Steiger, B
Meet Bennet Omalu, Md: The Physician Leader Whose Research Inspired the Movie Concussion Journal Article
In: Physician Leadership Journal, vol. 3, no. 2, pp. 8–10, 2016.
Abstract | BibTeX | Tags: *Brain Concussion/co [Complications], *Brain Injury, *Football, Athletic Injuries/co [Complications], Brain Injury, Chronic, Chronic/et [Etiology], Humans, Motion Pictures as Topic
@article{Steiger2016,
title = {Meet Bennet Omalu, Md: The Physician Leader Whose Research Inspired the Movie Concussion},
author = {Steiger, B},
year = {2016},
date = {2016-01-01},
journal = {Physician Leadership Journal},
volume = {3},
number = {2},
pages = {8--10},
abstract = {The pathologist who discovered chronic traumatic encephalopathy in professional football players didn't set out to attack America's favorite sport. He didn't even know much about the game.},
keywords = {*Brain Concussion/co [Complications], *Brain Injury, *Football, Athletic Injuries/co [Complications], Brain Injury, Chronic, Chronic/et [Etiology], Humans, Motion Pictures as Topic},
pubstate = {published},
tppubtype = {article}
}
Howell, D R; Mannix, R C; Quinn, B; Taylor, J A; Tan, C O; Meehan 3rd, W P
Physical Activity Level and Symptom Duration Are Not Associated After Concussion Journal Article
In: American Journal of Sports Medicine, vol. 44, no. 4, pp. 1040–1046, 2016.
Abstract | BibTeX | Tags: *Motor Activity, *Post-Concussion Syndrome/et [Etiology], Adolescent, adult, Athletic Injuries/co [Complications], Child, Cohort Studies, Female, Humans, Male, self report, Surveys and Questionnaires, Time Factors, Young Adult
@article{Howell2016,
title = {Physical Activity Level and Symptom Duration Are Not Associated After Concussion},
author = {Howell, D R and Mannix, R C and Quinn, B and Taylor, J A and Tan, C O and {Meehan 3rd}, W P},
year = {2016},
date = {2016-01-01},
journal = {American Journal of Sports Medicine},
volume = {44},
number = {4},
pages = {1040--1046},
abstract = {BACKGROUND: Physical rest after a concussion has been described as a key component in the management of the injury. Evidence supporting this recommendation, however, is limited. PURPOSE: To examine the association between physical activity and symptom duration in a cohort of patients after a concussion. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This study included 364 patients who were diagnosed with a concussion, were seen by a physician within 3 weeks of injury, and completed a questionnaire at the initial clinic visit. The questionnaire assessed the postconcussion symptom scale (PCSS) score, previous number of concussions, presence of the loss of consciousness or amnesia at the time of injury, and prior treatment for headaches. During each follow-up clinic visit, physical activity level was self-reported. A Cox proportional hazard model was constructed to determine the association between symptom duration, initial clinic visit responses, and self-reported physical activity level after the injury. RESULTS: Study participants ranged in age from 8 to 27 years (mean age, 15.0 years) and had sustained a mean of 0.8 prior concussions; 222 patients (61%) were male. On initial examination, the mean PCSS score was 34.7. The mean symptom duration was 48.9 days after the injury. Among the variables included in the model, initial PCSS score and female sex were independently associated with symptom duration, while physical activity level after the injury was not. For participants aged between 13 and 18 years, however, higher levels of physical activity after the injury were associated with a shorter symptom duration. CONCLUSION: Results from this study indicate that physical activity after the injury may not be universally detrimental to the recovery of concussion symptoms.Copyright © 2016 The Author(s).},
keywords = {*Motor Activity, *Post-Concussion Syndrome/et [Etiology], Adolescent, adult, Athletic Injuries/co [Complications], Child, Cohort Studies, Female, Humans, Male, self report, Surveys and Questionnaires, Time Factors, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Miller, J H; Gill, C; Kuhn, E N; Rocque, B G; Menendez, J Y; O'Neill, J A; Agee, B S; Brown, S T; Crowther, M; Davis, R D; Ferguson, D; Johnston, J M
