Kasamatsu, T; Cleary, M; Bennett, J; Howard, K; McLeod, T V
Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer Journal Article
In: Journal of Athletic Training, vol. 51, no. 2, pp. 153–161, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/px [Psychology], *Brain Concussion/px [Psychology], *Interdisciplinary Communication, *Learning, *Physical Education and Training, Adolescent, Athletic Injuries/di [Diagnosis], Brain Concussion/di [Diagnosis], cognition, Cross-Sectional Studies, Faculty, Humans, Schools, Surveys and Questionnaires
@article{Kasamatsu2016a,
title = {Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer},
author = {Kasamatsu, T and Cleary, M and Bennett, J and Howard, K and McLeod, T V},
year = {2016},
date = {2016-01-01},
journal = {Journal of Athletic Training},
volume = {51},
number = {2},
pages = {153--161},
abstract = {CONTEXT: Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools. OBJECTIVE: To examine ATs' perspectives on return to learn, cognitive rest, and communication with school professionals after concussion. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 1124 secondary school ATs completed the survey (28.5% response rate). The majority of participants were employed full time (752/1114 [67.5%]) in public schools (911/1117 [81.6%]). MAIN OUTCOME MEASURE(S): School and AT employment characteristics, demographics, number of concussions evaluated annually, and perceptions of school professionals' familiarity with ATs' responsibilities were independent variables. RESULTS: Of the ATs, 44% reported having an existing return-to-learn policy. The strongest predictor of a return-to-learn policy was frequent communication with teachers after concussion (odds ratio = 1.5; 95% confidence interval = 1.2, 1.7). Most ATs recommended complete cognitive rest (eg, no reading, television; 492/1087 [45.3%]) or limited cognitive activity based upon symptoms (391/1087 [36.0%]). Common academic accommodations were postponed due dates (789/954 [82.7%]), rest breaks (765/954 [80.2%]), and partial attendance (740/954 [77.6%]). Athletic trainers self-reported as primary monitors of health (764/1037 [73.7%]) and academic progression (359/1011 [35.5%]). The strongest predictor of ATs' communication with school professionals was their perception of school professionals' understanding of ATs' roles. CONCLUSIONS: Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes' physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes.},
keywords = {*Athletic Injuries/px [Psychology], *Brain Concussion/px [Psychology], *Interdisciplinary Communication, *Learning, *Physical Education and Training, Adolescent, Athletic Injuries/di [Diagnosis], Brain Concussion/di [Diagnosis], cognition, Cross-Sectional Studies, Faculty, Humans, Schools, Surveys and Questionnaires},
pubstate = {published},
tppubtype = {article}
}
Lombardi, N J; Tucker, B; Freedman, K B; Austin, L S; Eck, B; Pepe, M; Tjoumakaris, F P
Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine Journal Article
In: Orthopedics, vol. 39, no. 5, pp. e944–9, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Consensus, *Orthopedics/st [Standards], *Physical Therapy Specialty/st [Standards], *Referral and Consultation, Adolescent, Athletes, Athletic Injuries/ep [Epidemiology], Bone/di [Diagnosis], Bone/ep [Epidemiology], Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Contusions/di [Diagnosis], Contusions/ep [Epidemiology], Female, Fractures, Humans, Male, Observer Variation, Orthopedics/sn [Statistics & Numerical Data], Physical Therapy Specialty/sn [Statistics & Numeri, Schools, Sports, SPORTS medicine, Sprains and Strains/di [Diagnosis], Sprains and Strains/ep [Epidemiology]
@article{Lombardi2016,
title = {Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine},
author = {Lombardi, N J and Tucker, B and Freedman, K B and Austin, L S and Eck, B and Pepe, M and Tjoumakaris, F P},
year = {2016},
date = {2016-01-01},
journal = {Orthopedics},
volume = {39},
number = {5},
pages = {e944--9},
abstract = {It is standard practice in high school athletic programs for certified athletic trainers to evaluate and treat injured student athletes. In some cases, a trainer refers an athlete to a physician for definitive medical management. This study was conducted to determine the rate of agreement between athletic trainers and physicians regarding assessment of injuries in student athletes. All high school athletes who were injured between 2010 and 2012 at 5 regional high schools were included in a research database. All patients who were referred for physician evaluation and treatment were identified and included in this analysis. A total of 286 incidents met the inclusion criteria. A total of 263 (92%) of the athletic trainer assessments and physician diagnoses were in agreement. In the 23 cases of disagreement, fractures and sprains were the most common injuries. Kappa analysis showed the highest interrater agreement in injuries classified as dislocations and concussions and the lowest interrater agreement in meniscal/labral injuries and fractures. In the absence of a confirmed diagnosis, agreement among health care providers can be used to infer accuracy. According to this principle, as agreement between athletic trainers and physicians improves, there is a greater likelihood of arriving at the correct assessment and treatment plan. Athletic trainers are highly skilled professionals who are well trained in the evaluation of athletic injuries. The current study showed that additional training in identifying fractures may be beneficial to athletic trainers and the athletes they treat. [Orthopedics. 2016; 39(5):e944-e949.]. Copyright 2016, SLACK Incorporated.},
keywords = {*Athletic Injuries/di [Diagnosis], *Consensus, *Orthopedics/st [Standards], *Physical Therapy Specialty/st [Standards], *Referral and Consultation, Adolescent, Athletes, Athletic Injuries/ep [Epidemiology], Bone/di [Diagnosis], Bone/ep [Epidemiology], Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Contusions/di [Diagnosis], Contusions/ep [Epidemiology], Female, Fractures, Humans, Male, Observer Variation, Orthopedics/sn [Statistics \& Numerical Data], Physical Therapy Specialty/sn [Statistics \& Numeri, Schools, Sports, SPORTS medicine, Sprains and Strains/di [Diagnosis], Sprains and Strains/ep [Epidemiology]},
pubstate = {published},
tppubtype = {article}
}
Koerte, I K; Hufschmidt, J; Muehlmann, M; Tripodis, Y; Stamm, J M; Pasternak, O; Giwerc, M Y; Coleman, M J; Baugh, C M; Fritts, N G; Heinen, F; Lin, A; Stern, R A; Shenton, M E
Cavum Septi Pellucidi in Symptomatic Former Professional Football Players Journal Article
In: Journal of Neurotrauma, vol. 33, no. 4, pp. 346–353, 2016.
Abstract | BibTeX | Tags: *Athletes, *Football/in [Injuries], *Septum Pellucidum/pa [Pathology], adult, aged, Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Humans, Male, middle aged
@article{Koerte2016,
title = {Cavum Septi Pellucidi in Symptomatic Former Professional Football Players},
author = {Koerte, I K and Hufschmidt, J and Muehlmann, M and Tripodis, Y and Stamm, J M and Pasternak, O and Giwerc, M Y and Coleman, M J and Baugh, C M and Fritts, N G and Heinen, F and Lin, A and Stern, R A and Shenton, M E},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurotrauma},
volume = {33},
number = {4},
pages = {346--353},
abstract = {Post-mortem studies reveal a high rate of cavum septi pellucidi (CSP) in chronic traumatic encephalopathy (CTE). It remains, however, to be determined whether or not the presence of CSP may be a potential in vivo imaging marker in populations at high risk to develop CTE. The aim of this study was to evaluate CSP in former professional American football players presenting with cognitive and behavioral symptoms compared with noncontact sports athletes. Seventy-two symptomatic former professional football players (mean age 54.53 years, standard deviation [SD] 7.97) as well as 14 former professional noncontact sports athletes (mean age 57.14 years, SD 7.35) underwent high-resolution structural 3T magnetic resonance imaging. Two raters independently evaluated the CSP, and interrater reliability was calculated. Within National Football League players, an association of CSP measures with cognitive and behavioral functioning was evaluated using a multivariate mixed effects model. The measurements of the two raters were highly correlated (CSP length: rho = 0.98; Intraclass Correlation Coefficient [ICC] 0.99; p \< 0.0001; septum length: rho = 0.93; ICC 0.96; p \< 0.0001). For presence versus absence of CSP, there was high agreement (Cohen kappa = 0.83, p \< 0.0001). A higher rate of CSP, a greater length of CSP, as well as a greater ratio of CSP length to septum length was found in symptomatic former professional football players compared with athlete controls. In addition, a greater length of CSP was associated with decreased performance on a list learning task (Neuropsychological Assessment Battery List A Immediate Recall},
keywords = {*Athletes, *Football/in [Injuries], *Septum Pellucidum/pa [Pathology], adult, aged, Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Humans, Male, middle aged},
pubstate = {published},
tppubtype = {article}
}
Zemek, R; Barrowman, N; Freedman, S B; Gravel, J; Gagnon, I; McGahern, C; Aglipay, M; Sangha, G; Boutis, K; Beer, D; Craig, W; Burns, E; Farion, K J; Mikrogianakis, A; Barlow, K; Dubrovsky, A S; Meeuwisse, W; Gioia, G; Meehan 3rd, W P; Beauchamp, M H; Kamil, Y; Grool, A M; Hoshizaki, B; Anderson, P; Brooks, B L; Yeates, K O; Vassilyadi, M; Klassen, T; Keightley, M; Richer, L; DeMatteo, C; Osmond, M H; Pediatric Emergency Research Canada Concussion, Team
Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED Journal Article
In: JAMA, vol. 315, no. 10, pp. 1014–1025, 2016.
Abstract | BibTeX | Tags: *Post-Concussion Syndrome/di [Diagnosis], Accidents, Adolescent, Age Factors, Area Under Curve, Athletic Injuries/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Child, Emergency Service, Female, Follow-Up Studies, Hospital, Humans, Male, MEDICAL history taking, MULTIVARIATE analysis, Observer Variation, Outcome Assessment (Health Care), Post-Concussion Syndrome/et [Etiology], Preschool, Prospective Studies, RISK assessment, Sensitivity and Specificity, Sex Factors, Time Factors, Traffic/sn [Statistics & Numerical Data
@article{Zemek2016,
title = {Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED},
author = {Zemek, R and Barrowman, N and Freedman, S B and Gravel, J and Gagnon, I and McGahern, C and Aglipay, M and Sangha, G and Boutis, K and Beer, D and Craig, W and Burns, E and Farion, K J and Mikrogianakis, A and Barlow, K and Dubrovsky, A S and Meeuwisse, W and Gioia, G and {Meehan 3rd}, W P and Beauchamp, M H and Kamil, Y and Grool, A M and Hoshizaki, B and Anderson, P and Brooks, B L and Yeates, K O and Vassilyadi, M and Klassen, T and Keightley, M and Richer, L and DeMatteo, C and Osmond, M H and {Pediatric Emergency Research Canada Concussion}, Team},
year = {2016},
date = {2016-01-01},
journal = {JAMA},
volume = {315},
number = {10},
pages = {1014--1025},
abstract = {IMPORTANCE: Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE: To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-\<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. EXPOSURES: All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. MAIN OUTCOMES AND MEASURES: The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. RESULTS: In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n=2006 in the derivation cohort; n=1057 in the validation cohort) and 2584 of whom (n=1701 [85%] in the derivation cohort; n=883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n=510 [30.0%] in the derivation cohort and n=291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. CONCLUSIONS AND RELEVANCE: A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.},
keywords = {*Post-Concussion Syndrome/di [Diagnosis], Accidents, Adolescent, Age Factors, Area Under Curve, Athletic Injuries/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Child, Emergency Service, Female, Follow-Up Studies, Hospital, Humans, Male, MEDICAL history taking, MULTIVARIATE analysis, Observer Variation, Outcome Assessment (Health Care), Post-Concussion Syndrome/et [Etiology], Preschool, Prospective Studies, RISK assessment, Sensitivity and Specificity, Sex Factors, Time Factors, Traffic/sn [Statistics \& Numerical Data},
pubstate = {published},
tppubtype = {article}
}
Nelson, L D; Pfaller, A Y; Rein, L E; McCrea, M A
Rates and Predictors of Invalid Baseline Test Performance in High School and Collegiate Athletes for 3 Computerized Neurocognitive Tests: ANAM, Axon Sports, and ImPACT Journal Article
In: American Journal of Sports Medicine, vol. 43, no. 8, pp. 2018–2026, 2015.
