsin, Department of Neurosurgery, United States of America
| | - M W Collins
- University of Pittsburgh, Department of Orthopedic Surgery, United States of America
| | - A P Kontos
- University of Pittsburgh, Department of Orthopedic Surgery, United States of America
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36
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Faulkner JW, Snell DL. A Framework for Understanding the Contribution of Psychosocial Factors in Biopsychosocial Explanatory Models of Persistent Postconcussion Symptoms. Phys Ther 2022; 103:6812865. [PMID: 37104623 DOI: 10.1093/ptj/pzac156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/11/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Biopsychosocial models are currently used to explain the development of persistent postconcussion symptoms (PPCS) following concussion. These models support a holistic multidisciplinary management of postconcussion symptoms. One catalyst for the development of these models is the consistently strong evidence pertaining to the role of psychological factors in the development of PPCS. However, when applying biopsychosocial models in clinical practice, understanding and addressing the influence of psychological factors in PPCS can be challenging for clinicians. Accordingly, the objective of this article is to support clinicians in this process. In this perspective article, we discuss current understandings of the main psychological factors involved in PPCS in adults and summarize these into 5 interrelated tenets: preinjury psychosocial vulnerabilities, psychological distress following concussion, environment and contextual factors, transdiagnostic processes, and the role of learning principles. With these tenets in mind, an explanation of how PPCS develops in one person but not in another is proposed. The application of these tenets in clinical practice is then outlined. Guidance is provided on how these tenets can be used to identify psychosocial risk factors, derive predictions, and mitigate the development of PPCS after concussion from a psychological perspective within biopsychosocial conceptualizations.
Impact
This Perspective helps clinicians apply biopsychosocial explanatory models to the clinical management of concussion, providing summary tenets that can guide hypothesis testing, assessment, and treatment.
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Affiliation(s)
- Josh W Faulkner
- Te Herenga Waka, Victoria University of Wellington, Kelburn, Wellington, New Zealand
| | - Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, Christchurch, New Zealand
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Jang SH, Choi EB, Lee YS. Incidence and characteristics of physical disabilities in patients with postconcussion syndromefollowing mTBI. Medicine (Baltimore) 2022; 101:e29784. [PMID: 35777034 PMCID: PMC9239657 DOI: 10.1097/md.0000000000029784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study aimed to examine the incidence and characteristics of physical disabilities in patients with postconcussion syndrome (PCS) after a mild traumatic brain injury (mTBI). Of 203 patients diagnosed with PCS after mTBI, 10 patients with definite physical disabilities (worse than moderate disability on the Glasgow outcome scale [GOS], <4 points and inability to walk independently on the Functional Ambulation Category [FAC], <3 points) were enrolled. Ten of the 203 patients included in the analysis based on prespecified inclusion criteria were further evaluated. Seven patients had moderate disability on the GOS, whereas the remaining 3 showed severe disability. On the Modified Barthel Index, 5 patients were moderately dependent, and 2 patients were severely dependent. By the Motricity Index, 9 patients showed mild quadriparesis, and 1 had mild hemiparesis. All 10 patients could grasp-release their fingers as per the Modified Brunnstrom Classification. By contrast, 7 patients required verbal supervision for independent gait by the FAC, and the remaining 3 patients needed intermittent support from 1 person for independent gait. Approximately 5% of patients with PCS after mTBI had a definite physical disability, and most of these patients showed mild quadriparesis. These results suggest that a definite physical disability can occur in patients with PCS after mTBI.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Eun Bi Choi
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Young Seo Lee
- Department of Psychology, College of Social & Behavioral Science, University of Utah Salt Lake City, Utah, United States
- *Correspondence: Young seo Lee, Department of Psychology, College of Social & Behavioral Science, University of Utah Asia Campus, 119-3, Songdomunhwa-ro, Yeonsu-gu, Incheon, Republic of Korea (e-mail: )
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Clark CN, Edwards MJ, Ong BE, Goodliffe L, Ahmad H, Dilley MD, Betteridge S, Griffin C, Jenkins PO. Reframing postconcussional syndrome as an interface disorder of neurology, psychiatry and psychology. Brain 2022; 145:1906-1915. [PMID: 35472071 PMCID: PMC9246708 DOI: 10.1093/brain/awac149] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Persistent symptoms following a minor head injury can cause significant morbidity, yet the underlying mechanisms for this are poorly understood. The shortcomings of the current terminology that refer to non-specific symptom clusters is discussed. This update considers the need for a multi-dimensional approach for the heterogenous mechanisms driving persistent symptoms after mild traumatic brain injury. Relevant pathophysiology is discussed to make the case for mild traumatic brain injury to be conceptualized as an interface disorder spanning neurology, psychiatry and psychology. The relevance of pre-injury factors, psychological co-morbidities and their interaction with the injury to produce persistent symptoms are reviewed. The interplay with psychiatric diagnoses, functional and somatic symptom disorder presentations and the influence of the medicolegal process is considered. The judicious use and interpretation of investigations given the above complexity is discussed, with suggestions of how the explanation of the diagnostic formulation to the patient can be tailored, including insight into the above processes, to aid recovery. Moving beyond the one-dimensional concept of 'postconcussional syndrome' and reframing the cause of persistent symptoms following mild traumatic brain injury in a bio-psycho-socio-ecological model will hopefully improve understanding of the underlying contributory mechanistic interactions and facilitate treatment.