Predictors of delayed recovery following pediatric sports-related concussion: a case-control study Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 491–496, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Outcome Assessment (Health Care)/mt [Methods], Adolescent, Athletic Injuries/co [Complications], Athletic Injuries/ep [Epidemiology], Brain Concussion/ep [Epidemiology], Brain Concussion/et [Etiology], Case-Control Studies, Child, Female, Humans, Male, Post-Concussion Syndrome/di [Diagnosis], Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], Prognosis, Recovery of Function, Risk Factors
@article{Miller2016,
title = {Predictors of delayed recovery following pediatric sports-related concussion: a case-control study},
author = {Miller, J H and Gill, C and Kuhn, E N and Rocque, B G and Menendez, J Y and O'Neill, J A and Agee, B S and Brown, S T and Crowther, M and Davis, R D and Ferguson, D and Johnston, J M},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {491--496},
abstract = {OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (\> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score \< 80 (aOR 5.58, 95% CI 2.61-11.93), and female sex (aOR 3.48, 95% CI 1.43-8.49) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days. For patients without SCAT2 scores, female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery (aOR 4.41, 95% CI 1.93-10.07 and aOR 3.87, 95% CI 1.13-13.24, respectively). Concussions resulting from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores (OR 2.59, 95% CI 1.28-5.26 and OR 2.17, 95% CI 0.99-7.73, respectively). Amnesia, balance abnormalities, and a history of migraines were not associated with symptoms lasting longer than 28 days. CONCLUSIONS This case-control study suggests candidate risk factors for predicting prolonged recovery following sports-related concussion. Large prospective cohort studies of youth athletes examined and treated with standardized protocols will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Outcome Assessment (Health Care)/mt [Methods], Adolescent, Athletic Injuries/co [Complications], Athletic Injuries/ep [Epidemiology], Brain Concussion/ep [Epidemiology], Brain Concussion/et [Etiology], Case-Control Studies, Child, Female, Humans, Male, Post-Concussion Syndrome/di [Diagnosis], Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], Prognosis, Recovery of Function, Risk Factors},
pubstate = {published},
tppubtype = {article}
}
Odom, M J; Lee, Y M; Zuckerman, S L; Apple, R P; Germanos, T; Solomon, G S; Sills, A K
Balance Assessment in Sports-Related Concussion: Evaluating Test-Retest Reliability of the Equilibrate System Journal Article
In: J Surg Orthop Adv, vol. 25, no. 2, pp. 93–98, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Postural Balance, *Sensation Disorders/di [Diagnosis], adult, Athletic Injuries/co [Complications], Brain Concussion/co [Complications], Computer-Assisted, DIAGNOSIS, Female, Humans, Male, Reproducibility of Results, Sensation Disorders/et [Etiology], Young Adult
@article{Odom2016,
title = {Balance Assessment in Sports-Related Concussion: Evaluating Test-Retest Reliability of the Equilibrate System},
author = {Odom, M J and Lee, Y M and Zuckerman, S L and Apple, R P and Germanos, T and Solomon, G S and Sills, A K},
year = {2016},
date = {2016-01-01},
journal = {J Surg Orthop Adv},
volume = {25},
number = {2},
pages = {93--98},
abstract = {This study evaluated the test-retest reliability of a novel computer-based, portable balance assessment tool, the Equilibrate System (ES), used to diagnose sports-related concussion. Twenty-seven students participated in ES testing consisting of three sessions over 4 weeks. The modified Balance Error Scoring System was performed. For each participant, test-retest reliability was established using the intraclass correlation coefficient (ICC). The ES test-retest reliability from baseline to week 2 produced an ICC value of 0.495 (95% CI, 0.123-0.745). Week 2 testing produced ICC values of 0.602 (95% CI, 0.279-0.803) and 0.610 (95% CI, 0.299-0.804), respectively. All other single measures test-retest reliability values produced poor ICC values. Same-day ES testing showed fair to good test-retest reliability while interweek measures displayed poor to fair test-retest reliability. Testing conditions should be controlled when using computerized balance assessment methods. ES testing should only be used as a part of a comprehensive assessment.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Postural Balance, *Sensation Disorders/di [Diagnosis], adult, Athletic Injuries/co [Complications], Brain Concussion/co [Complications], Computer-Assisted, DIAGNOSIS, Female, Humans, Male, Reproducibility of Results, Sensation Disorders/et [Etiology], Young Adult},