Abstract | BibTeX | Tags: *Athletes/px [Psychology], *Neuropsychological Tests, Adolescent, Athletic Injuries/di [Diagnosis], Athletic Injuries/px [Psychology], Attention Deficit Disorder with Hyperactivity/co [, Brain Concussion/di [Diagnosis], Brain Concussion/px [Psychology], Female, Humans, intelligence, Male, Reproducibility of Results, Students/px [Psychology], Young Adult
@article{Nelson2015,
title = {Rates and Predictors of Invalid Baseline Test Performance in High School and Collegiate Athletes for 3 Computerized Neurocognitive Tests: ANAM, Axon Sports, and ImPACT},
author = {Nelson, L D and Pfaller, A Y and Rein, L E and McCrea, M A},
year = {2015},
date = {2015-01-01},
journal = {American Journal of Sports Medicine},
volume = {43},
number = {8},
pages = {2018--2026},
abstract = {BACKGROUND: Preseason baseline testing using computerized neurocognitive tests (CNTs) is increasingly performed on athletes. Adequate effort is critical to establish valid estimates of ability, but many users do not evaluate performance validity, and the conditions that affect validity are not well understood across the available CNTs. PURPOSE: To examine the rates and predictors of invalid baseline performance for 3 popular CNTs: Automated Neuropsychological Assessment Metrics (ANAM), Axon Sports, and Immediate Post-Concussion and Cognitive Testing (ImPACT). STUDY DESIGN: Controlled laboratory study. METHODS: High school and collegiate athletes (N = 2063) completed 2 of 3 CNTs each during preseason evaluations. All possible pairings were present across the sample, and the order of administration was randomized. Examiners provided 1-on-1, scripted pretest instructions, emphasizing the importance of good effort. Profile validity was determined by the manufacturers' standard criteria. RESULTS: The overall percentage of tests flagged as of questionable validity was lowest for ImPACT (2.7%) and higher for ANAM and Axon (10.7% and 11.3%, respectively). The majority of invalid baseline profiles were flagged as such because of failure on only 1 validity criterion. Several athlete and testing factors (eg, attention deficit hyperactivity disorder [ADHD], estimated general intellectual ability, administration order) predicted validity status for 1 or more CNTs. Considering only first CNT administrations and participants without ADHD and/or a learning disability (n = 1835) brought the rates of invalid baseline performances to 2.1%, 8.8%, and 7.0% for ImPACT, ANAM, and Axon, respectively. Invalid profiles on the Medical Symptom Validity Test (MSVT) were rare (1.8% of participants) and demonstrated poor correspondence to CNT validity outcomes. CONCLUSION: The validity criteria for these CNTs may not identify the same causes of invalidity or be equally sensitive to effort. The validity indicators may not be equally appropriate for some athletes (eg, those with neurodevelopmental disorders). CLINICAL RELEVANCE: The data suggest that athletes do not put forth widespread low effort or that some validity criteria are more sensitive to invalid performance than others. It is important for examiners to be aware of the conditions that maximize the quality of baseline assessments and to understand what sources of invalid performance are captured by the validity criteria that they obtain.Copyright © 2015 The Author(s).},
keywords = {*Athletes/px [Psychology], *Neuropsychological Tests, Adolescent, Athletic Injuries/di [Diagnosis], Athletic Injuries/px [Psychology], Attention Deficit Disorder with Hyperactivity/co [, Brain Concussion/di [Diagnosis], Brain Concussion/px [Psychology], Female, Humans, intelligence, Male, Reproducibility of Results, Students/px [Psychology], Young Adult},
pubstate = {published},
tppubtype = {article}
}
Buckley, T A; Burdette, G; Kelly, K
Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives Journal Article
In: Journal of Athletic Training, vol. 50, no. 8, pp. 879–888, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/th [Therapy], *Brain Concussion/th [Therapy], *Sports/ph [Physiology], Athletic Injuries/di [Diagnosis], Brain Concussion/di [Diagnosis], Cross-Sectional Studies, Female, Humans, Male, Neuropsychological Tests, Physicians', Practice Guidelines as Topic, Practice Patterns, Return to Sport/ph [Physiology], Sports Medicine/mt [Methods], Surveys and Questionnaires
@article{Buckley2015,
title = {Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives},
author = {Buckley, T A and Burdette, G and Kelly, K},
year = {2015},
date = {2015-01-01},
journal = {Journal of Athletic Training},
volume = {50},
number = {8},
pages = {879--888},
abstract = {CONTEXT: The National Collegiate Athletic Association (NCAA) has published concussion-management practice guidelines consistent with recent position and consensus statements. Whereas NCAA Division I athletic trainers appear highly compliant, little is known about the concussion-management practice patterns of athletic trainers at smaller institutions where staffing and resources may be limited. OBJECTIVE: To descriptively define the concussion-management practice patterns of NCAA Division II and III athletic trainers. DESIGN: Cross-sectional study. SETTING: Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 755 respondents (response rate = 40.2%) from NCAA Division II and Division III institutions. MAIN OUTCOME MEASURE(S): The primary outcome measures were the rate of multifaceted concussion-assessment techniques, defined as 3 or more assessments; the specific practice patterns of each assessment battery; and tests used during a clinical examination. RESULTS: Most respondents indicated using a multifaceted assessment during acute assessment (Division II = 76.9%},
keywords = {*Athletic Injuries/th [Therapy], *Brain Concussion/th [Therapy], *Sports/ph [Physiology], Athletic Injuries/di [Diagnosis], Brain Concussion/di [Diagnosis], Cross-Sectional Studies, Female, Humans, Male, Neuropsychological Tests, Physicians', Practice Guidelines as Topic, Practice Patterns, Return to Sport/ph [Physiology], Sports Medicine/mt [Methods], Surveys and Questionnaires},
pubstate = {published},
tppubtype = {article}
}
Laws, J
The Bright Spotlight on Pro Football Concussions Journal Article
In: Occupational Health & Safety, vol. 84, no. 10, pp. 4, 2015.
BibTeX | Tags: *Brain Concussion/et [Etiology], *Football/in [Injuries], *Motion Pictures as Topic, Brain Concussion/di [Diagnosis], Brain Concussion/th [Therapy], CANADA, Humans, UNITED States
@article{Laws2015,
title = {The Bright Spotlight on Pro Football Concussions},
author = {Laws, J},
year = {2015},
date = {2015-01-01},
journal = {Occupational Health \& Safety},
volume = {84},
number = {10},
pages = {4},
keywords = {*Brain Concussion/et [Etiology], *Football/in [Injuries], *Motion Pictures as Topic, Brain Concussion/di [Diagnosis], Brain Concussion/th [Therapy], CANADA, Humans, UNITED States},
pubstate = {published},
tppubtype = {article}
}
Olivera, A; Lejbman, N; Jeromin, A; French, L M; Kim, H S; Cashion, A; Mysliwiec, V; Diaz-Arrastia, R; Gill, J
Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment Journal Article
In: JAMA Neurology, vol. 72, no. 10, pp. 1109–1116, 2015.
Abstract | BibTeX | Tags: *Brain Concussion/me [Metabolism], *Brain Injuries/me [Metabolism], *Depression/me [Metabolism], *Military Personnel, *Stress Disorders, *tau Proteins/bl [Blood], 0 (tau Proteins), 2003-2011, adult, Afghan Campaign 2001-, Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Injuries/co [Complications], Brain Injuries/di [Diagnosis], Depression/co [Complications], Depression/di [Diagnosis], Female, Humans, Iraq War, Male, Post-Traumatic/di [Diagnosis], Post-Traumatic/me [Metabolism], Retrospective Studies, self report, Stress Disorders, Young Adult
@article{Olivera2015,
title = {Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment},
author = {Olivera, A and Lejbman, N and Jeromin, A and French, L M and Kim, H S and Cashion, A and Mysliwiec, V and Diaz-Arrastia, R and Gill, J},
year = {2015},
date = {2015-01-01},
journal = {JAMA Neurology},
volume = {72},
number = {10},
pages = {1109--1116},
abstract = {IMPORTANCE: Approximately one-third of military personnel who deploy for combat operations sustain 1 or more traumatic brain injuries (TBIs), which increases the risk for chronic symptoms of postconcussive disorder, posttraumatic stress disorder, and depression and for the development of chronic traumatic encephalopathy. Elevated concentrations of tau are observed in blood shortly following a TBI, but, to our knowledge, the role of tau elevations in blood in the onset and maintenance of chronic symptoms after TBI has not been investigated. OBJECTIVES: To assess peripheral tau levels in military personnel exposed to TBI and to examine the relationship between chronic neurological symptoms and tau elevations. DESIGN, SETTING, AND PARTICIPANTS: Observational assessment from September 2012 to August 2014 of US military personnel at the Madigan Army Medical Center who had been deployed within the previous 18 months. Plasma total tau concentrations were measured using a novel ultrasensitive single-molecule enzyme-linked immunosorbent assay. Classification of participants with and without self-reported TBI was made using the Warrior Administered Retrospective Casualty Assessment Tool. Self-reported symptoms of postconcussive disorder, posttraumatic stress disorder, and depression were determined by the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist Military Version, and the Quick Inventory of Depressive Symptomatology, respectively. Group differences in tau concentrations were determined through analysis of variance models, and area under the receiver operating characteristic curve determined the sensitivity and specificity of tau concentrations in predicting TBI and chronic symptoms. Seventy participants with self-reported TBI on the Warrior Administered Retrospective Casualty Assessment Tool and 28 control participants with no TBI exposure were included. MAIN OUTCOMES AND MEASURES: Concentration of total tau in peripheral blood. RESULTS: Concentrations of plasma tau were significantly elevated in the 70 participants with self-reported TBI compared with the 28 controls (mean [SD], 1.13 [0.78] vs 0.63 [0.48] pg/mL, respectively; F1},
keywords = {*Brain Concussion/me [Metabolism], *Brain Injuries/me [Metabolism], *Depression/me [Metabolism], *Military Personnel, *Stress Disorders, *tau Proteins/bl [Blood], 0 (tau Proteins), 2003-2011, adult, Afghan Campaign 2001-, Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Injuries/co [Complications], Brain Injuries/di [Diagnosis], Depression/co [Complications], Depression/di [Diagnosis], Female, Humans, Iraq War, Male, Post-Traumatic/di [Diagnosis], Post-Traumatic/me [Metabolism], Retrospective Studies, self report, Stress Disorders, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Chun, I Y; Mao, X; Breedlove, E L; Leverenz, L J; Nauman, E A; Talavage, T M
DTI Detection of Longitudinal WM Abnormalities Due to Accumulated Head Impacts Journal Article
In: Developmental Neuropsychology, vol. 40, no. 2, pp. 92–97, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/pa [Pathology], *Craniocerebral Trauma/pp [Physiopathology], *Diffusion Magnetic Resonance Imaging/mt [Methods], *Football/in [Injuries], *White Matter/ab [Abnormalities], *White Matter/pp [Physiopathology], Adolescent, Athletes, Brain Concussion/di [Diagnosis], Brain Concussion/pp [Physiopathology], Brain/pp [Physiopathology], Brain/ra [Radiography], Craniocerebral Trauma/di [Diagnosis], Head, Humans, Schools, Time Factors, White Matter/pa [Pathology]
@article{Chun2015,
title = {DTI Detection of Longitudinal WM Abnormalities Due to Accumulated Head Impacts},
author = {Chun, I Y and Mao, X and Breedlove, E L and Leverenz, L J and Nauman, E A and Talavage, T M},
year = {2015},
date = {2015-01-01},
journal = {Developmental Neuropsychology},
volume = {40},
number = {2},
pages = {92--97},
abstract = {Longitudinal evaluation using diffusion-weighted imaging and collision event monitoring was performed on high school athletes who participate in American football. Observed changes in white matter health were suggestive of injury and found to be correlated with accumulation of head collision events during practices and games.},
keywords = {*Athletic Injuries/pa [Pathology], *Craniocerebral Trauma/pp [Physiopathology], *Diffusion Magnetic Resonance Imaging/mt [Methods], *Football/in [Injuries], *White Matter/ab [Abnormalities], *White Matter/pp [Physiopathology], Adolescent, Athletes, Brain Concussion/di [Diagnosis], Brain Concussion/pp [Physiopathology], Brain/pp [Physiopathology], Brain/ra [Radiography], Craniocerebral Trauma/di [Diagnosis], Head, Humans, Schools, Time Factors, White Matter/pa [Pathology]},
pubstate = {published},
tppubtype = {article}
}
Master, C L; Balcer, L; Collins, M
Concussion Journal Article
In: Annals of Internal Medicine, vol. 160, no. 3, pp. ITC2–1, 2014.