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Affiliation(s)
- Camilla N Clark
- Institute of Molecular & Clinical Sciences, St George's University of London, SW17 0RE London, UK
- UK DRI Care Research and Technology Centre, Imperial College London, W12 0BZ London, UK
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Mark J Edwards
- Institute of Molecular & Clinical Sciences, St George's University of London, SW17 0RE London, UK
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Bee Eng Ong
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Luke Goodliffe
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Hena Ahmad
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Michael D Dilley
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Shai Betteridge
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Colette Griffin
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
| | - Peter O Jenkins
- UK DRI Care Research and Technology Centre, Imperial College London, W12 0BZ London, UK
- Neurology department, Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust, SW17 0QT London, UK
- Neurology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Kamba G, Plourde V. Psychoeducational Interventions and Postconcussive Recovery in Children and Adolescents: A Rapid Systematic Review. Arch Clin Neuropsychol 2022; 37:568-582. [PMID: 35262665 DOI: 10.1093/arclin/acac011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVE The purpose of this rapid systematic review was to identify and synthesize results of empirical studies that have examined psychoeducational interventions provided to children and adolescents aged 5-19 recovering from a concussion and their families. METHODS This study followed the PRISMA guidelines adjusted for a rapid systematic review. We searched three databases (EMBASE, PsycInfo and MEDLINE) with key terms for concussion (or mild traumatic brain injury - mTBI), the intervention (psychoeducation, instructions, and reassurance) and the target population (children and adolescents aged 5 to 19). Our search strategy generated 2225 unique records and seven were included. We performed a quality appraisal on the included studies using the Mixed Methods Appraisal Tool (MMAT). RESULTS Results indicated that psychoeducational interventions had satisfactory feasibility results. Caregivers generally found the intervention to be useful to determine return to play (n=2) and understand consequences following a concussion (n=1). However, results from studies on post-concussive symptom improvement (n=4) and post-intervention concussion knowledge (n=2) showed variability and mixed findings. Methodological quality was low for most studies. CONCLUSIONS This present review shows that there are very few published studies on psychoeducational interventions offered to children, adolescents, and families for the post-concussion management. Current evidence suggests that those interventions are useful in guiding caregivers during their child's recovery. However, the impact of psychoeducational interventions on post-concussive recovery seems to be less clear.