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}
}
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}
}
Kostyun, R
Sleep Disturbances in Concussed Athletes: A Review of the Literature Journal Article
In: Connecticut Medicine, vol. 79, no. 3, pp. 161–165, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries, *Brain Concussion, *Disease Management, *Sleep Wake Disorders, Adolescent, Athletes/px [Psychology], Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Cognition/ph [Physiology], Humans, Neuropsychological Tests, Sleep Wake Disorders/et [Etiology], Sleep Wake Disorders/pp [Physiopathology], Sleep Wake Disorders/th [Therapy], Young Adult
@article{Kostyun2015a,
title = {Sleep Disturbances in Concussed Athletes: A Review of the Literature},
author = {Kostyun, R},
year = {2015},
date = {2015-01-01},
journal = {Connecticut Medicine},
volume = {79},
number = {3},
pages = {161--165},
abstract = {Adolescents and young adults recovering from a concussion may experience subjective changes in their normal sleeping patterns. These subjective sleep complaints may influence a patient's perceived concussion symptoms and negatively impact cognition and school function. Clinicians should be cognizant of these changes in normal sleeping patterns for adolescent and young adult concussion patient and familiarize themselves with available treatment options.},
keywords = {*Athletic Injuries, *Brain Concussion, *Disease Management, *Sleep Wake Disorders, Adolescent, Athletes/px [Psychology], Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Cognition/ph [Physiology], Humans, Neuropsychological Tests, Sleep Wake Disorders/et [Etiology], Sleep Wake Disorders/pp [Physiopathology], Sleep Wake Disorders/th [Therapy], Young Adult},
pubstate = {published},
tppubtype = {article}
}
Bieniek, K F; Ross, O A; Cormier, K A; Walton, R L; Soto-Ortolaza, A; Johnston, A E; DeSaro, P; Boylan, K B; Graff-Radford, N R; Wszolek, Z K; Rademakers, R; Boeve, B F; McKee, A C; Dickson, D W
Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank Journal Article
In: Acta Neuropathologica, vol. 130, no. 6, pp. 877–889, 2015.
Abstract | BibTeX | Tags: *Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/et [Etiology], *Neurodegenerative Diseases/pa [Pathology], 0 (Apolipoproteins E), 0 (MAPT protein, 0 (Membrane Proteins), 0 (Nerve Tissue Proteins), 0 (tau Proteins), 0 (TMEM106B protein, aged, Apolipoproteins E/ge [Genetics], Athletic Injuries/co [Complications], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/et [Etiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Female, human), Humans, immunohistochemistry, Male, Membrane Proteins/ge [Genetics], Nerve Tissue Proteins/ge [Genetics], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Retrospective Studies, tau Proteins/ge [Genetics], tau Proteins/me [Metabolism], Tissue Banks
@article{Bieniek2015,
title = {Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank},
author = {Bieniek, K F and Ross, O A and Cormier, K A and Walton, R L and Soto-Ortolaza, A and Johnston, A E and DeSaro, P and Boylan, K B and Graff-Radford, N R and Wszolek, Z K and Rademakers, R and Boeve, B F and McKee, A C and Dickson, D W},
year = {2015},
date = {2015-01-01},
journal = {Acta Neuropathologica},
volume = {130},
number = {6},
pages = {877--889},
abstract = {Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive traumatic brain injury (TBI) and characterized by deposition of hyperphosphorylated tau at the depths of sulci. We sought to determine the presence of CTE pathology in a brain bank for neurodegenerative disorders for individuals with and without a history of contact sports participation. Available medical records of 1721 men were reviewed for evidence of past history of injury or participation in contact sports. Subsequently, cerebral cortical samples were processed for tau immunohistochemistry in cases with a documented history of sports exposure as well as age- and disease-matched men and women without such exposure. For cases with available frozen tissue, genetic analysis was performed for variants in APOE, MAPT, and TMEM106B. Immunohistochemistry revealed 21 of 66 former athletes had cortical tau pathology consistent with CTE. CTE pathology was not detected in 198 individuals without exposure to contact sports, including 33 individuals with documented