BibTeX | Tags: *Brain Concussion, Brain Concussion/di [Diagnosis], Brain Concussion/pc [Prevention & Control], Brain Concussion/th [Therapy], Humans, Overviews, Patient Education as Topic, Prognosis
@article{Master2014,
title = {Concussion},
author = {Master, C L and Balcer, L and Collins, M},
year = {2014},
date = {2014-01-01},
journal = {Annals of Internal Medicine},
volume = {160},
number = {3},
pages = {ITC2--1},
keywords = {*Brain Concussion, Brain Concussion/di [Diagnosis], Brain Concussion/pc [Prevention \& Control], Brain Concussion/th [Therapy], Humans, Overviews, Patient Education as Topic, Prognosis},
pubstate = {published},
tppubtype = {article}
}
Logan, B W; Goldman, S; Zola, M; Mackey, A
Concussive brain injury in the military: September 2001 to the present Journal Article
In: Behav Sci Law, vol. 31, no. 6, pp. 803–813, 2013.
Abstract | BibTeX | Tags: *Brain Concussion/th [Therapy], *Military Personnel/px [Psychology], 2003-2011, Afghan Campaign 2001-, Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Evidence-Based Medicine, Humans, Iraq War, United States/ep [Epidemiology]
@article{Logan2013,
title = {Concussive brain injury in the military: September 2001 to the present},
author = {Logan, B W and Goldman, S and Zola, M and Mackey, A},
year = {2013},
date = {2013-01-01},
journal = {Behav Sci Law},
volume = {31},
number = {6},
pages = {803--813},
abstract = {Since the terrorist attacks of September 11, 2001, 1,348,405 citizens have been deployed to combat in Operation Iraqi Freedom (OIF), Operation New Dawn in Iraq, and Operation Enduring Freedom in Afghanistan (OEF). During this same period 266,810 (20%) of these individuals have been diagnosed with a traumatic brain injury (TBI). The majority of these were Army soldiers, with 155,282 (58%) receiving the diagnosis. Mild TBI comprised 82% of the total, with the remainder being moderate to severe. Over this same period the Department of Defense (DoD) has invested $374.9 million to enhance access and quality of care services, including 57 TBI treatment centers in the combat theater and throughout the U.S. The Army's medical research division, the Medical Research and Material Command (MRMC), has invested an additional $700 million to TBI research during this time. The effort has faced a number of challenges, including limited human subject basic and translational research, limited epidemiological data on combat-related injuries, limited capacity and standards for data acquisition, and a lack of standardized evidenced-based protocols for treatment. All these areas have undergone significant growth and development, leading to the comprehensive system of care present today. A further challenge in this patient population has been the clinical co-morbidity of TBI, post-traumatic stress disorder, and chronic pain syndrome. The Army and the DoD have created treatment programs that are interdisciplinary in clinical approach, targeting particular neuropsychological domains of dysfunction rather than diagnostic category or etiology of injury. This article presents the history of this effort, the challenges to accurate and adequate diagnosis and care that remain, and the future of brain injury clinical and research efforts in the military. Copyright © 2013 John Wiley \& Sons, Ltd.},
keywords = {*Brain Concussion/th [Therapy], *Military Personnel/px [Psychology], 2003-2011, Afghan Campaign 2001-, Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Evidence-Based Medicine, Humans, Iraq War, United States/ep [Epidemiology]},
pubstate = {published},
tppubtype = {article}
}
Dubourg, J; Messerer, M
Sports-related chronic repetitive head trauma as a cause of pituitary dysfunction Journal Article
In: Neurosurgical Focus, vol. 31, no. 5, pp. E2, 2011.
Abstract | BibTeX | Tags: *Athletic Injuries/pp [Physiopathology], *Brain Injuries/pp [Physiopathology], *HEAD injuries, *Pituitary Diseases/et [Etiology], *Pituitary Gland/pp [Physiopathology], Athletic Injuries/co [Complications], Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/pp [Physiopathology], Brain Injuries/et [Etiology], chronic disease, Closed/co [Complications], Closed/pp [Physiopathology], Early Diagnosis, Head Injuries, Humans, Pituitary Diseases/pp [Physiopathology], Pituitary Gland/in [Injuries]
@article{Dubourg2011,
title = {Sports-related chronic repetitive head trauma as a cause of pituitary dysfunction},
author = {Dubourg, J and Messerer, M},
year = {2011},
date = {2011-01-01},
journal = {Neurosurgical Focus},
volume = {31},
number = {5},
pages = {E2},
abstract = {Traumatic brain injury (TBI) is recognized as a cause of hypopituitarism even after mild TBI. Although over the past decade, a growing body of research has detailed neuroendocrine changes induced by TBI, the mechanisms and risk factors responsible for this pituitary dysfunction are still unclear. Around the world, sports-especially combative sports-are very popular. However, sports are not generally considered as a cause of TBI in most epidemiological studies, and the link between sports-related head trauma and hypopituitarism has not been investigated until recently. Thus, there is a paucity of data regarding this important concern. Because of the large number of young sports participants with near-normal life expectancy, the implications of undiagnosed or untreated postconcussion pituitary dysfunction can be dramatic. Understanding the pathophysiological mechanisms and risk factors of hypopituitarism caused by sports injuries is thus an important issue that concerns both medical staff and sponsors of sports. The aim of this paper was to summarize the best evidence for understanding the pathophysiological mechanisms and to discuss the current data and recommendations on sports-related head trauma as a cause of hypopituitarism.},
keywords = {*Athletic Injuries/pp [Physiopathology], *Brain Injuries/pp [Physiopathology], *HEAD injuries, *Pituitary Diseases/et [Etiology], *Pituitary Gland/pp [Physiopathology], Athletic Injuries/co [Complications], Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/pp [Physiopathology], Brain Injuries/et [Etiology], chronic disease, Closed/co [Complications], Closed/pp [Physiopathology], Early Diagnosis, Head Injuries, Humans, Pituitary Diseases/pp [Physiopathology], Pituitary Gland/in [Injuries]},
pubstate = {published},
tppubtype = {article}
}
Thornton, A E; Cox, D N; Whitfield, K; Fouladi, R T
Cumulative concussion exposure in rugby players: neurocognitive and symptomatic outcomes Journal Article
In: Journal of Clinical & Experimental Neuropsychology, vol. 30, no. 4, pp. 398–409, 2008.
Abstract | BibTeX | Tags: *Brain Concussion/co [Complications], *COGNITION, *Cognition Disorders/et [Etiology], *Football/in [Injuries], adult, Age Factors, aged, Brain Concussion/di [Diagnosis], Female, Humans, Male, middle aged, Neuropsychological Tests, Predictive Value of Tests, REGRESSION analysis, Surveys and Questionnaires, Trauma Severity Indices
@article{Thornton2008a,
title = {Cumulative concussion exposure in rugby players: neurocognitive and symptomatic outcomes},
author = {Thornton, A E and Cox, D N and Whitfield, K and Fouladi, R T},
year = {2008},
date = {2008-01-01},
journal = {Journal of Clinical \& Experimental Neuropsychology},
volume = {30},
number = {4},
pages = {398--409},
abstract = {A total of 111 rugby players underwent comprehensive testing to determine the impact of self-reported concussion exposure. Reliable estimates of concussion exposure were associated with an increase in postconcussion symptoms (PCS), but not diminished neurocognitive functioning. Importantly, the effects of concussion exposure on PCS varied as a function of player status. More specifically, extent of concussion exposure was associated with increased memory complaints and overall PCS endorsements in a dose-dependent manner for retired and older recreational players, but not for those who were younger and playing at more competitive levels. Future work should systematically evaluate the constituent participant factors that may influence differential concussion outcomes.},
keywords = {*Brain Concussion/co [Complications], *COGNITION, *Cognition Disorders/et [Etiology], *Football/in [Injuries], adult, Age Factors, aged, Brain Concussion/di [Diagnosis], Female, Humans, Male, middle aged, Neuropsychological Tests, Predictive Value of Tests, REGRESSION analysis, Surveys and Questionnaires, Trauma Severity Indices},
pubstate = {published},
tppubtype = {article}
}
Horner, A; VanDemark, M; Jensen, G A
The challenge of assessing a patient with dementia and head injury Journal Article
In: AACN Clinical Issues, vol. 13, no. 1, pp. 73–83, 2002.
Abstract | BibTeX | Tags: *Craniocerebral Trauma/co [Complications], *Dementia/co [Complications], Accidental Falls, Accidents, aged, Alzheimer Disease/di [Diagnosis], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Brain Concussion/pp [Physiopathology], Craniocerebral Trauma/di [Diagnosis], Craniocerebral Trauma/pp [Physiopathology], Delirium/di [Diagnosis], Delirium/et [Etiology], Home, Humans
@article{Horner2002,
title = {The challenge of assessing a patient with dementia and head injury},
author = {Horner, A and VanDemark, M and Jensen, G A},
year = {2002},
date = {2002-01-01},
journal = {AACN Clinical Issues},
volume = {13},
number = {1},
pages = {73--83},
abstract = {Alzheimer's disease is emerging as a major health challenge for the 21st century. The reported case study discusses a 74-year-old woman with dementia of the Alzheimer type who sustained a head injury when she fell down the basement stairs. Differentiating the head injury from the preexisting dementia was complicated and required creative and astute assessment. Objective assessment tools discussed include the Mini-Mental State Examination, a delirium guide, and the Tinetti assessment tool. Predisposition to delirium is significant because of the comorbidities associated with cognitive impairment and head injury. Interventions to prevent delirium are recommended.},
keywords = {*Craniocerebral Trauma/co [Complications], *Dementia/co [Complications], Accidental Falls, Accidents, aged, Alzheimer Disease/di [Diagnosis], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Brain Concussion/pp [Physiopathology], Craniocerebral Trauma/di [Diagnosis], Craniocerebral Trauma/pp [Physiopathology], Delirium/di [Diagnosis], Delirium/et [Etiology], Home, Humans},
pubstate = {published},
tppubtype = {article}
}
Heinrichs, R W; Celinski, M J
Frequency of occurrence of a WAIS dementia profile in male head trauma patients Journal Article
In: Journal of Clinical & Experimental Neuropsychology, vol. 9, no. 2, pp. 187–190, 1987.
Abstract | BibTeX | Tags: *Brain Injuries/di [Diagnosis], *Dementia/di [Diagnosis], *Wechsler Scales, adult, Brain Concussion/di [Diagnosis], Cerebral Hemorrhage/di [Diagnosis], Humans, middle aged, Psychometrics
@article{Heinrichs1987,
title = {Frequency of occurrence of a WAIS dementia profile in male head trauma patients},
author = {Heinrichs, R W and Celinski, M J},
year = {1987},
date = {1987-01-01},
journal = {Journal of Clinical \& Experimental Neuropsychology},
volume = {9},
number = {2},
pages = {187--190},
abstract = {This study investigated Fuld's (1983) contention that a WAIS dementia profile occurs infrequently in conditions other than Alzheimer's Disease. A sample of 50 male head trauma patients was examined for incidence of the profile. The WAIS profile occurred in five cases (10%) of the patients. This compares favourably with the figures reported for patients with multiple infarcts and is consistent with Fuld's position.},
keywords = {*Brain Injuries/di [Diagnosis], *Dementia/di [Diagnosis], *Wechsler Scales, adult, Brain Concussion/di [Diagnosis], Cerebral Hemorrhage/di [Diagnosis], Humans, middle aged, Psychometrics},
pubstate = {published},
tppubtype = {article}
}
Kasamatsu, T; Cleary, M; Bennett, J; Howard, K; McLeod, T V
Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer Journal Article
In: Journal of Athletic Training, vol. 51, no. 2, pp. 153–161, 2016.
