References

2015

Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S

Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article

In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed

@article{Morgan2015,

title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},

author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},

doi = {10.1007/s00381-015-2916-y},

year  = {2015},

date = {2015-01-01},

journal = {Child's Nervous System},

volume = {31},

number = {12},

pages = {2305--2309},

abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},

keywords = {Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Ellis, M J; Leiter, J; Hall, T; McDonald, P J; Sawyer, S; Silver, N; Bunge, M; Essig, M

Neuroimaging findings in pediatric sports-related concussion Journal Article

In: Journal of Neurosurgery. Pediatrics., vol. 16, no. 3, pp. 241–247, 2015.

Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed

@article{Ellis2015b,

title = {Neuroimaging findings in pediatric sports-related concussion},

author = {Ellis, M J and Leiter, J and Hall, T and McDonald, P J and Sawyer, S and Silver, N and Bunge, M and Essig, M},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery. Pediatrics.},

volume = {16},

number = {3},

pages = {241--247},

abstract = {OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age \< 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.},

keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age < 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.

Walter, K D; Halstead, M E

Concussion in Teenage Athletes Journal Article

In: Adolescent Medicine, vol. 26, no. 1, pp. 39–52, 2015.

BibTeX | Tags: *Athletes, *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], Adolescent, Athletic Injuries/ep [Epidemiology], Athletic Injuries/pc [Prevention & Control], Brain Concussion/ep [Epidemiology], Brain Concussion/pc [Prevention & Control], Humans, Magnetic Resonance Imaging, Neurocognitive Disorders/di [Diagnosis], Tomography, X-Ray Computed

Pham, H; Zemek, R

A 15-year-old rugby player with a head injury Journal Article

In: CMAJ Canadian Medical Association Journal, vol. 187, no. 3, pp. 200–202, 2015.

BibTeX | Tags: *Brain Concussion/di [Diagnosis], *Football/in [Injuries], Adolescent, Athletic Injuries/di [Diagnosis], Athletic Injuries/rh [Rehabilitation], Brain Concussion/ra [Radiography], Brain Concussion/rh [Rehabilitation], Brain Concussion/th [Therapy], Female, Glasgow Coma Scale, Humans, Physical Examination, Recovery of Function, Tomography, X-Ray Computed

Phillips, S; Woessner, D

Sports-Related Traumatic Brain Injury Journal Article

In: Primary Care - Clinics in Office Practice, vol. 42, no. 2, pp. 243–248, 2015.

Abstract | Links | BibTeX | Tags: Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed

@article{Phillips2015b,

title = {Sports-Related Traumatic Brain Injury},

author = {Phillips, S and Woessner, D},

doi = {10.1016/j.pop.2015.01.010},

year  = {2015},

date = {2015-01-01},

journal = {Primary Care - Clinics in Office Practice},

volume = {42},

number = {2},

pages = {243--248},

abstract = {Concussions have garnered more attention in the medical literature, media, and social media. As such, in the nomenclature according to the Centers for Disease Control and Prevention, the term concussion has been supplanted by the term mild traumatic brain injury. Current numbers indicate that 1.7 million TBIs are documented annually, with estimates around 3 million annually (173,285 sports- and recreation-related TBIs among children and adolescents). The Sideline Concussion Assessment Tool 3 and the NFL Sideline Concussion Assessment Tool are commonly used sideline tools. © 2015 Elsevier Inc.},

keywords = {Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

1987

Jordan, B D

Neurologic aspects of boxing Journal Article

In: Archives of Neurology, vol. 44, no. 4, pp. 453–459, 1987.

Abstract | BibTeX | Tags: *Athletic Injuries, *Boxing, *Brain Injuries, Athletic Injuries/ep [Epidemiology], Athletic Injuries/pa [Pathology], Athletic Injuries/pc [Prevention & Control], Athletic Injuries/pp [Physiopathology], Brain Concussion/et [Etiology], Brain Injuries/ep [Epidemiology], Brain Injuries/pa [Pathology], Brain Injuries/pc [Prevention & Control], Brain Injuries/pp [Physiopathology], Humans, Magnetic Resonance Spectroscopy, Tomography, X-Ray Computed