single-incident TBI sustained from falls, motor vehicle accidents, domestic violence, or assaults. Among those exposed to contact sports, those with CTE pathology did not differ from those without CTE pathology with respect to noted clinicopathologic features. There were no significant differences in genetic variants for those with CTE pathology, but we observed a slight increase in MAPT H1 haplotype, and there tended to be fewer homozygous carriers of the protective TMEM106B rs3173615 minor allele in those with sports exposure and CTE pathology compared to those without CTE pathology. In conclusion, this study has identified a small, yet significant, subset of individuals with neurodegenerative disorders and concomitant CTE pathology. CTE pathology was only detected in individuals with documented participation in contact sports. Exposure to contact sports was the greatest risk factor for CTE pathology. Future studies addressing clinical correlates of CTE pathology are needed.},
keywords = {*Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/et [Etiology], *Neurodegenerative Diseases/pa [Pathology], 0 (Apolipoproteins E), 0 (MAPT protein, 0 (Membrane Proteins), 0 (Nerve Tissue Proteins), 0 (tau Proteins), 0 (TMEM106B protein, aged, Apolipoproteins E/ge [Genetics], Athletic Injuries/co [Complications], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/et [Etiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Female, human), Humans, immunohistochemistry, Male, Membrane Proteins/ge [Genetics], Nerve Tissue Proteins/ge [Genetics], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Retrospective Studies, tau Proteins/ge [Genetics], tau Proteins/me [Metabolism], Tissue Banks},
pubstate = {published},
tppubtype = {article}
}
Meehan 3rd, W; Mannix, R; Zafonte, R; Pascual-Leone, A
Chronic traumatic encephalopathy and athletes Journal Article
In: Neurology, vol. 85, no. 17, pp. 1504–1511, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/pa [Pathology], *Brain Concussion/pa [Pathology], *Brain Injury, *Brain/pa [Pathology], *Cognition Disorders/pa [Pathology], *Suicidal Ideation, Aggression/px [Psychology], Athletes, Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Cognition Disorders/et [Etiology], Cognition Disorders/px [Psychology], Headache/et [Etiology], Headache/pa [Pathology], Humans, Mood Disorders/et [Etiology], Mood Disorders/pa [Pathology], Mood Disorders/px [Psychology], Speech Disorders/et [Etiology], Speech Disorders/pa [Pathology], Speech Disorders/px [Psychology]
@article{Meehan3rd2015a,
title = {Chronic traumatic encephalopathy and athletes},
author = {{Meehan 3rd}, W and Mannix, R and Zafonte, R and Pascual-Leone, A},
year = {2015},
date = {2015-01-01},
journal = {Neurology},
volume = {85},
number = {17},
pages = {1504--1511},
abstract = {Recent case reports have described athletes previously exposed to repetitive head trauma while participating in contact sports who later in life developed mood disorders, headaches, cognitive difficulties, suicidal ideation, difficulties with speech, and aggressive behavior. Postmortem discoveries show that some of these athletes have pathologic findings that are collectively termed chronic traumatic encephalopathy (CTE). Current hypotheses suggest that concussions or perhaps blows to the head that do not cause the signs and symptoms necessary for making the diagnosis of concussion, so-called subconcussive blows, cause both the clinical and pathologic findings. There are, however, some athletes who participate in contact sports who do not develop the findings ascribed to CTE. Furthermore, there are people who have headaches, mood disorders, cognitive difficulties, suicidal ideation, and other clinical problems who have neither been exposed to repeated head trauma nor possessed the pathologic postmortem findings of those currently diagnosed with CTE. The current lack of prospective data and properly designed case-control studies limits the current understanding of CTE, leading to debate about the causes of the neuropathologic findings and the clinical observations. Given the potential for referral and recall bias in available studies, it remains unclear whether or not the pathologic findings made postmortem cause the presumed neurobehavioral sequela and whether the presumed risk factors, such as sports activity, cerebral concussions, and subconcussive blows, are solely causative of the clinical signs and symptoms. This article discusses the current evidence and the associated limitations. Copyright © 2015 American Academy of Neurology.},