@article{Kasamatsu2016a,
title = {Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer},
author = {Kasamatsu, T and Cleary, M and Bennett, J and Howard, K and McLeod, T V},
year = {2016},
date = {2016-01-01},
journal = {Journal of Athletic Training},
volume = {51},
number = {2},
pages = {153--161},
abstract = {CONTEXT: Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools. OBJECTIVE: To examine ATs' perspectives on return to learn, cognitive rest, and communication with school professionals after concussion. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 1124 secondary school ATs completed the survey (28.5% response rate). The majority of participants were employed full time (752/1114 [67.5%]) in public schools (911/1117 [81.6%]). MAIN OUTCOME MEASURE(S): School and AT employment characteristics, demographics, number of concussions evaluated annually, and perceptions of school professionals' familiarity with ATs' responsibilities were independent variables. RESULTS: Of the ATs, 44% reported having an existing return-to-learn policy. The strongest predictor of a return-to-learn policy was frequent communication with teachers after concussion (odds ratio = 1.5; 95% confidence interval = 1.2, 1.7). Most ATs recommended complete cognitive rest (eg, no reading, television; 492/1087 [45.3%]) or limited cognitive activity based upon symptoms (391/1087 [36.0%]). Common academic accommodations were postponed due dates (789/954 [82.7%]), rest breaks (765/954 [80.2%]), and partial attendance (740/954 [77.6%]). Athletic trainers self-reported as primary monitors of health (764/1037 [73.7%]) and academic progression (359/1011 [35.5%]). The strongest predictor of ATs' communication with school professionals was their perception of school professionals' understanding of ATs' roles. CONCLUSIONS: Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes' physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lombardi, N J; Tucker, B; Freedman, K B; Austin, L S; Eck, B; Pepe, M; Tjoumakaris, F P
Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine Journal Article
In: Orthopedics, vol. 39, no. 5, pp. e944–9, 2016.
@article{Lombardi2016,
title = {Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine},
author = {Lombardi, N J and Tucker, B and Freedman, K B and Austin, L S and Eck, B and Pepe, M and Tjoumakaris, F P},
year = {2016},
date = {2016-01-01},
journal = {Orthopedics},
volume = {39},
number = {5},
pages = {e944--9},
abstract = {It is standard practice in high school athletic programs for certified athletic trainers to evaluate and treat injured student athletes. In some cases, a trainer refers an athlete to a physician for definitive medical management. This study was conducted to determine the rate of agreement between athletic trainers and physicians regarding assessment of injuries in student athletes. All high school athletes who were injured between 2010 and 2012 at 5 regional high schools were included in a research database. All patients who were referred for physician evaluation and treatment were identified and included in this analysis. A total of 286 incidents met the inclusion criteria. A total of 263 (92%) of the athletic trainer assessments and physician diagnoses were in agreement. In the 23 cases of disagreement, fractures and sprains were the most common injuries. Kappa analysis showed the highest interrater agreement in injuries classified as dislocations and concussions and the lowest interrater agreement in meniscal/labral injuries and fractures. In the absence of a confirmed diagnosis, agreement among health care providers can be used to infer accuracy. According to this principle, as agreement between athletic trainers and physicians improves, there is a greater likelihood of arriving at the correct assessment and treatment plan. Athletic trainers are highly skilled professionals who are well trained in the evaluation of athletic injuries. The current study showed that additional training in identifying fractures may be beneficial to athletic trainers and the athletes they treat. [Orthopedics. 2016; 39(5):e944-e949.]. Copyright 2016, SLACK Incorporated.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Koerte, I K; Hufschmidt, J; Muehlmann, M; Tripodis, Y; Stamm, J M; Pasternak, O; Giwerc, M Y; Coleman, M J; Baugh, C M; Fritts, N G; Heinen, F; Lin, A; Stern, R A; Shenton, M E
Cavum Septi Pellucidi in Symptomatic Former Professional Football Players Journal Article
In: Journal of Neurotrauma, vol. 33, no. 4, pp. 346–353, 2016.
@article{Koerte2016,
title = {Cavum Septi Pellucidi in Symptomatic Former Professional Football Players},
author = {Koerte, I K and Hufschmidt, J and Muehlmann, M and Tripodis, Y and Stamm, J M and Pasternak, O and Giwerc, M Y and Coleman, M J and Baugh, C M and Fritts, N G and Heinen, F and Lin, A and Stern, R A and Shenton, M E},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurotrauma},
volume = {33},
number = {4},
pages = {346--353},
abstract = {Post-mortem studies reveal a high rate of cavum septi pellucidi (CSP) in chronic traumatic encephalopathy (CTE). It remains, however, to be determined whether or not the presence of CSP may be a potential in vivo imaging marker in populations at high risk to develop CTE. The aim of this study was to evaluate CSP in former professional American football players presenting with cognitive and behavioral symptoms compared with noncontact sports athletes. Seventy-two symptomatic former professional football players (mean age 54.53 years, standard deviation [SD] 7.97) as well as 14 former professional noncontact sports athletes (mean age 57.14 years, SD 7.35) underwent high-resolution structural 3T magnetic resonance imaging. Two raters independently evaluated the CSP, and interrater reliability was calculated. Within National Football League players, an association of CSP measures with cognitive and behavioral functioning was evaluated using a multivariate mixed effects model. The measurements of the two raters were highly correlated (CSP length: rho = 0.98; Intraclass Correlation Coefficient [ICC] 0.99; p \< 0.0001; septum length: rho = 0.93; ICC 0.96; p \< 0.0001). For presence versus absence of CSP, there was high agreement (Cohen kappa = 0.83, p \< 0.0001). A higher rate of CSP, a greater length of CSP, as well as a greater ratio of CSP length to septum length was found in symptomatic former professional football players compared with athlete controls. In addition, a greater length of CSP was associated with decreased performance on a list learning task (Neuropsychological Assessment Battery List A Immediate Recall},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Zemek, R; Barrowman, N; Freedman, S B; Gravel, J; Gagnon, I; McGahern, C; Aglipay, M; Sangha, G; Boutis, K; Beer, D; Craig, W; Burns, E; Farion, K J; Mikrogianakis, A; Barlow, K; Dubrovsky, A S; Meeuwisse, W; Gioia, G; Meehan 3rd, W P; Beauchamp, M H; Kamil, Y; Grool, A M; Hoshizaki, B; Anderson, P; Brooks, B L; Yeates, K O; Vassilyadi, M; Klassen, T; Keightley, M; Richer, L; DeMatteo, C; Osmond, M H; Pediatric Emergency Research Canada Concussion, Team
Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED Journal Article
In: JAMA, vol. 315, no. 10, pp. 1014–1025, 2016.
@article{Zemek2016,
title = {Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED},
author = {Zemek, R and Barrowman, N and Freedman, S B and Gravel, J and Gagnon, I and McGahern, C and Aglipay, M and Sangha, G and Boutis, K and Beer, D and Craig, W and Burns, E and Farion, K J and Mikrogianakis, A and Barlow, K and Dubrovsky, A S and Meeuwisse, W and Gioia, G and {Meehan 3rd}, W P and Beauchamp, M H and Kamil, Y and Grool, A M and Hoshizaki, B and Anderson, P and Brooks, B L and Yeates, K O and Vassilyadi, M and Klassen, T and Keightley, M and Richer, L and DeMatteo, C and Osmond, M H and {Pediatric Emergency Research Canada Concussion}, Team},
year = {2016},
date = {2016-01-01},
journal = {JAMA},
volume = {315},
number = {10},
pages = {1014--1025},
abstract = {IMPORTANCE: Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE: To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-\<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. EXPOSURES: All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. MAIN OUTCOMES AND MEASURES: The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. RESULTS: In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n=2006 in the derivation cohort; n=1057 in the validation cohort) and 2584 of whom (n=1701 [85%] in the derivation cohort; n=883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n=510 [30.0%] in the derivation cohort and n=291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. CONCLUSIONS AND RELEVANCE: A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Nelson, L D; Pfaller, A Y; Rein, L E; McCrea, M A
Rates and Predictors of Invalid Baseline Test Performance in High School and Collegiate Athletes for 3 Computerized Neurocognitive Tests: ANAM, Axon Sports, and ImPACT Journal Article
In: American Journal of Sports Medicine, vol. 43, no. 8, pp. 2018–2026, 2015.
@article{Nelson2015,
title = {Rates and Predictors of Invalid Baseline Test Performance in High School and Collegiate Athletes for 3 Computerized Neurocognitive Tests: ANAM, Axon Sports, and ImPACT},
author = {Nelson, L D and Pfaller, A Y and Rein, L E and McCrea, M A},
year = {2015},
date = {2015-01-01},
journal = {American Journal of Sports Medicine},
volume = {43},
number = {8},
pages = {2018--2026},
abstract = {BACKGROUND: Preseason baseline testing using computerized neurocognitive tests (CNTs) is increasingly performed on athletes. Adequate effort is critical to establish valid estimates of ability, but many users do not evaluate performance validity, and the conditions that affect validity are not well understood across the available CNTs. PURPOSE: To examine the rates and predictors of invalid baseline performance for 3 popular CNTs: Automated Neuropsychological Assessment Metrics (ANAM), Axon Sports, and Immediate Post-Concussion and Cognitive Testing (ImPACT). STUDY DESIGN: Controlled laboratory study. METHODS: High school and collegiate athletes (N = 2063) completed 2 of 3 CNTs each during preseason evaluations. All possible pairings were present across the sample, and the order of administration was randomized. Examiners provided 1-on-1, scripted pretest instructions, emphasizing the importance of good effort. Profile validity was determined by the manufacturers' standard criteria. RESULTS: The overall percentage of tests flagged as of questionable validity was lowest for ImPACT (2.7%) and higher for ANAM and Axon (10.7% and 11.3%, respectively). The majority of invalid baseline profiles were flagged as such because of failure on only 1 validity criterion. Several athlete and testing factors (eg, attention deficit hyperactivity disorder [ADHD], estimated general intellectual ability, administration order) predicted validity status for 1 or more CNTs. Considering only first CNT administrations and participants without ADHD and/or a learning disability (n = 1835) brought the rates of invalid baseline performances to 2.1%, 8.8%, and 7.0% for ImPACT, ANAM, and Axon, respectively. Invalid profiles on the Medical Symptom Validity Test (MSVT) were rare (1.8% of participants) and demonstrated poor correspondence to CNT validity outcomes. CONCLUSION: The validity criteria for these CNTs may not identify the same causes of invalidity or be equally sensitive to effort. The validity indicators may not be equally appropriate for some athletes (eg, those with neurodevelopmental disorders). CLINICAL RELEVANCE: The data suggest that athletes do not put forth widespread low effort or that some validity criteria are more sensitive to invalid performance than others. It is important for examiners to be aware of the conditions that maximize the quality of baseline assessments and to understand what sources of invalid performance are captured by the validity criteria that they obtain.Copyright © 2015 The Author(s).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Buckley, T A; Burdette, G; Kelly, K
Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives Journal Article
In: Journal of Athletic Training, vol. 50, no. 8, pp. 879–888, 2015.
@article{Buckley2015,
title = {Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives},
author = {Buckley, T A and Burdette, G and Kelly, K},
year = {2015},
date = {2015-01-01},
journal = {Journal of Athletic Training},
volume = {50},
number = {8},
pages = {879--888},
abstract = {CONTEXT: The National Collegiate Athletic Association (NCAA) has published concussion-management practice guidelines consistent with recent position and consensus statements. Whereas NCAA Division I athletic trainers appear highly compliant, little is known about the concussion-management practice patterns of athletic trainers at smaller institutions where staffing and resources may be limited. OBJECTIVE: To descriptively define the concussion-management practice patterns of NCAA Division II and III athletic trainers. DESIGN: Cross-sectional study. SETTING: Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 755 respondents (response rate = 40.2%) from NCAA Division II and Division III institutions. MAIN OUTCOME MEASURE(S): The primary outcome measures were the rate of multifaceted concussion-assessment techniques, defined as 3 or more assessments; the specific practice patterns of each assessment battery; and tests used during a clinical examination. RESULTS: Most respondents indicated using a multifaceted assessment during acute assessment (Division II = 76.9%},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Laws, J
The Bright Spotlight on Pro Football Concussions Journal Article
In: Occupational Health & Safety, vol. 84, no. 10, pp. 4, 2015.