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Affiliation(s)
- Gloria Kamba
- School of Psychology, Université de Moncton, Moncton, New-Brunswick, Canada
| | - Vickie Plourde
- Centre de formation médicale du Nouveau-Brunswick, Université de Sherbrooke, Moncton, New Brunswick, Canada; Faculté Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
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Shepherd D, Heinonen-Guzejev M, Heikkilä K, Landon J, Theadom A. Sensitivity to Noise Following a Mild Traumatic Brain Injury: A Longitudinal Study. J Head Trauma Rehabil 2021; 36:E289-E301. [PMID: 33656468 DOI: 10.1097/htr.0000000000000645] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe changes in the prevalence and clinical correlates of noise sensitivity (NS) in mild traumatic brain injury (mTBI) across a 12-month period and to determine whether NS at an early stage of recovery has predictive value for later postconcussive symptoms. SETTING A mixed urban and rural region of New Zealand. PARTICIPANTS Data for 341 adults (201 males, 140 females; age range from 16 to 91 years) were extracted from a 1-year TBI incidence, and outcomes study was conducted in New Zealand. DESIGN Secondary analysis of data from a community-based, longitudinal population study of an mTBI incidence cohort collected within 1 week of injury (baseline) and at 1, 6, and 12 months postinjury. MAIN MEASURES Measures at baseline (within 2 weeks of the injury) and 1, 6, and 12 months included the Rivermead Post-concussion Symptoms Questionnaire and its NS item, the Hospital Depression and Anxiety Scale, and the computerized CNS-Vital Signs neurocognitive test. RESULTS NS progressively declined postinjury, from 45% at baseline to 28% at 12 months. In turn, NS showed itself as a significant predictor of future postconcussive symptoms. CONCLUSION Taken together with previous research, the findings of the current study indicate that NS may have clinical utility in flagging vulnerability to persistent postconcussive symptoms.
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Affiliation(s)
- Daniel Shepherd
- Department of Psychology, Auckland University of Technology, Auckland, New Zealand (Drs Shepherd, Landon, and Theadom); and Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland (Drs Heinonen-Guzejev and Heikkilä)
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Tsai PY, Chen YC, Wang JY, Chung KH, Lai CH. Effect of repetitive transcranial magnetic stimulation on depression and cognition in individuals with traumatic brain injury: a systematic review and meta-analysis. Sci Rep 2021; 11:16940. [PMID: 34417481 PMCID: PMC8379199 DOI: 10.1038/s41598-021-95838-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/26/2021] [Indexed: 11/08/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an FDA-approved therapy in major depressive disorder. However, its treatment efficacy on depression after traumatic brain injury (TBI) remains inconclusive. We conducted a meta-analysis to assess the effectiveness of executing rTMS over dorsolateral prefrontal cortex (DLPFC) on depression, cognitive impairment and post-concussion syndrome in individuals with traumatic brain injury. This study contained seven randomized controlled trials that published before April 5, 2020 in PubMed, Embase, Scopus, Cochrane, and Web of Science databases. The rTMS had significant anti-depressant effect (SMD = 1.03, p = 0.02), but the effects dissipated at 1-month follow-up (SMD = 0.39, p = 0.62). In the subgroup analysis, only applying rTMS to left DLPFC area of post-TBI patients showed significant anti-depressant effect (SMD = 0.98, p = 0.04). Moreover, current data observed that rTMS on post-TBI patients possessed substantial improvement in visuospatial memory (SMD = 0.39, p < 0.0001), but wasn't in processing speed (SMD = - 0.18, p = 0.32) and selective attention (SMD = 0.21, p = 0.31). In addition, the effect of rTMS is not superior to sham on postconcussion syndrome. In conclusion, the short-term antidepressant effect of left DLPFC rTMS in patients with TBI was significant. However, the effectiveness of rTMS on cognition and postconcussion syndrome in patients with post-TBI depression was limited.
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Affiliation(s)
- Ping-Yen Tsai
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yang-Ching Chen
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Family Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jia-Yi Wang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan
- Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Hsuan Chung
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Hung Lai
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 252, Wu-Hsing St., Taipei City, 110, Taiwan.