keywords = {*Athletic Injuries/pa [Pathology], *Brain Concussion/pa [Pathology], *Brain Injury, *Brain/pa [Pathology], *Cognition Disorders/pa [Pathology], *Suicidal Ideation, Aggression/px [Psychology], Athletes, Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Cognition Disorders/et [Etiology], Cognition Disorders/px [Psychology], Headache/et [Etiology], Headache/pa [Pathology], Humans, Mood Disorders/et [Etiology], Mood Disorders/pa [Pathology], Mood Disorders/px [Psychology], Speech Disorders/et [Etiology], Speech Disorders/pa [Pathology], Speech Disorders/px [Psychology]},
pubstate = {published},
tppubtype = {article}
}
Duenas, M J; Hsu, S N; Jandial, R
Visual screening test for rapid sideline determination of concussive and sub-concussive events Journal Article
In: Neurosurgery, vol. 73, no. 4, pp. N17–8, 2013.
BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Vision Screening/mt [Methods], Athletic Injuries/co [Complications], Brain Concussion/et [Etiology], Humans
@article{Duenas2013,
title = {Visual screening test for rapid sideline determination of concussive and sub-concussive events},
author = {Duenas, M J and Hsu, S N and Jandial, R},
year = {2013},
date = {2013-01-01},
journal = {Neurosurgery},
volume = {73},
number = {4},
pages = {N17--8},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Vision Screening/mt [Methods], Athletic Injuries/co [Complications], Brain Concussion/et [Etiology], Humans},
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}
}
Butcher, I; McHugh, G S; Lu, J; Steyerberg, E W; Hernandez, A V; Mushkudiani, N; Maas, A I; Marmarou, A; Murray, G D
Prognostic value of cause of injury in traumatic brain injury: results from the IMPACT study Journal Article
In: Journal of Neurotrauma, vol. 24, no. 2, pp. 281–286, 2007.
Abstract | BibTeX | Tags: *Brain Injuries/di [Diagnosis], *Brain Injuries/et [Etiology], Accidents, adult, Age Factors, Athletic Injuries/co [Complications], Athletic Injuries/di [Diagnosis], Databases, Factual, Glasgow Outcome Scale, Humans, middle aged, Predictive Value of Tests, Prognosis, violence
@article{Butcher2007,
title = {Prognostic value of cause of injury in traumatic brain injury: results from the IMPACT study},
author = {Butcher, I and McHugh, G S and Lu, J and Steyerberg, E W and Hernandez, A V and Mushkudiani, N and Maas, A I and Marmarou, A and Murray, G D},
year = {2007},
date = {2007-01-01},
journal = {Journal of Neurotrauma},
volume = {24},
number = {2},
pages = {281--286},
abstract = {We aimed to describe and quantify the relationship between cause of injury and final outcome following traumatic brain injury (TBI). Individual patient data (N = 8708) from eight therapeutic Phase III randomized clinical trials in moderate or severe TBI, and three TBI surveys were used to investigate the relationship between cause of injury and outcome, as assessed by the Glasgow Outcome Scale (GOS) at 6 months. Proportional odds methodology was applied to quantify the strength of the association and expressed as an odds ratio in a meta-analysis. Heterogeneity across studies was assessed and associations with other predictive factors explored. In a univariate analysis, a strong association between the cause of injury and long-term outcome in moderate to severe TBI patients was observed, with consistent results across the studies. Road traffic accidents (OR 0.66, 95% CI 0.60-0.73), assaults (OR 0.66, 95% CI 0.52-0.84), and injuries sustained during sporting or recreational activities (OR 0.45, 95% CI 0.28-0.71) were all associated with better outcomes than the reference category of falls. Falls were found to be associated with an older age and with a higher incidence of mass lesions. Following adjustment for age in the analysis, the relationship between cause of injury and outcome was lost.},
keywords = {*Brain Injuries/di [Diagnosis], *Brain Injuries/et [Etiology], Accidents, adult, Age Factors, Athletic Injuries/co [Complications], Athletic Injuries/di [Diagnosis], Databases, Factual, Glasgow Outcome Scale, Humans, middle aged, Predictive Value of Tests, Prognosis, violence},
pubstate = {published},
tppubtype = {article}
}
Steiger, B
Meet Bennet Omalu, Md: The Physician Leader Whose Research Inspired the Movie Concussion Journal Article
In: Physician Leadership Journal, vol. 3, no. 2, pp. 8–10, 2016.