@article{Laws2015,
title = {The Bright Spotlight on Pro Football Concussions},
author = {Laws, J},
year = {2015},
date = {2015-01-01},
journal = {Occupational Health \& Safety},
volume = {84},
number = {10},
pages = {4},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Olivera, A; Lejbman, N; Jeromin, A; French, L M; Kim, H S; Cashion, A; Mysliwiec, V; Diaz-Arrastia, R; Gill, J
Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment Journal Article
In: JAMA Neurology, vol. 72, no. 10, pp. 1109–1116, 2015.
@article{Olivera2015,
title = {Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment},
author = {Olivera, A and Lejbman, N and Jeromin, A and French, L M and Kim, H S and Cashion, A and Mysliwiec, V and Diaz-Arrastia, R and Gill, J},
year = {2015},
date = {2015-01-01},
journal = {JAMA Neurology},
volume = {72},
number = {10},
pages = {1109--1116},
abstract = {IMPORTANCE: Approximately one-third of military personnel who deploy for combat operations sustain 1 or more traumatic brain injuries (TBIs), which increases the risk for chronic symptoms of postconcussive disorder, posttraumatic stress disorder, and depression and for the development of chronic traumatic encephalopathy. Elevated concentrations of tau are observed in blood shortly following a TBI, but, to our knowledge, the role of tau elevations in blood in the onset and maintenance of chronic symptoms after TBI has not been investigated. OBJECTIVES: To assess peripheral tau levels in military personnel exposed to TBI and to examine the relationship between chronic neurological symptoms and tau elevations. DESIGN, SETTING, AND PARTICIPANTS: Observational assessment from September 2012 to August 2014 of US military personnel at the Madigan Army Medical Center who had been deployed within the previous 18 months. Plasma total tau concentrations were measured using a novel ultrasensitive single-molecule enzyme-linked immunosorbent assay. Classification of participants with and without self-reported TBI was made using the Warrior Administered Retrospective Casualty Assessment Tool. Self-reported symptoms of postconcussive disorder, posttraumatic stress disorder, and depression were determined by the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist Military Version, and the Quick Inventory of Depressive Symptomatology, respectively. Group differences in tau concentrations were determined through analysis of variance models, and area under the receiver operating characteristic curve determined the sensitivity and specificity of tau concentrations in predicting TBI and chronic symptoms. Seventy participants with self-reported TBI on the Warrior Administered Retrospective Casualty Assessment Tool and 28 control participants with no TBI exposure were included. MAIN OUTCOMES AND MEASURES: Concentration of total tau in peripheral blood. RESULTS: Concentrations of plasma tau were significantly elevated in the 70 participants with self-reported TBI compared with the 28 controls (mean [SD], 1.13 [0.78] vs 0.63 [0.48] pg/mL, respectively; F1},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Chun, I Y; Mao, X; Breedlove, E L; Leverenz, L J; Nauman, E A; Talavage, T M
DTI Detection of Longitudinal WM Abnormalities Due to Accumulated Head Impacts Journal Article
In: Developmental Neuropsychology, vol. 40, no. 2, pp. 92–97, 2015.
@article{Chun2015,
title = {DTI Detection of Longitudinal WM Abnormalities Due to Accumulated Head Impacts},
author = {Chun, I Y and Mao, X and Breedlove, E L and Leverenz, L J and Nauman, E A and Talavage, T M},
year = {2015},
date = {2015-01-01},
journal = {Developmental Neuropsychology},
volume = {40},
number = {2},
pages = {92--97},
abstract = {Longitudinal evaluation using diffusion-weighted imaging and collision event monitoring was performed on high school athletes who participate in American football. Observed changes in white matter health were suggestive of injury and found to be correlated with accumulation of head collision events during practices and games.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Master, C L; Balcer, L; Collins, M
Concussion Journal Article
In: Annals of Internal Medicine, vol. 160, no. 3, pp. ITC2–1, 2014.
@article{Master2014,
title = {Concussion},
author = {Master, C L and Balcer, L and Collins, M},
year = {2014},
date = {2014-01-01},
journal = {Annals of Internal Medicine},
volume = {160},
number = {3},
pages = {ITC2--1},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Logan, B W; Goldman, S; Zola, M; Mackey, A
Concussive brain injury in the military: September 2001 to the present Journal Article
In: Behav Sci Law, vol. 31, no. 6, pp. 803–813, 2013.
@article{Logan2013,
title = {Concussive brain injury in the military: September 2001 to the present},
author = {Logan, B W and Goldman, S and Zola, M and Mackey, A},
year = {2013},
date = {2013-01-01},
journal = {Behav Sci Law},
volume = {31},
number = {6},
pages = {803--813},
abstract = {Since the terrorist attacks of September 11, 2001, 1,348,405 citizens have been deployed to combat in Operation Iraqi Freedom (OIF), Operation New Dawn in Iraq, and Operation Enduring Freedom in Afghanistan (OEF). During this same period 266,810 (20%) of these individuals have been diagnosed with a traumatic brain injury (TBI). The majority of these were Army soldiers, with 155,282 (58%) receiving the diagnosis. Mild TBI comprised 82% of the total, with the remainder being moderate to severe. Over this same period the Department of Defense (DoD) has invested $374.9 million to enhance access and quality of care services, including 57 TBI treatment centers in the combat theater and throughout the U.S. The Army's medical research division, the Medical Research and Material Command (MRMC), has invested an additional $700 million to TBI research during this time. The effort has faced a number of challenges, including limited human subject basic and translational research, limited epidemiological data on combat-related injuries, limited capacity and standards for data acquisition, and a lack of standardized evidenced-based protocols for treatment. All these areas have undergone significant growth and development, leading to the comprehensive system of care present today. A further challenge in this patient population has been the clinical co-morbidity of TBI, post-traumatic stress disorder, and chronic pain syndrome. The Army and the DoD have created treatment programs that are interdisciplinary in clinical approach, targeting particular neuropsychological domains of dysfunction rather than diagnostic category or etiology of injury. This article presents the history of this effort, the challenges to accurate and adequate diagnosis and care that remain, and the future of brain injury clinical and research efforts in the military. Copyright © 2013 John Wiley \& Sons, Ltd.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Dubourg, J; Messerer, M
Sports-related chronic repetitive head trauma as a cause of pituitary dysfunction Journal Article
In: Neurosurgical Focus, vol. 31, no. 5, pp. E2, 2011.
@article{Dubourg2011,
title = {Sports-related chronic repetitive head trauma as a cause of pituitary dysfunction},
author = {Dubourg, J and Messerer, M},
year = {2011},
date = {2011-01-01},
journal = {Neurosurgical Focus},
volume = {31},
number = {5},
pages = {E2},
abstract = {Traumatic brain injury (TBI) is recognized as a cause of hypopituitarism even after mild TBI. Although over the past decade, a growing body of research has detailed neuroendocrine changes induced by TBI, the mechanisms and risk factors responsible for this pituitary dysfunction are still unclear. Around the world, sports-especially combative sports-are very popular. However, sports are not generally considered as a cause of TBI in most epidemiological studies, and the link between sports-related head trauma and hypopituitarism has not been investigated until recently. Thus, there is a paucity of data regarding this important concern. Because of the large number of young sports participants with near-normal life expectancy, the implications of undiagnosed or untreated postconcussion pituitary dysfunction can be dramatic. Understanding the pathophysiological mechanisms and risk factors of hypopituitarism caused by sports injuries is thus an important issue that concerns both medical staff and sponsors of sports. The aim of this paper was to summarize the best evidence for understanding the pathophysiological mechanisms and to discuss the current data and recommendations on sports-related head trauma as a cause of hypopituitarism.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Thornton, A E; Cox, D N; Whitfield, K; Fouladi, R T
Cumulative concussion exposure in rugby players: neurocognitive and symptomatic outcomes Journal Article
In: Journal of Clinical & Experimental Neuropsychology, vol. 30, no. 4, pp. 398–409, 2008.
@article{Thornton2008a,
title = {Cumulative concussion exposure in rugby players: neurocognitive and symptomatic outcomes},
author = {Thornton, A E and Cox, D N and Whitfield, K and Fouladi, R T},
year = {2008},
date = {2008-01-01},
journal = {Journal of Clinical \& Experimental Neuropsychology},
volume = {30},
number = {4},
pages = {398--409},
abstract = {A total of 111 rugby players underwent comprehensive testing to determine the impact of self-reported concussion exposure. Reliable estimates of concussion exposure were associated with an increase in postconcussion symptoms (PCS), but not diminished neurocognitive functioning. Importantly, the effects of concussion exposure on PCS varied as a function of player status. More specifically, extent of concussion exposure was associated with increased memory complaints and overall PCS endorsements in a dose-dependent manner for retired and older recreational players, but not for those who were younger and playing at more competitive levels. Future work should systematically evaluate the constituent participant factors that may influence differential concussion outcomes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Horner, A; VanDemark, M; Jensen, G A
The challenge of assessing a patient with dementia and head injury Journal Article
In: AACN Clinical Issues, vol. 13, no. 1, pp. 73–83, 2002.
@article{Horner2002,
title = {The challenge of assessing a patient with dementia and head injury},
author = {Horner, A and VanDemark, M and Jensen, G A},
year = {2002},
date = {2002-01-01},
journal = {AACN Clinical Issues},
volume = {13},
number = {1},
pages = {73--83},
abstract = {Alzheimer's disease is emerging as a major health challenge for the 21st century. The reported case study discusses a 74-year-old woman with dementia of the Alzheimer type who sustained a head injury when she fell down the basement stairs. Differentiating the head injury from the preexisting dementia was complicated and required creative and astute assessment. Objective assessment tools discussed include the Mini-Mental State Examination, a delirium guide, and the Tinetti assessment tool. Predisposition to delirium is significant because of the comorbidities associated with cognitive impairment and head injury. Interventions to prevent delirium are recommended.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Heinrichs, R W; Celinski, M J
Frequency of occurrence of a WAIS dementia profile in male head trauma patients Journal Article
In: Journal of Clinical & Experimental Neuropsychology, vol. 9, no. 2, pp. 187–190, 1987.