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Womble MN, McAllister-Deitrick J, Marchetti GF, PsyD ER, Collins MW, Elbin RJ, Kontos AP. Risk Factors for Vestibular and Oculomotor Outcomes After Sport-Related Concussion. Clin J Sport Med 2021; 31:e193-e199. [PMID: 31219931 PMCID: PMC6904531 DOI: 10.1097/jsm.0000000000000761] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the association between risk factors and vestibular-oculomotor outcomes after sport-related concussion (SRC). STUDY DESIGN Cross-sectional study of patients seen 5.7 ± 5.4 days (range 0-30 days) after injury. SETTING Specialty clinic. PARTICIPANTS Eighty-five athletes (50 male athletes and 35 female athletes) aged 14.1 ± 2.8 years (range 9-24 years) seeking clinical care for SRC. INTERVENTIONS Participants completed a clinical interview, history questionnaire, symptom inventory, and vestibular/ocularmotor screening (VOMS). Chi-square tests with odds ratios and diagnostic accuracy were used to examine the association between risk factors and VOMS outcomes. MAIN OUTCOME MEASURES The VOMS. RESULTS Female sex (χ2 = 4.9, P = 0.03), on-field dizziness (χ2 = 7.1, P = 0.008), fogginess (χ2 = 10.3, P = 0.001), and post-traumatic migraine (PTM) symptoms including headache (χ2 = 16.7, P = 0.001), nausea (χ2 = 10.9, P = 0.001), light sensitivity (χ2 = 14.9, P = 0.001), and noise sensitivity (χ2 = 8.7, P = 0.003) were associated with presence of one or more postconcussion VOMS score above clinical cutoff. On-field dizziness (χ2 = 3.8, P = 0.05), fogginess (χ2 = 7.9, P = 0.005), and PTM-like symptoms including nausea (χ2 = 9.0, P = 0.003) and noise sensitivity (χ2 = 7.2, P = 0.007) were associated with obtaining a postconcussion near-point convergence (NPC) distance cutoff >5 cm. The likelihood ratios were 5.93 and 5.14 for VOMS symptoms and NPC distance, respectively. CONCLUSIONS Female sex, on-field dizziness, fogginess, and PTM symptoms were predictive of experiencing vestibular-oculomotor symptoms/impairment after SRC.
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Affiliation(s)
- Melissa N. Womble
- Inova Medical Group, Department of Sports Medicine, Inova Sports Medicine Concussion Program, Fairfax, VA
| | | | - Gregory F. Marchetti
- Duquesne University, Department of Physical Therapy, Rangos School of Health Sciences, Pittsburgh, PA
| | - Erin Reynolds PsyD
- Baylor Scott & White Sports Therapy & Research, Sports Concussion Center, Frisco, TX
| | - Michael W. Collins
- University of Pittsburgh, Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, Pittsburgh, PA
| | - RJ Elbin
- University of Arkansas, Department of Health, Human Performance and Recreation, Office for Sport Concussion Research, Fayetteville, AR
| | - Anthony P. Kontos
- University of Pittsburgh, Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, Pittsburgh, PA
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Levin HS, Temkin NR, Barber J, Nelson LD, Robertson C, Brennan J, Stein MB, Yue JK, Giacino JT, McCrea MA, Diaz-Arrastia R, Mukherjee P, Okonkwo DO, Boase K, Markowitz AJ, Bodien Y, Taylor S, Vassar MJ, Manley GT. Association of Sex and Age With Mild Traumatic Brain Injury-Related Symptoms: A TRACK-TBI Study. JAMA Netw Open 2021; 4:e213046. [PMID: 33822070 PMCID: PMC8025125 DOI: 10.1001/jamanetworkopen.2021.3046] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Knowledge of differences in mild traumatic brain injury (mTBI) recovery by sex and age may inform individualized treatment of these patients. OBJECTIVE To identify sex-related differences in symptom recovery from mTBI; secondarily, to explore age differences within women, who demonstrate poorer outcomes after TBI. DESIGN, SETTING, AND PARTICIPANTS The prospective cohort study Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) recruited 2000 patients with mTBI from February 26, 2014, to July 3, 2018, and 299 patients with orthopedic trauma (who served as controls) from January 26, 2016, to July 27, 2018. Patients were recruited from 18 level I trauma centers and followed up for 12 months. Data were analyzed from August 19, 2020, to March 3, 2021. EXPOSURES Patients with mTBI (defined by a Glasgow Coma Scale score of 13-15) triaged to head computed tomography in 24 hours or less; patients with orthopedic trauma served as controls. MAIN OUTCOMES AND MEASURES Measured outcomes included (1) the Rivermead Post Concussion Symptoms Questionnaire (RPQ), a 16-item self-report scale that assesses postconcussion symptom severity over the past 7 days relative to preinjury; (2) the Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5), a 20-item test that measures the severity of posttraumatic stress disorder symptoms; (3) the Patient Health Questionnaire-9 (PHQ-9), a 9-item scale that measures depression based on symptom frequency over the past 2 weeks; and (4) the Brief Symptom Inventory-18 (BSI-18), an 18-item scale of psychological distress (split into Depression and Anxiety subscales). RESULTS A total of 2000 patients with mTBI (1331 men [67%; mean (SD) age, 41.0 (17.3) years; 1026 White (78%)] and 669 women [33%; mean (SD) age, 43.0 (18.5) years; 