@article{Jordan1987,

title = {Neurologic aspects of boxing},

author = {Jordan, B D},

year  = {1987},

date = {1987-01-01},

journal = {Archives of Neurology},

volume = {44},

number = {4},

pages = {453--459},

abstract = {The assessment and prevention of potentially adverse neurologic consequences of boxing requires two important considerations. Acute neurologic injuries should be distinguished from chronic brain injuries and the level of competitive boxing (ie, amateur vs professional) must also be taken into account. Acute neurologic injuries such as concussion, post-concussion syndrome, intracranial hemorrhage, and brain contusion are more readily identified than chronic neurologic injuries because of their immediate devastation of the nervous system. In contrast, chronic neurologic injuries differ in their pathophysiologic mechanisms that are exemplified by an insidious onset and progression after the cessation of boxing. Accordingly, the chronic traumatic encephalopathy of boxing poses the most serious neurologic threat of boxing. Amateur boxing differs from professional boxing in the duration of fights, rules and regulatory policies, medical evaluation, and protective devices. These factors could produce a differential effect on the risk of injury to the brain. The prevention of neurologic injuries in boxing requires the integration of proper neurologic evaluation by qualified ring-side physicians, the design and utilization of effective protective devices, and the establishment of national regulatory agencies.},

keywords = {*Athletic Injuries, *Boxing, *Brain Injuries, Athletic Injuries/ep [Epidemiology], Athletic Injuries/pa [Pathology], Athletic Injuries/pc [Prevention \&amp; Control], Athletic Injuries/pp [Physiopathology], Brain Concussion/et [Etiology], Brain Injuries/ep [Epidemiology], Brain Injuries/pa [Pathology], Brain Injuries/pc [Prevention \&amp; Control], Brain Injuries/pp [Physiopathology], Humans, Magnetic Resonance Spectroscopy, Tomography, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Reference Search

Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S

Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article

In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.

Abstract | Links | BibTeX

@article{Morgan2015,

title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},

author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},

doi = {10.1007/s00381-015-2916-y},

year  = {2015},

date = {2015-01-01},

journal = {Child's Nervous System},

volume = {31},

number = {12},

pages = {2305--2309},

abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Ellis, M J; Leiter, J; Hall, T; McDonald, P J; Sawyer, S; Silver, N; Bunge, M; Essig, M

Neuroimaging findings in pediatric sports-related concussion Journal Article

In: Journal of Neurosurgery. Pediatrics., vol. 16, no. 3, pp. 241–247, 2015.

Abstract | BibTeX

@article{Ellis2015b,

title = {Neuroimaging findings in pediatric sports-related concussion},

author = {Ellis, M J and Leiter, J and Hall, T and McDonald, P J and Sawyer, S and Silver, N and Bunge, M and Essig, M},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery. Pediatrics.},

volume = {16},

number = {3},

pages = {241--247},

abstract = {OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age \< 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

Walter, K D; Halstead, M E

Concussion in Teenage Athletes Journal Article

In: Adolescent Medicine, vol. 26, no. 1, pp. 39–52, 2015.

BibTeX

Pham, H; Zemek, R

A 15-year-old rugby player with a head injury Journal Article

In: CMAJ Canadian Medical Association Journal, vol. 187, no. 3, pp. 200–202, 2015.

BibTeX

Phillips, S; Woessner, D

Sports-Related Traumatic Brain Injury Journal Article

In: Primary Care - Clinics in Office Practice, vol. 42, no. 2, pp. 243–248, 2015.

Abstract | Links | BibTeX

Jordan, B D

Neurologic aspects of boxing Journal Article

In: Archives of Neurology, vol. 44, no. 4, pp. 453–459, 1987.

Abstract | BibTeX

Most Referenced Keywords

Show all

2015

Morgan, C D; Zuckerman, S L; King, L E; Beaird, S E; Sills, A K; Solomon, G S

Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging Journal Article

In: Child's Nervous System, vol. 31, no. 12, pp. 2305–2309, 2015.