@article{Heinrichs1987,
title = {Frequency of occurrence of a WAIS dementia profile in male head trauma patients},
author = {Heinrichs, R W and Celinski, M J},
year = {1987},
date = {1987-01-01},
journal = {Journal of Clinical \& Experimental Neuropsychology},
volume = {9},
number = {2},
pages = {187--190},
abstract = {This study investigated Fuld's (1983) contention that a WAIS dementia profile occurs infrequently in conditions other than Alzheimer's Disease. A sample of 50 male head trauma patients was examined for incidence of the profile. The WAIS profile occurred in five cases (10%) of the patients. This compares favourably with the figures reported for patients with multiple infarcts and is consistent with Fuld's position.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Kasamatsu, T; Cleary, M; Bennett, J; Howard, K; McLeod, T V
Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer Journal Article
In: Journal of Athletic Training, vol. 51, no. 2, pp. 153–161, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/px [Psychology], *Brain Concussion/px [Psychology], *Interdisciplinary Communication, *Learning, *Physical Education and Training, Adolescent, Athletic Injuries/di [Diagnosis], Brain Concussion/di [Diagnosis], cognition, Cross-Sectional Studies, Faculty, Humans, Schools, Surveys and Questionnaires
@article{Kasamatsu2016a,
title = {Examining Academic Support After Concussion for the Adolescent Student-Athlete: Perspectives of the Athletic Trainer},
author = {Kasamatsu, T and Cleary, M and Bennett, J and Howard, K and McLeod, T V},
year = {2016},
date = {2016-01-01},
journal = {Journal of Athletic Training},
volume = {51},
number = {2},
pages = {153--161},
abstract = {CONTEXT: Student-athletes may require cognitive rest and academic support after concussion. Athletic trainers (ATs) in secondary schools are uniquely positioned to provide medical care and to collaborate with school professionals while managing concussions. However, little is known regarding return-to-learn policies and their implementation in secondary schools. OBJECTIVE: To examine ATs' perspectives on return to learn, cognitive rest, and communication with school professionals after concussion. DESIGN: Cross-sectional study. SETTING: Web-based survey. PATIENTS OR OTHER PARTICIPANTS: A total of 1124 secondary school ATs completed the survey (28.5% response rate). The majority of participants were employed full time (752/1114 [67.5%]) in public schools (911/1117 [81.6%]). MAIN OUTCOME MEASURE(S): School and AT employment characteristics, demographics, number of concussions evaluated annually, and perceptions of school professionals' familiarity with ATs' responsibilities were independent variables. RESULTS: Of the ATs, 44% reported having an existing return-to-learn policy. The strongest predictor of a return-to-learn policy was frequent communication with teachers after concussion (odds ratio = 1.5; 95% confidence interval = 1.2, 1.7). Most ATs recommended complete cognitive rest (eg, no reading, television; 492/1087 [45.3%]) or limited cognitive activity based upon symptoms (391/1087 [36.0%]). Common academic accommodations were postponed due dates (789/954 [82.7%]), rest breaks (765/954 [80.2%]), and partial attendance (740/954 [77.6%]). Athletic trainers self-reported as primary monitors of health (764/1037 [73.7%]) and academic progression (359/1011 [35.5%]). The strongest predictor of ATs' communication with school professionals was their perception of school professionals' understanding of ATs' roles. CONCLUSIONS: Overall, ATs followed best practices for cognitive rest and return to learn after concussion. Although ATs are central to the management of student-athletes' physical health after concussion, school professionals may be better suited to monitor academic progress. Increased communication between the AT and school professionals is recommended to monitor recovery and facilitate academic support for symptomatic student-athletes.},
keywords = {*Athletic Injuries/px [Psychology], *Brain Concussion/px [Psychology], *Interdisciplinary Communication, *Learning, *Physical Education and Training, Adolescent, Athletic Injuries/di [Diagnosis], Brain Concussion/di [Diagnosis], cognition, Cross-Sectional Studies, Faculty, Humans, Schools, Surveys and Questionnaires},
pubstate = {published},
tppubtype = {article}
}
Lombardi, N J; Tucker, B; Freedman, K B; Austin, L S; Eck, B; Pepe, M; Tjoumakaris, F P
Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine Journal Article
In: Orthopedics, vol. 39, no. 5, pp. e944–9, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Consensus, *Orthopedics/st [Standards], *Physical Therapy Specialty/st [Standards], *Referral and Consultation, Adolescent, Athletes, Athletic Injuries/ep [Epidemiology], Bone/di [Diagnosis], Bone/ep [Epidemiology], Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Contusions/di [Diagnosis], Contusions/ep [Epidemiology], Female, Fractures, Humans, Male, Observer Variation, Orthopedics/sn [Statistics & Numerical Data], Physical Therapy Specialty/sn [Statistics & Numeri, Schools, Sports, SPORTS medicine, Sprains and Strains/di [Diagnosis], Sprains and Strains/ep [Epidemiology]
@article{Lombardi2016,
title = {Accuracy of Athletic Trainer and Physician Diagnoses in Sports Medicine},
author = {Lombardi, N J and Tucker, B and Freedman, K B and Austin, L S and Eck, B and Pepe, M and Tjoumakaris, F P},
year = {2016},
date = {2016-01-01},
journal = {Orthopedics},
volume = {39},
number = {5},
pages = {e944--9},
abstract = {It is standard practice in high school athletic programs for certified athletic trainers to evaluate and treat injured student athletes. In some cases, a trainer refers an athlete to a physician for definitive medical management. This study was conducted to determine the rate of agreement between athletic trainers and physicians regarding assessment of injuries in student athletes. All high school athletes who were injured between 2010 and 2012 at 5 regional high schools were included in a research database. All patients who were referred for physician evaluation and treatment were identified and included in this analysis. A total of 286 incidents met the inclusion criteria. A total of 263 (92%) of the athletic trainer assessments and physician diagnoses were in agreement. In the 23 cases of disagreement, fractures and sprains were the most common injuries. Kappa analysis showed the highest interrater agreement in injuries classified as dislocations and concussions and the lowest interrater agreement in meniscal/labral injuries and fractures. In the absence of a confirmed diagnosis, agreement among health care providers can be used to infer accuracy. According to this principle, as agreement between athletic trainers and physicians improves, there is a greater likelihood of arriving at the correct assessment and treatment plan. Athletic trainers are highly skilled professionals who are well trained in the evaluation of athletic injuries. The current study showed that additional training in identifying fractures may be beneficial to athletic trainers and the athletes they treat. [Orthopedics. 2016; 39(5):e944-e949.]. Copyright 2016, SLACK Incorporated.},
keywords = {*Athletic Injuries/di [Diagnosis], *Consensus, *Orthopedics/st [Standards], *Physical Therapy Specialty/st [Standards], *Referral and Consultation, Adolescent, Athletes, Athletic Injuries/ep [Epidemiology], Bone/di [Diagnosis], Bone/ep [Epidemiology], Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Contusions/di [Diagnosis], Contusions/ep [Epidemiology], Female, Fractures, Humans, Male, Observer Variation, Orthopedics/sn [Statistics \& Numerical Data], Physical Therapy Specialty/sn [Statistics \& Numeri, Schools, Sports, SPORTS medicine, Sprains and Strains/di [Diagnosis], Sprains and Strains/ep [Epidemiology]},
pubstate = {published},
tppubtype = {article}
}
Koerte, I K; Hufschmidt, J; Muehlmann, M; Tripodis, Y; Stamm, J M; Pasternak, O; Giwerc, M Y; Coleman, M J; Baugh, C M; Fritts, N G; Heinen, F; Lin, A; Stern, R A; Shenton, M E
Cavum Septi Pellucidi in Symptomatic Former Professional Football Players Journal Article
In: Journal of Neurotrauma, vol. 33, no. 4, pp. 346–353, 2016.
Abstract | BibTeX | Tags: *Athletes, *Football/in [Injuries], *Septum Pellucidum/pa [Pathology], adult, aged, Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Humans, Male, middle aged
@article{Koerte2016,
title = {Cavum Septi Pellucidi in Symptomatic Former Professional Football Players},
author = {Koerte, I K and Hufschmidt, J and Muehlmann, M and Tripodis, Y and Stamm, J M and Pasternak, O and Giwerc, M Y and Coleman, M J and Baugh, C M and Fritts, N G and Heinen, F and Lin, A and Stern, R A and Shenton, M E},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurotrauma},
volume = {33},
number = {4},
pages = {346--353},
abstract = {Post-mortem studies reveal a high rate of cavum septi pellucidi (CSP) in chronic traumatic encephalopathy (CTE). It remains, however, to be determined whether or not the presence of CSP may be a potential in vivo imaging marker in populations at high risk to develop CTE. The aim of this study was to evaluate CSP in former professional American football players presenting with cognitive and behavioral symptoms compared with noncontact sports athletes. Seventy-two symptomatic former professional football players (mean age 54.53 years, standard deviation [SD] 7.97) as well as 14 former professional noncontact sports athletes (mean age 57.14 years, SD 7.35) underwent high-resolution structural 3T magnetic resonance imaging. Two raters independently evaluated the CSP, and interrater reliability was calculated. Within National Football League players, an association of CSP measures with cognitive and behavioral functioning was evaluated using a multivariate mixed effects model. The measurements of the two raters were highly correlated (CSP length: rho = 0.98; Intraclass Correlation Coefficient [ICC] 0.99; p \< 0.0001; septum length: rho = 0.93; ICC 0.96; p \< 0.0001). For presence versus absence of CSP, there was high agreement (Cohen kappa = 0.83, p \< 0.0001). A higher rate of CSP, a greater length of CSP, as well as a greater ratio of CSP length to septum length was found in symptomatic former professional football players compared with athlete controls. In addition, a greater length of CSP was associated with decreased performance on a list learning task (Neuropsychological Assessment Battery List A Immediate Recall},
keywords = {*Athletes, *Football/in [Injuries], *Septum Pellucidum/pa [Pathology], adult, aged, Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Humans, Male, middle aged},
pubstate = {published},
tppubtype = {article}
}
Zemek, R; Barrowman, N; Freedman, S B; Gravel, J; Gagnon, I; McGahern, C; Aglipay, M; Sangha, G; Boutis, K; Beer, D; Craig, W; Burns, E; Farion, K J; Mikrogianakis, A; Barlow, K; Dubrovsky, A S; Meeuwisse, W; Gioia, G; Meehan 3rd, W P; Beauchamp, M H; Kamil, Y; Grool, A M; Hoshizaki, B; Anderson, P; Brooks, B L; Yeates, K O; Vassilyadi, M; Klassen, T; Keightley, M; Richer, L; DeMatteo, C; Osmond, M H; Pediatric Emergency Research Canada Concussion, Team
Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED Journal Article
In: JAMA, vol. 315, no. 10, pp. 1014–1025, 2016.
Abstract | BibTeX | Tags: *Post-Concussion Syndrome/di [Diagnosis], Accidents, Adolescent, Age Factors, Area Under Curve, Athletic Injuries/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Child, Emergency Service, Female, Follow-Up Studies, Hospital, Humans, Male, MEDICAL history taking, MULTIVARIATE analysis, Observer Variation, Outcome Assessment (Health Care), Post-Concussion Syndrome/et [Etiology], Preschool, Prospective Studies, RISK assessment, Sensitivity and Specificity, Sex Factors, Time Factors, Traffic/sn [Statistics & Numerical Data
@article{Zemek2016,
title = {Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED},
author = {Zemek, R and Barrowman, N and Freedman, S B and Gravel, J and Gagnon, I and McGahern, C and Aglipay, M and Sangha, G and Boutis, K and Beer, D and Craig, W and Burns, E and Farion, K J and Mikrogianakis, A and Barlow, K and Dubrovsky, A S and Meeuwisse, W and Gioia, G and {Meehan 3rd}, W P and Beauchamp, M H and Kamil, Y and Grool, A M and Hoshizaki, B and Anderson, P and Brooks, B L and Yeates, K O and Vassilyadi, M and Klassen, T and Keightley, M and Richer, L and DeMatteo, C and Osmond, M H and {Pediatric Emergency Research Canada Concussion}, Team},
year = {2016},
date = {2016-01-01},
journal = {JAMA},
volume = {315},
number = {10},
pages = {1014--1025},
abstract = {IMPORTANCE: Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE: To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS: Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-\<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. EXPOSURES: All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. MAIN OUTCOMES AND MEASURES: The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. RESULTS: In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n=2006 in the derivation cohort; n=1057 in the validation cohort) and 2584 of whom (n=1701 [85%] in the derivation cohort; n=883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n=510 [30.0%] in the derivation cohort and n=291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. CONCLUSIONS AND RELEVANCE: A clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.},
keywords = {*Post-Concussion Syndrome/di [Diagnosis], Accidents, Adolescent, Age Factors, Area Under Curve, Athletic Injuries/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Child, Emergency Service, Female, Follow-Up Studies, Hospital, Humans, Male, MEDICAL history taking, MULTIVARIATE analysis, Observer Variation, Outcome Assessment (Health Care), Post-Concussion Syndrome/et [Etiology], Preschool, Prospective Studies, RISK assessment, Sensitivity and Specificity, Sex Factors, Time Factors, Traffic/sn [Statistics \& Numerical Data},
pubstate = {published},
tppubtype = {article}
}
Nelson, L D; Pfaller, A Y; Rein, L E; McCrea, M A
Rates and Predictors of Invalid Baseline Test Performance in High School and Collegiate Athletes for 3 Computerized Neurocognitive Tests: ANAM, Axon Sports, and ImPACT Journal Article
In: American Journal of Sports Medicine, vol. 43, no. 8, pp. 2018–2026, 2015.