505 (76%) White]). After adjustment of multiple comparisons, significant TBI × sex interactions were observed for cognitive symptoms (B = 0.76; 5% false discovery rate-corrected P = .02) and somatic RPQ symptoms (B = 0.80; 5% false discovery rate-corrected P = .02), with worse symptoms in women with mTBI than men, but no sex difference in symptoms in control patients with orthopedic trauma. Within the female patients evaluated, there was a significant TBI × age interaction for somatic RPQ symptoms, which were worse in female patients with mTBI aged 35 to 49 years compared with those aged 17 to 34 years (B = 1.65; P = .02) or older than 50 years (B = 1.66; P = .02). CONCLUSIONS AND RELEVANCE This study found that women were more vulnerable than men to persistent mTBI-related cognitive and somatic symptoms, whereas no sex difference in symptom burden was seen after orthopedic injury. Postconcussion symptoms were also worse in women aged 35 to 49 years than in younger and older women, but further investigation is needed to corroborate these findings and to identify the mechanisms involved. Results suggest that individualized clinical management of mTBI should consider sex and age, as some women are especially predisposed to chronic postconcussion symptoms even 12 months after injury.
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Affiliation(s)
- Harvey S. Levin
- Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Nancy R. Temkin
- Department of Neurological Surgery, University of Washington, Seattle
- Department of Biostatistics, University of Washington, Seattle
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | | | | | | | | | - Joseph T. Giacino
- Spaulding Rehabilitation Center, Boston, Massachusetts
- Massachusetts General Hospital, Boston
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
- Department of Neurology, Medical College of Wisconsin, Milwaukee
| | | | | | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh
| | - Kim Boase
- Department of Neurological Surgery, University of Washington, Seattle
| | | | - Yelena Bodien
- Spaulding Rehabilitation Center, Boston, Massachusetts
- Massachusetts General Hospital, Boston
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Kamins J, Richards R, Barney BJ, Locandro C, Pacchia CF, Charles AC, Cook LJ, Gioia G, Giza CC, Blume HK. Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion. JAMA Netw Open 2021; 4:e211312. [PMID: 33683335 PMCID: PMC7941198 DOI: 10.1001/jamanetworkopen.2021.1312] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE The Four Corners Youth Consortium was created to fill the gap in our understanding of youth concussion. This study is the first analysis of posttraumatic headache (PTH) phenotype and prognosis in this cohort of concussed youth. OBJECTIVE To describe the characteristics of youth with PTH and determine whether the PTH phenotype is associated with outcome. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined outcomes from patients in a multi-institutional registry of traumatic brain injury (TBI) clinics from December 2017 to June 2019. Inclusion criteria included being between ages 5 and 18 years at enrollment and presentation within 8 weeks of a mild TBI. Data were analyzed between February 2019 and January 2021. EXPOSURE Mild TBI with standard care. MAIN OUTCOMES AND MEASURES Time to recovery and headache 3 months after injury; measurement device is the Postconcussion Symptom Inventory (PCSI). PTH with migraine phenotype was defined as moderate-severe headache that is new or significantly worse compared with baseline and associated with nausea and/or photophobia and phonophobia. RESULTS A total of 612 patients with 625 concussions were enrolled, of whom 387 patients with 395 concussions consented to participate in this study. One hundred nine concussions were excluded (concussions, rather than patients, were the unit of analysis), leaving 281 participants with 286 concussions (168 [58.7%] girls; 195 [75.6%] White; 238 [83.2%] aged 13-18 years). At the initial visit, 133 concussions (46.5%) were from patients experiencing PTH with a migraine phenotype, 57 (20%) were from patients experiencing PTH with a nonmigraine phenotype, and 96 (34%) were from patients with no PTH. Patients with any PTH after concussion were more likely to have prolonged recovery than those without PTH (median [interquartile range], 89 [48-165] days vs 44 [26-96] days; log-rank P < .001). Patients with PTH and a migraine phenotype took significantly longer to recover than those with nonmigraine phenotype (median [interquartile range], 95 [54-195] days vs 70 [46-119] days; log-rank P = .01). Within each phenotype, there was no significant difference between sexes in recovery or PTH at 3 months. CONCLUSIONS AND RELEVANCE PTH with a migraine phenotype is associated with persistent symptoms following concussion compared with nonmigraine PTH or no PTH. Given that female sex is associated with higher rates of migraine and migraine PTH, our finding may be one explanation for findings in prior studies that girls are at higher risk for persistent postconcussion symptoms than boys.