@article{Morgan2015,

title = {Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging},

author = {Morgan, C D and Zuckerman, S L and King, L E and Beaird, S E and Sills, A K and Solomon, G S},

doi = {10.1007/s00381-015-2916-y},

year  = {2015},

date = {2015-01-01},

journal = {Child's Nervous System},

volume = {31},

number = {12},

pages = {2305--2309},

abstract = {Purpose: Approximately 90% of concussions are transient, with symptoms resolving within 10\textendash14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS. Methods: We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected. Results: Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI. Conclusions: In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase. © 2015, Springer-Verlag Berlin Heidelberg.},

keywords = {Adolescent, arachnoid cyst, Article, brain, Brain Injury, Child, Computed tomography (CT) neuroimaging, computer assisted tomography, Computer-Assisted, Concussion, cost effectiveness analysis, cost utility analysis, DECISION making, diagnostic value, DSM-IV, Female, human, Humans, image processing, Magnetic Resonance Imaging, Magnetic resonance imaging (MRI), major clinical study, Male, mild traumatic brain injury, neuroimaging, neurosurgery, nuclear magnetic resonance, nuclear magnetic resonance imaging, pathology, Post-Concussion Syndrome, postconcussion syndrome, Preschool, preschool child, priority journal, Radiography, Retrospective Studies, retrospective study, Sports, STATISTICS, Tomography, traumatic brain injury, X ray, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Ellis, M J; Leiter, J; Hall, T; McDonald, P J; Sawyer, S; Silver, N; Bunge, M; Essig, M

Neuroimaging findings in pediatric sports-related concussion Journal Article

In: Journal of Neurosurgery. Pediatrics., vol. 16, no. 3, pp. 241–247, 2015.

@article{Ellis2015b,

title = {Neuroimaging findings in pediatric sports-related concussion},

author = {Ellis, M J and Leiter, J and Hall, T and McDonald, P J and Sawyer, S and Silver, N and Bunge, M and Essig, M},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery. Pediatrics.},

volume = {16},

number = {3},

pages = {241--247},

abstract = {OBJECT: The goal in this review was to summarize the results of clinical neuroimaging studies performed in patients with sports-related concussion (SRC) who were referred to a multidisciplinar ypediatric concussion program. METHODS: The authors conducted a retrospective review of medical records and neuroimaging findings for all patients referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Inclusion criteria were as follows: 1) age \< 19 years; and 2) physician-diagnosed SRC. All patients underwent evaluation and follow-up by the same neurosurgeon. The 2 outcomes examined in this review were the frequency of neuroimaging studies performed in this population (including CT and MRI) and the findings of those studies. Clinical indications for neuroimaging and the impact of neuroimaging findings on clinical decision making were summarized where available. This investigation was approved by the local institutional ethics review board. RESULTS: A total of 151 patients (mean age 14 years, 59% female) were included this study. Overall, 36 patients (24%) underwent neuroimaging studies, the results of which were normal in 78% of cases. Sixteen percent of patients underwent CT imaging; results were normal in 79% of cases. Abnormal CT findings included the following: arachnoid cyst (1 patient), skull fracture (2 patients), suspected intracranial hemorrhage (1 patient), and suspected hemorrhage into an arachnoid cyst (1 patient). Eleven percent of patients underwent MRI; results were normal in 75% of cases. Abnormal MRI findings included the following: intraparenchymal hemorrhage and sylvian fissure arachnoid cyst (1 patient); nonhemorrhagic contusion (1 patient); demyelinating disease (1 patient); and posterior fossa arachnoid cyst, cerebellar volume loss, and nonspecific white matter changes (1 patient). CONCLUSIONS: Results of clinical neuroimaging studies are normal in the majority of pediatric patients with SRC. However, in selected cases neuroimaging can provide information that impacts decision making about return to play and retirement from the sport.},

keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Brain Concussion/et [Etiology], *Neuroimaging, Adolescent, Arachnoid Cysts/di [Diagnosis], Athletic Injuries/co [Complications], Athletic Injuries/pa [Pathology], Brain Concussion/pa [Pathology], Brain Injuries/di [Diagnosis], Brain Injuries/et [Etiology], Child, Contusions/di [Diagnosis], Dizziness/et [Etiology], Female, Follow-Up Studies, Headache/et [Etiology], Humans, Intracranial Hemorrhages/di [Diagnosis], Magnetic Resonance Imaging, Male, Neuroimaging/mt [Methods], postural balance, Predictive Value of Tests, Retrospective Studies, Skull Fractures/di [Diagnosis], Tomography, Unconsciousness/et [Etiology], X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

Walter, K D; Halstead, M E

Concussion in Teenage Athletes Journal Article

In: Adolescent Medicine, vol. 26, no. 1, pp. 39–52, 2015.