Abstract | BibTeX | Tags: *Athletes/px [Psychology], *Neuropsychological Tests, Adolescent, Athletic Injuries/di [Diagnosis], Athletic Injuries/px [Psychology], Attention Deficit Disorder with Hyperactivity/co [, Brain Concussion/di [Diagnosis], Brain Concussion/px [Psychology], Female, Humans, intelligence, Male, Reproducibility of Results, Students/px [Psychology], Young Adult
@article{Nelson2015,
title = {Rates and Predictors of Invalid Baseline Test Performance in High School and Collegiate Athletes for 3 Computerized Neurocognitive Tests: ANAM, Axon Sports, and ImPACT},
author = {Nelson, L D and Pfaller, A Y and Rein, L E and McCrea, M A},
year = {2015},
date = {2015-01-01},
journal = {American Journal of Sports Medicine},
volume = {43},
number = {8},
pages = {2018--2026},
abstract = {BACKGROUND: Preseason baseline testing using computerized neurocognitive tests (CNTs) is increasingly performed on athletes. Adequate effort is critical to establish valid estimates of ability, but many users do not evaluate performance validity, and the conditions that affect validity are not well understood across the available CNTs. PURPOSE: To examine the rates and predictors of invalid baseline performance for 3 popular CNTs: Automated Neuropsychological Assessment Metrics (ANAM), Axon Sports, and Immediate Post-Concussion and Cognitive Testing (ImPACT). STUDY DESIGN: Controlled laboratory study. METHODS: High school and collegiate athletes (N = 2063) completed 2 of 3 CNTs each during preseason evaluations. All possible pairings were present across the sample, and the order of administration was randomized. Examiners provided 1-on-1, scripted pretest instructions, emphasizing the importance of good effort. Profile validity was determined by the manufacturers' standard criteria. RESULTS: The overall percentage of tests flagged as of questionable validity was lowest for ImPACT (2.7%) and higher for ANAM and Axon (10.7% and 11.3%, respectively). The majority of invalid baseline profiles were flagged as such because of failure on only 1 validity criterion. Several athlete and testing factors (eg, attention deficit hyperactivity disorder [ADHD], estimated general intellectual ability, administration order) predicted validity status for 1 or more CNTs. Considering only first CNT administrations and participants without ADHD and/or a learning disability (n = 1835) brought the rates of invalid baseline performances to 2.1%, 8.8%, and 7.0% for ImPACT, ANAM, and Axon, respectively. Invalid profiles on the Medical Symptom Validity Test (MSVT) were rare (1.8% of participants) and demonstrated poor correspondence to CNT validity outcomes. CONCLUSION: The validity criteria for these CNTs may not identify the same causes of invalidity or be equally sensitive to effort. The validity indicators may not be equally appropriate for some athletes (eg, those with neurodevelopmental disorders). CLINICAL RELEVANCE: The data suggest that athletes do not put forth widespread low effort or that some validity criteria are more sensitive to invalid performance than others. It is important for examiners to be aware of the conditions that maximize the quality of baseline assessments and to understand what sources of invalid performance are captured by the validity criteria that they obtain.Copyright © 2015 The Author(s).},
keywords = {*Athletes/px [Psychology], *Neuropsychological Tests, Adolescent, Athletic Injuries/di [Diagnosis], Athletic Injuries/px [Psychology], Attention Deficit Disorder with Hyperactivity/co [, Brain Concussion/di [Diagnosis], Brain Concussion/px [Psychology], Female, Humans, intelligence, Male, Reproducibility of Results, Students/px [Psychology], Young Adult},
pubstate = {published},
tppubtype = {article}
}
Buckley, T A; Burdette, G; Kelly, K
Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives Journal Article
In: Journal of Athletic Training, vol. 50, no. 8, pp. 879–888, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/th [Therapy], *Brain Concussion/th [Therapy], *Sports/ph [Physiology], Athletic Injuries/di [Diagnosis], Brain Concussion/di [Diagnosis], Cross-Sectional Studies, Female, Humans, Male, Neuropsychological Tests, Physicians', Practice Guidelines as Topic, Practice Patterns, Return to Sport/ph [Physiology], Sports Medicine/mt [Methods], Surveys and Questionnaires
@article{Buckley2015,
title = {Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives},
author = {Buckley, T A and Burdette, G and Kelly, K},
year = {2015},
date = {2015-01-01},
journal = {Journal of Athletic Training},
volume = {50},
number = {8},
pages = {879--888},
abstract = {CONTEXT: The National Collegiate Athletic Association (NCAA) has published concussion-management practice guidelines consistent with recent position and consensus statements. Whereas NCAA Division I athletic trainers appear highly compliant, little is known about the concussion-management practice patterns of athletic trainers at smaller institutions where staffing and resources may be limited. OBJECTIVE: To descriptively define the concussion-management practice patterns of NCAA Division II and III athletic trainers. DESIGN: Cross-sectional study. SETTING: Web-based questionnaire. PATIENTS OR OTHER PARTICIPANTS: A total of 755 respondents (response rate = 40.2%) from NCAA Division II and Division III institutions. MAIN OUTCOME MEASURE(S): The primary outcome measures were the rate of multifaceted concussion-assessment techniques, defined as 3 or more assessments; the specific practice patterns of each assessment battery; and tests used during a clinical examination. RESULTS: Most respondents indicated using a multifaceted assessment during acute assessment (Division II = 76.9%},
keywords = {*Athletic Injuries/th [Therapy], *Brain Concussion/th [Therapy], *Sports/ph [Physiology], Athletic Injuries/di [Diagnosis], Brain Concussion/di [Diagnosis], Cross-Sectional Studies, Female, Humans, Male, Neuropsychological Tests, Physicians', Practice Guidelines as Topic, Practice Patterns, Return to Sport/ph [Physiology], Sports Medicine/mt [Methods], Surveys and Questionnaires},
pubstate = {published},
tppubtype = {article}
}
Laws, J
The Bright Spotlight on Pro Football Concussions Journal Article
In: Occupational Health & Safety, vol. 84, no. 10, pp. 4, 2015.
BibTeX | Tags: *Brain Concussion/et [Etiology], *Football/in [Injuries], *Motion Pictures as Topic, Brain Concussion/di [Diagnosis], Brain Concussion/th [Therapy], CANADA, Humans, UNITED States
@article{Laws2015,
title = {The Bright Spotlight on Pro Football Concussions},
author = {Laws, J},
year = {2015},
date = {2015-01-01},
journal = {Occupational Health \& Safety},
volume = {84},
number = {10},
pages = {4},
keywords = {*Brain Concussion/et [Etiology], *Football/in [Injuries], *Motion Pictures as Topic, Brain Concussion/di [Diagnosis], Brain Concussion/th [Therapy], CANADA, Humans, UNITED States},
pubstate = {published},
tppubtype = {article}
}
Olivera, A; Lejbman, N; Jeromin, A; French, L M; Kim, H S; Cashion, A; Mysliwiec, V; Diaz-Arrastia, R; Gill, J
Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment Journal Article
In: JAMA Neurology, vol. 72, no. 10, pp. 1109–1116, 2015.
Abstract | BibTeX | Tags: *Brain Concussion/me [Metabolism], *Brain Injuries/me [Metabolism], *Depression/me [Metabolism], *Military Personnel, *Stress Disorders, *tau Proteins/bl [Blood], 0 (tau Proteins), 2003-2011, adult, Afghan Campaign 2001-, Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Injuries/co [Complications], Brain Injuries/di [Diagnosis], Depression/co [Complications], Depression/di [Diagnosis], Female, Humans, Iraq War, Male, Post-Traumatic/di [Diagnosis], Post-Traumatic/me [Metabolism], Retrospective Studies, self report, Stress Disorders, Young Adult
@article{Olivera2015,
title = {Peripheral Total Tau in Military Personnel Who Sustain Traumatic Brain Injuries During Deployment},
author = {Olivera, A and Lejbman, N and Jeromin, A and French, L M and Kim, H S and Cashion, A and Mysliwiec, V and Diaz-Arrastia, R and Gill, J},
year = {2015},
date = {2015-01-01},
journal = {JAMA Neurology},
volume = {72},
number = {10},
pages = {1109--1116},
abstract = {IMPORTANCE: Approximately one-third of military personnel who deploy for combat operations sustain 1 or more traumatic brain injuries (TBIs), which increases the risk for chronic symptoms of postconcussive disorder, posttraumatic stress disorder, and depression and for the development of chronic traumatic encephalopathy. Elevated concentrations of tau are observed in blood shortly following a TBI, but, to our knowledge, the role of tau elevations in blood in the onset and maintenance of chronic symptoms after TBI has not been investigated. OBJECTIVES: To assess peripheral tau levels in military personnel exposed to TBI and to examine the relationship between chronic neurological symptoms and tau elevations. DESIGN, SETTING, AND PARTICIPANTS: Observational assessment from September 2012 to August 2014 of US military personnel at the Madigan Army Medical Center who had been deployed within the previous 18 months. Plasma total tau concentrations were measured using a novel ultrasensitive single-molecule enzyme-linked immunosorbent assay. Classification of participants with and without self-reported TBI was made using the Warrior Administered Retrospective Casualty Assessment Tool. Self-reported symptoms of postconcussive disorder, posttraumatic stress disorder, and depression were determined by the Neurobehavioral Symptom Inventory, the Posttraumatic Stress Disorder Checklist Military Version, and the Quick Inventory of Depressive Symptomatology, respectively. Group differences in tau concentrations were determined through analysis of variance models, and area under the receiver operating characteristic curve determined the sensitivity and specificity of tau concentrations in predicting TBI and chronic symptoms. Seventy participants with self-reported TBI on the Warrior Administered Retrospective Casualty Assessment Tool and 28 control participants with no TBI exposure were included. MAIN OUTCOMES AND MEASURES: Concentration of total tau in peripheral blood. RESULTS: Concentrations of plasma tau were significantly elevated in the 70 participants with self-reported TBI compared with the 28 controls (mean [SD], 1.13 [0.78] vs 0.63 [0.48] pg/mL, respectively; F1},
keywords = {*Brain Concussion/me [Metabolism], *Brain Injuries/me [Metabolism], *Depression/me [Metabolism], *Military Personnel, *Stress Disorders, *tau Proteins/bl [Blood], 0 (tau Proteins), 2003-2011, adult, Afghan Campaign 2001-, Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Injuries/co [Complications], Brain Injuries/di [Diagnosis], Depression/co [Complications], Depression/di [Diagnosis], Female, Humans, Iraq War, Male, Post-Traumatic/di [Diagnosis], Post-Traumatic/me [Metabolism], Retrospective Studies, self report, Stress Disorders, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Chun, I Y; Mao, X; Breedlove, E L; Leverenz, L J; Nauman, E A; Talavage, T M
DTI Detection of Longitudinal WM Abnormalities Due to Accumulated Head Impacts Journal Article
In: Developmental Neuropsychology, vol. 40, no. 2, pp. 92–97, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/pa [Pathology], *Craniocerebral Trauma/pp [Physiopathology], *Diffusion Magnetic Resonance Imaging/mt [Methods], *Football/in [Injuries], *White Matter/ab [Abnormalities], *White Matter/pp [Physiopathology], Adolescent, Athletes, Brain Concussion/di [Diagnosis], Brain Concussion/pp [Physiopathology], Brain/pp [Physiopathology], Brain/ra [Radiography], Craniocerebral Trauma/di [Diagnosis], Head, Humans, Schools, Time Factors, White Matter/pa [Pathology]
@article{Chun2015,
title = {DTI Detection of Longitudinal WM Abnormalities Due to Accumulated Head Impacts},
author = {Chun, I Y and Mao, X and Breedlove, E L and Leverenz, L J and Nauman, E A and Talavage, T M},
year = {2015},
date = {2015-01-01},
journal = {Developmental Neuropsychology},
volume = {40},
number = {2},
pages = {92--97},
abstract = {Longitudinal evaluation using diffusion-weighted imaging and collision event monitoring was performed on high school athletes who participate in American football. Observed changes in white matter health were suggestive of injury and found to be correlated with accumulation of head collision events during practices and games.},
keywords = {*Athletic Injuries/pa [Pathology], *Craniocerebral Trauma/pp [Physiopathology], *Diffusion Magnetic Resonance Imaging/mt [Methods], *Football/in [Injuries], *White Matter/ab [Abnormalities], *White Matter/pp [Physiopathology], Adolescent, Athletes, Brain Concussion/di [Diagnosis], Brain Concussion/pp [Physiopathology], Brain/pp [Physiopathology], Brain/ra [Radiography], Craniocerebral Trauma/di [Diagnosis], Head, Humans, Schools, Time Factors, White Matter/pa [Pathology]},
pubstate = {published},
tppubtype = {article}
}
Master, C L; Balcer, L; Collins, M
Concussion Journal Article
In: Annals of Internal Medicine, vol. 160, no. 3, pp. ITC2–1, 2014.