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Affiliation(s)
- Joshua Kamins
- Goldberg Migraine Program, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles
- UCLA Steve Tisch BrainSPORT Program, Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles
| | - Rachel Richards
- Department of Pediatrics, University of Utah, Salt Lake City
| | | | | | | | - Andrew C. Charles
- Goldberg Migraine Program, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles
| | | | - Gerard Gioia
- Division of Pediatric Neuropsychology, Children's National Hospital, SCORE Program, Rockville, Maryland
| | - Christopher C. Giza
- UCLA Steve Tisch BrainSPORT Program, Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles
- Department of Pediatrics, Pediatric Neurology Division, UCLA Mattel Children’s Hospital, University of California, Los Angeles
| | - Heidi K. Blume
- Division of Pediatric Neurology, Seattle Children’s Hospital, University of Washington, Seattle
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Guedes VA, Kenney K, Shahim P, Qu BX, Lai C, Devoto C, Walker WC, Nolen T, Diaz-Arrastia R, Gill JM. Exosomal neurofilament light: A prognostic biomarker for remote symptoms after mild traumatic brain injury? Neurology 2020; 94:e2412-e2423. [PMID: 32461282 PMCID: PMC7455370 DOI: 10.1212/wnl.0000000000009577] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To measure exosomal and plasma levels of candidate blood biomarkers in veterans with history of mild traumatic brain injury (mTBI) and test their relationship with chronic symptoms. METHODS Exosomal and plasma levels of neurofilament light (NfL) chain, tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, and vascular endothelial growth factor (VEGF) were measured using an ultrasensitive assay in a cohort of 195 veterans, enrolled in the Chronic Effects of Neurotrauma Consortium Longitudinal Study. We examined relationships between candidate biomarkers and symptoms of postconcussive syndrome (PCS), posttraumatic stress disorder (PTSD), and depression. Biomarker levels were compared among those with no traumatic brain injury (TBI) (controls), 1-2 mTBIs, and repetitive (3 or more) mTBIs. RESULTS Elevated exosomal and plasma levels of NfL were associated with repetitive mTBIs and with chronic PCS, PTSD, and depression symptoms. Plasma TNF-α levels correlated with PCS and PTSD symptoms. The total number of mTBIs correlated with exosomal and plasma NfL levels and plasma IL-6. Increased number of years since the most recent TBI correlated with higher exosomal NfL and lower plasma IL-6 levels, while increased number of years since first TBI correlated with higher levels of exosomal and plasma NfL, as well as plasma TNF-α and VEGF. CONCLUSION Repetitive mTBIs are associated with elevated exosomal and plasma levels of NfL, even years following these injuries, with the greatest elevations in those with chronic PCS, PTSD, and depression symptoms. Our results suggest a possible neuroinflammatory and axonal disruptive basis for symptoms that persist years after mTBI, especially repetitive.