Pham, H; Zemek, R

A 15-year-old rugby player with a head injury Journal Article

In: CMAJ Canadian Medical Association Journal, vol. 187, no. 3, pp. 200–202, 2015.

Phillips, S; Woessner, D

Sports-Related Traumatic Brain Injury Journal Article

In: Primary Care - Clinics in Office Practice, vol. 42, no. 2, pp. 243–248, 2015.

@article{Phillips2015b,

title = {Sports-Related Traumatic Brain Injury},

author = {Phillips, S and Woessner, D},

doi = {10.1016/j.pop.2015.01.010},

year  = {2015},

date = {2015-01-01},

journal = {Primary Care - Clinics in Office Practice},

volume = {42},

number = {2},

pages = {243--248},

abstract = {Concussions have garnered more attention in the medical literature, media, and social media. As such, in the nomenclature according to the Centers for Disease Control and Prevention, the term concussion has been supplanted by the term mild traumatic brain injury. Current numbers indicate that 1.7 million TBIs are documented annually, with estimates around 3 million annually (173,285 sports- and recreation-related TBIs among children and adolescents). The Sideline Concussion Assessment Tool 3 and the NFL Sideline Concussion Assessment Tool are commonly used sideline tools. © 2015 Elsevier Inc.},

keywords = {Anxiety, Athletic Injuries, attention deficit disorder, balance disorder, Balance Error Scoring System, benzodiazepine derivative, beta adrenergic receptor blocking agent, body equilibrium, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion, coordination disorder, depression, Dizziness, drowsiness, evaluation and follow up, headache, human, Humans, irritability, meclozine, memory disorder, mental concentration, Mild TBI guidelines, mild traumatic brain injury, mood change, mTBI, nausea, NFL Sideline Concussion Assessment Tool, nuclear magnetic resonance imaging, paracetamol, personal hygiene, postconcussion syndrome, Postconcussive syndrome, Primary Health Care, priority journal, procedures, recurrent disease, rest, Review, scoring system, Sideline Concussion Assessment Tool 3, Sideline concussion assessment tool 3 (SCAT3), sleep disorder, Sport, sport injury, Sports, Sports-related, Tomography, traumatic brain injury, tricyclic antidepressant agent, VERTIGO, visual disorder, vomiting, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

1987

Jordan, B D

Neurologic aspects of boxing Journal Article

In: Archives of Neurology, vol. 44, no. 4, pp. 453–459, 1987.

@article{Jordan1987,

title = {Neurologic aspects of boxing},

author = {Jordan, B D},

year  = {1987},

date = {1987-01-01},

journal = {Archives of Neurology},

volume = {44},

number = {4},

pages = {453--459},

abstract = {The assessment and prevention of potentially adverse neurologic consequences of boxing requires two important considerations. Acute neurologic injuries should be distinguished from chronic brain injuries and the level of competitive boxing (ie, amateur vs professional) must also be taken into account. Acute neurologic injuries such as concussion, post-concussion syndrome, intracranial hemorrhage, and brain contusion are more readily identified than chronic neurologic injuries because of their immediate devastation of the nervous system. In contrast, chronic neurologic injuries differ in their pathophysiologic mechanisms that are exemplified by an insidious onset and progression after the cessation of boxing. Accordingly, the chronic traumatic encephalopathy of boxing poses the most serious neurologic threat of boxing. Amateur boxing differs from professional boxing in the duration of fights, rules and regulatory policies, medical evaluation, and protective devices. These factors could produce a differential effect on the risk of injury to the brain. The prevention of neurologic injuries in boxing requires the integration of proper neurologic evaluation by qualified ring-side physicians, the design and utilization of effective protective devices, and the establishment of national regulatory agencies.},

keywords = {*Athletic Injuries, *Boxing, *Brain Injuries, Athletic Injuries/ep [Epidemiology], Athletic Injuries/pa [Pathology], Athletic Injuries/pc [Prevention \&amp; Control], Athletic Injuries/pp [Physiopathology], Brain Concussion/et [Etiology], Brain Injuries/ep [Epidemiology], Brain Injuries/pa [Pathology], Brain Injuries/pc [Prevention \&amp; Control], Brain Injuries/pp [Physiopathology], Humans, Magnetic Resonance Spectroscopy, Tomography, X-Ray Computed},

pubstate = {published},

tppubtype = {article}

}

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