BibTeX | Tags: *Brain Concussion, Brain Concussion/di [Diagnosis], Brain Concussion/pc [Prevention & Control], Brain Concussion/th [Therapy], Humans, Overviews, Patient Education as Topic, Prognosis
@article{Master2014,
title = {Concussion},
author = {Master, C L and Balcer, L and Collins, M},
year = {2014},
date = {2014-01-01},
journal = {Annals of Internal Medicine},
volume = {160},
number = {3},
pages = {ITC2--1},
keywords = {*Brain Concussion, Brain Concussion/di [Diagnosis], Brain Concussion/pc [Prevention \& Control], Brain Concussion/th [Therapy], Humans, Overviews, Patient Education as Topic, Prognosis},
pubstate = {published},
tppubtype = {article}
}
Logan, B W; Goldman, S; Zola, M; Mackey, A
Concussive brain injury in the military: September 2001 to the present Journal Article
In: Behav Sci Law, vol. 31, no. 6, pp. 803–813, 2013.
Abstract | BibTeX | Tags: *Brain Concussion/th [Therapy], *Military Personnel/px [Psychology], 2003-2011, Afghan Campaign 2001-, Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Evidence-Based Medicine, Humans, Iraq War, United States/ep [Epidemiology]
@article{Logan2013,
title = {Concussive brain injury in the military: September 2001 to the present},
author = {Logan, B W and Goldman, S and Zola, M and Mackey, A},
year = {2013},
date = {2013-01-01},
journal = {Behav Sci Law},
volume = {31},
number = {6},
pages = {803--813},
abstract = {Since the terrorist attacks of September 11, 2001, 1,348,405 citizens have been deployed to combat in Operation Iraqi Freedom (OIF), Operation New Dawn in Iraq, and Operation Enduring Freedom in Afghanistan (OEF). During this same period 266,810 (20%) of these individuals have been diagnosed with a traumatic brain injury (TBI). The majority of these were Army soldiers, with 155,282 (58%) receiving the diagnosis. Mild TBI comprised 82% of the total, with the remainder being moderate to severe. Over this same period the Department of Defense (DoD) has invested $374.9 million to enhance access and quality of care services, including 57 TBI treatment centers in the combat theater and throughout the U.S. The Army's medical research division, the Medical Research and Material Command (MRMC), has invested an additional $700 million to TBI research during this time. The effort has faced a number of challenges, including limited human subject basic and translational research, limited epidemiological data on combat-related injuries, limited capacity and standards for data acquisition, and a lack of standardized evidenced-based protocols for treatment. All these areas have undergone significant growth and development, leading to the comprehensive system of care present today. A further challenge in this patient population has been the clinical co-morbidity of TBI, post-traumatic stress disorder, and chronic pain syndrome. The Army and the DoD have created treatment programs that are interdisciplinary in clinical approach, targeting particular neuropsychological domains of dysfunction rather than diagnostic category or etiology of injury. This article presents the history of this effort, the challenges to accurate and adequate diagnosis and care that remain, and the future of brain injury clinical and research efforts in the military. Copyright © 2013 John Wiley \& Sons, Ltd.},
keywords = {*Brain Concussion/th [Therapy], *Military Personnel/px [Psychology], 2003-2011, Afghan Campaign 2001-, Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/ep [Epidemiology], Evidence-Based Medicine, Humans, Iraq War, United States/ep [Epidemiology]},
pubstate = {published},
tppubtype = {article}
}
Dubourg, J; Messerer, M
Sports-related chronic repetitive head trauma as a cause of pituitary dysfunction Journal Article
In: Neurosurgical Focus, vol. 31, no. 5, pp. E2, 2011.
Abstract | BibTeX | Tags: *Athletic Injuries/pp [Physiopathology], *Brain Injuries/pp [Physiopathology], *HEAD injuries, *Pituitary Diseases/et [Etiology], *Pituitary Gland/pp [Physiopathology], Athletic Injuries/co [Complications], Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/pp [Physiopathology], Brain Injuries/et [Etiology], chronic disease, Closed/co [Complications], Closed/pp [Physiopathology], Early Diagnosis, Head Injuries, Humans, Pituitary Diseases/pp [Physiopathology], Pituitary Gland/in [Injuries]
@article{Dubourg2011,
title = {Sports-related chronic repetitive head trauma as a cause of pituitary dysfunction},
author = {Dubourg, J and Messerer, M},
year = {2011},
date = {2011-01-01},
journal = {Neurosurgical Focus},
volume = {31},
number = {5},
pages = {E2},
abstract = {Traumatic brain injury (TBI) is recognized as a cause of hypopituitarism even after mild TBI. Although over the past decade, a growing body of research has detailed neuroendocrine changes induced by TBI, the mechanisms and risk factors responsible for this pituitary dysfunction are still unclear. Around the world, sports-especially combative sports-are very popular. However, sports are not generally considered as a cause of TBI in most epidemiological studies, and the link between sports-related head trauma and hypopituitarism has not been investigated until recently. Thus, there is a paucity of data regarding this important concern. Because of the large number of young sports participants with near-normal life expectancy, the implications of undiagnosed or untreated postconcussion pituitary dysfunction can be dramatic. Understanding the pathophysiological mechanisms and risk factors of hypopituitarism caused by sports injuries is thus an important issue that concerns both medical staff and sponsors of sports. The aim of this paper was to summarize the best evidence for understanding the pathophysiological mechanisms and to discuss the current data and recommendations on sports-related head trauma as a cause of hypopituitarism.},
keywords = {*Athletic Injuries/pp [Physiopathology], *Brain Injuries/pp [Physiopathology], *HEAD injuries, *Pituitary Diseases/et [Etiology], *Pituitary Gland/pp [Physiopathology], Athletic Injuries/co [Complications], Brain Concussion/co [Complications], Brain Concussion/di [Diagnosis], Brain Concussion/pp [Physiopathology], Brain Injuries/et [Etiology], chronic disease, Closed/co [Complications], Closed/pp [Physiopathology], Early Diagnosis, Head Injuries, Humans, Pituitary Diseases/pp [Physiopathology], Pituitary Gland/in [Injuries]},
pubstate = {published},
tppubtype = {article}
}
Thornton, A E; Cox, D N; Whitfield, K; Fouladi, R T
Cumulative concussion exposure in rugby players: neurocognitive and symptomatic outcomes Journal Article
In: Journal of Clinical & Experimental Neuropsychology, vol. 30, no. 4, pp. 398–409, 2008.
Abstract | BibTeX | Tags: *Brain Concussion/co [Complications], *COGNITION, *Cognition Disorders/et [Etiology], *Football/in [Injuries], adult, Age Factors, aged, Brain Concussion/di [Diagnosis], Female, Humans, Male, middle aged, Neuropsychological Tests, Predictive Value of Tests, REGRESSION analysis, Surveys and Questionnaires, Trauma Severity Indices
@article{Thornton2008a,
title = {Cumulative concussion exposure in rugby players: neurocognitive and symptomatic outcomes},
author = {Thornton, A E and Cox, D N and Whitfield, K and Fouladi, R T},
year = {2008},
date = {2008-01-01},
journal = {Journal of Clinical \& Experimental Neuropsychology},
volume = {30},
number = {4},
pages = {398--409},
abstract = {A total of 111 rugby players underwent comprehensive testing to determine the impact of self-reported concussion exposure. Reliable estimates of concussion exposure were associated with an increase in postconcussion symptoms (PCS), but not diminished neurocognitive functioning. Importantly, the effects of concussion exposure on PCS varied as a function of player status. More specifically, extent of concussion exposure was associated with increased memory complaints and overall PCS endorsements in a dose-dependent manner for retired and older recreational players, but not for those who were younger and playing at more competitive levels. Future work should systematically evaluate the constituent participant factors that may influence differential concussion outcomes.},
keywords = {*Brain Concussion/co [Complications], *COGNITION, *Cognition Disorders/et [Etiology], *Football/in [Injuries], adult, Age Factors, aged, Brain Concussion/di [Diagnosis], Female, Humans, Male, middle aged, Neuropsychological Tests, Predictive Value of Tests, REGRESSION analysis, Surveys and Questionnaires, Trauma Severity Indices},
pubstate = {published},
tppubtype = {article}
}
Horner, A; VanDemark, M; Jensen, G A
The challenge of assessing a patient with dementia and head injury Journal Article
In: AACN Clinical Issues, vol. 13, no. 1, pp. 73–83, 2002.
Abstract | BibTeX | Tags: *Craniocerebral Trauma/co [Complications], *Dementia/co [Complications], Accidental Falls, Accidents, aged, Alzheimer Disease/di [Diagnosis], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Brain Concussion/pp [Physiopathology], Craniocerebral Trauma/di [Diagnosis], Craniocerebral Trauma/pp [Physiopathology], Delirium/di [Diagnosis], Delirium/et [Etiology], Home, Humans
@article{Horner2002,
title = {The challenge of assessing a patient with dementia and head injury},
author = {Horner, A and VanDemark, M and Jensen, G A},
year = {2002},
date = {2002-01-01},
journal = {AACN Clinical Issues},
volume = {13},
number = {1},
pages = {73--83},
abstract = {Alzheimer's disease is emerging as a major health challenge for the 21st century. The reported case study discusses a 74-year-old woman with dementia of the Alzheimer type who sustained a head injury when she fell down the basement stairs. Differentiating the head injury from the preexisting dementia was complicated and required creative and astute assessment. Objective assessment tools discussed include the Mini-Mental State Examination, a delirium guide, and the Tinetti assessment tool. Predisposition to delirium is significant because of the comorbidities associated with cognitive impairment and head injury. Interventions to prevent delirium are recommended.},
keywords = {*Craniocerebral Trauma/co [Complications], *Dementia/co [Complications], Accidental Falls, Accidents, aged, Alzheimer Disease/di [Diagnosis], Brain Concussion/di [Diagnosis], Brain Concussion/et [Etiology], Brain Concussion/pp [Physiopathology], Craniocerebral Trauma/di [Diagnosis], Craniocerebral Trauma/pp [Physiopathology], Delirium/di [Diagnosis], Delirium/et [Etiology], Home, Humans},
pubstate = {published},
tppubtype = {article}
}
Heinrichs, R W; Celinski, M J
Frequency of occurrence of a WAIS dementia profile in male head trauma patients Journal Article
In: Journal of Clinical & Experimental Neuropsychology, vol. 9, no. 2, pp. 187–190, 1987.
Abstract | BibTeX | Tags: *Brain Injuries/di [Diagnosis], *Dementia/di [Diagnosis], *Wechsler Scales, adult, Brain Concussion/di [Diagnosis], Cerebral Hemorrhage/di [Diagnosis], Humans, middle aged, Psychometrics
@article{Heinrichs1987,
title = {Frequency of occurrence of a WAIS dementia profile in male head trauma patients},
author = {Heinrichs, R W and Celinski, M J},
year = {1987},
date = {1987-01-01},
journal = {Journal of Clinical \& Experimental Neuropsychology},
volume = {9},
number = {2},
pages = {187--190},
abstract = {This study investigated Fuld's (1983) contention that a WAIS dementia profile occurs infrequently in conditions other than Alzheimer's Disease. A sample of 50 male head trauma patients was examined for incidence of the profile. The WAIS profile occurred in five cases (10%) of the patients. This compares favourably with the figures reported for patients with multiple infarcts and is consistent with Fuld's position.},
keywords = {*Brain Injuries/di [Diagnosis], *Dementia/di [Diagnosis], *Wechsler Scales, adult, Brain Concussion/di [Diagnosis], Cerebral Hemorrhage/di [Diagnosis], Humans, middle aged, Psychometrics},
pubstate = {published},
tppubtype = {article}
}