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Affiliation(s)
- Vivian A Guedes
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Kimbra Kenney
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia.
| | - Pashtun Shahim
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Bao-Xi Qu
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Chen Lai
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Christina Devoto
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - William C Walker
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Tracy Nolen
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Ramon Diaz-Arrastia
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
| | - Jessica M Gill
- From the National Institute of Nursing Research (V.A.G., C.L., C.D., J.M.G.), National Institute of Neurological Disorders and Stroke (P.S.), and Center for Neuroscience and Regenerative Medicine (P.S., J.M.G.) and Department of Neurology (K.K., B.-X.Q.), Uniformed Services University of the Health Sciences, NIH; Walter Reed National Military Medical Center (K.K.), National Intrepid Center of Excellence, Bethesda, MD; Department of Physical Medicine & Rehabilitation (W.C.W.), Virginia Commonwealth University, Richmond; RTI International (T.N.), Research Triangle Park, NC; and Department of Neurology (R.D.-A.), University of Pennsylvania, Philadelphia
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Schilling S, Mansour A, Sullivan L, Ding K, Pommering T, Yang J. Symptom Burden and Profiles in Concussed Children with and without Prolonged Recovery. Int J Environ Res Public Health 2020; 17:ijerph17010351. [PMID: 31947942 PMCID: PMC6981707 DOI: 10.3390/ijerph17010351] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/27/2022]
Abstract
Although symptom burden and symptom profile severity are independent predictors of post-concussion symptom duration, few studies have examined their effects on prolonged recovery simultaneously. This study examined differences in symptom burden and symptom profile scores between concussed children with prolonged recovery and those with typical recovery. We conducted a retrospective case-control study of concussed children aged 10–18 years. Prolonged recovery was defined as symptom duration beyond 28 days post-injury. Symptom burden was measured as total symptom score (TSS) at injury. Symptom profiles included: (1) vestibular, (2) ocular, (3) cognitive/fatigue, (4) migraine, and (5) anxiety. A total of 4380 unique concussions sustained by 3777 patients were included; 80.3% white, 60.0% male, and 44.0% aged 13–15 years. The prolonged recovery group had a significantly higher TSS and greater number of symptoms than the typical recovery group (p < 0.001 and p < 0.001, respectively). The prolonged recovery group had significantly higher scores on all five symptom profiles, including vestibular (p < 0.001), ocular (p < 0.001), cognitive/fatigue (p < 0.001), migraine (p < 0.001) and anxiety (p < 0.001), than the typical recovery group, even after adjusting for number of symptoms and other covariates. Further studies using prospective cohort designs are needed to better understand the influence of symptom burden and profiles on pediatric concussion recovery.
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Affiliation(s)
- Samantha Schilling
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (S.S.); (A.M.); (J.Y.)
| | - Adam Mansour
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (S.S.); (A.M.); (J.Y.)
| | - Lindsay Sullivan
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (S.S.); (A.M.); (J.Y.)
- Correspondence: ; Tel.: +614-355-5852
| | - Kele Ding
- Department of Health Sciences, Kent State University, Kent, OH 44240, USA;
| | - Thomas Pommering
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
- Division of Sports Medicine, Nationwide Children’s Hospital, Columbus, OH 43205, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH 43205, USA; (S.S.); (A.M.); (J.Y.)
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
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47
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Hart BB, Weaver LK, Wilson SH, Lindblad AS, Churchill S, Deru K. Executive summary: Secondary analyses of DoD-sponsored studies examining hyperbaric oxygen for persistent post-concussive symptoms after mild traumatic brain injury. Undersea Hyperb Med 2019; 46:221-226. [PMID: 31394593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Lindell K Weaver
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah U.S
| | | | | | - Susan Churchill
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
| | - Kayla Deru
- Division of Hyperbaric Medicine, Intermountain Medical Center, Murray, Utah and Intermountain LDS Hospital, Salt Lake City, Utah U.S
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48
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Underwood S, Campbell S, Deasy C. Telephone Follow-Up of Mild Traumatic Brain Injury; A Feasibility Study. Ir Med J 2019; 112:984. [PMID: 31650788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background This study investigates the prevalence of Post-Concussion Syndrome (PCS) one-year post-injury in patients that were treated for Mild Traumatic Brain Injury (mTBI) in the Clinical Decision Unit (CDU) of Cork University Hospital’s (CUH) Emergency Department. Methods Adults treated for mTBI in 2013 completed a telephone questionnaire comprising the Rivermead Post Concussion Symptoms Questionnaire (RPQ), the Short Form 12 (SF-12), and the EuroQol Health Outcome Assessment Tool (EQ5D5L). Results There were 112 patients identified. Of these, 57 (51%) were successfully contacted. The median age was 40 (IQR 27.5 – 57.5) and 58% were male. The most common mechanism of injury was a mechanical fall (28%). PCS of at least mild severity was present in 12 (21%). Overall, females tended to have worse outcomes (mean Physical Function score; males: females, 97.7: 76; p < 0.004). Conclusions mTBI patients continue to suffer from PCS at one-year post-injury and females had a worse physical function outcome.
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Affiliation(s)
- S Underwood
- Cork University Hospital, Wilton, Cork, Ireland
| | - S Campbell
- Cork University Hospital, Wilton, Cork, Ireland
| | - C Deasy
- Cork University Hospital, Wilton, Cork, Ireland
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49
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Sufrinko A, McAllister-Deitrick J, Elbin RJ, Collins MW, Kontos AP. Family History of Migraine Associated With Posttraumatic Migraine Symptoms Following Sport-Related Concussion. J Head Trauma Rehabil 2019; 33:7-14. [PMID: 28520665 PMCID: PMC5693792 DOI: 10.1097/htr.0000000000000315] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether family history of migraine increased the likelihood of posttraumatic migraine (PTM) symptom presentation in adolescents following concussion, and examine the influence of family history of migraine and PTM on postinjury outcomes. SETTING Outpatient concussion clinic. PARTICIPANTS A total of 153 patients with concussion (103 males and 50 females) aged 15.72 ± 1.48 years (range 12-18 years). DESIGN Cross-sectional, observational study of patients presenting for initial evaluation 4.72 ± 3.05 days (range 1-14) postinjury. MAIN MEASURES Computerized neurocognitive testing, symptom report, and vestibular/oculomotor screening. RESULTS Patients with a family history of migraine were 2.6 times (odds ratio = 2.60, confidence interval = 1.35-5.02, P = .003) more likely to present with PTM compared with patients without a family history. Results of multivariate analyses of covariance, controlling for concussion history, revealed significant main effects for PTM on (1) Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT)/Post-Concussion Symptom Scale (PCSS) (F = 15.43, P <.001) and (2) Vestibular/Ocular Motor Screening (VOMS) (F = 8.52, P < .001). There was no main effect for family history of migraine on ImPACT/PCSS (P = .22) and VOMS (P = .83) or interaction between family history of migraine and PTM on ImPACT/PCSS (P = .84) and VOMS (P = .52). CONCLUSION Family history of migraine is associated with PTM symptoms following sport-related concussion, suggesting a genetic predisposition for migraine may serve as a catalyst or trigger for onset of PTM. However, only presence of PTM, rather than family history of migraine, was related to worse neurocognitive and vestibular/oculomotor outcomes.
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Affiliation(s)
- Alicia Sufrinko
- UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania (Drs Sufrinko, McAllister-Deitrick, Collins, and Kontos); and Department of Health, Human Performance and Recreation/Office for Sport Concussion Research, University of Arkansas, Fayetteville (Dr Elbin)
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50
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Leuba C, Verdon V, Della Santa V. [Management of related contact sport mTBI]. Rev Med Suisse 2019; 15:1390-1392. [PMID: 31411828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sports and hobbies are important cause of accident and the incidence of reported traumatic brain injury is about 10 000 case/years in Switzerland. Hockey and handball are very high-risk contact sports. The term « mild traumatic brain injury » (mTBI) involves a patient with an initial Glasgow coma scale between 13 and 15. Signs and symptoms are variable and non-specific. They extend to loss of consciousness to neurocognitive disorders. TBI are potentially life threatening. Therefore, their management must be fast and effective in the emergency department. Long-term complications are also frequent and caregivers have to identify and support the patients who are at risk to develop post-concussion syndrome. Multidisciplinary supportive care and decision-making related to return to sport are necessary.
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Affiliation(s)
- Charlotte Leuba
- Département des urgences, HNe-Pourtalès, Hôpital neuchâtelois, 2000 Neuchâtel
| | - Vincent Verdon
- Unité de neuropsychologie, Service de neurologie, Département des urgences, HNe-Pourtalès, 2000 Neuchâtel
| | - Vincent Della Santa
- Département des urgences, HNe-Pourtalès, Hôpital neuchâtelois, 2000 Neuchâtel
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