@article{Steiger2016,
title = {Meet Bennet Omalu, Md: The Physician Leader Whose Research Inspired the Movie Concussion},
author = {Steiger, B},
year = {2016},
date = {2016-01-01},
journal = {Physician Leadership Journal},
volume = {3},
number = {2},
pages = {8--10},
abstract = {The pathologist who discovered chronic traumatic encephalopathy in professional football players didn't set out to attack America's favorite sport. He didn't even know much about the game.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Howell, D R; Mannix, R C; Quinn, B; Taylor, J A; Tan, C O; Meehan 3rd, W P
Physical Activity Level and Symptom Duration Are Not Associated After Concussion Journal Article
In: American Journal of Sports Medicine, vol. 44, no. 4, pp. 1040–1046, 2016.
@article{Howell2016,
title = {Physical Activity Level and Symptom Duration Are Not Associated After Concussion},
author = {Howell, D R and Mannix, R C and Quinn, B and Taylor, J A and Tan, C O and {Meehan 3rd}, W P},
year = {2016},
date = {2016-01-01},
journal = {American Journal of Sports Medicine},
volume = {44},
number = {4},
pages = {1040--1046},
abstract = {BACKGROUND: Physical rest after a concussion has been described as a key component in the management of the injury. Evidence supporting this recommendation, however, is limited. PURPOSE: To examine the association between physical activity and symptom duration in a cohort of patients after a concussion. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This study included 364 patients who were diagnosed with a concussion, were seen by a physician within 3 weeks of injury, and completed a questionnaire at the initial clinic visit. The questionnaire assessed the postconcussion symptom scale (PCSS) score, previous number of concussions, presence of the loss of consciousness or amnesia at the time of injury, and prior treatment for headaches. During each follow-up clinic visit, physical activity level was self-reported. A Cox proportional hazard model was constructed to determine the association between symptom duration, initial clinic visit responses, and self-reported physical activity level after the injury. RESULTS: Study participants ranged in age from 8 to 27 years (mean age, 15.0 years) and had sustained a mean of 0.8 prior concussions; 222 patients (61%) were male. On initial examination, the mean PCSS score was 34.7. The mean symptom duration was 48.9 days after the injury. Among the variables included in the model, initial PCSS score and female sex were independently associated with symptom duration, while physical activity level after the injury was not. For participants aged between 13 and 18 years, however, higher levels of physical activity after the injury were associated with a shorter symptom duration. CONCLUSION: Results from this study indicate that physical activity after the injury may not be universally detrimental to the recovery of concussion symptoms.Copyright © 2016 The Author(s).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Miller, J H; Gill, C; Kuhn, E N; Rocque, B G; Menendez, J Y; O'Neill, J A; Agee, B S; Brown, S T; Crowther, M; Davis, R D; Ferguson, D; Johnston, J M
Predictors of delayed recovery following pediatric sports-related concussion: a case-control study Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 491–496, 2016.
@article{Miller2016,
title = {Predictors of delayed recovery following pediatric sports-related concussion: a case-control study},
author = {Miller, J H and Gill, C and Kuhn, E N and Rocque, B G and Menendez, J Y and O'Neill, J A and Agee, B S and Brown, S T and Crowther, M and Davis, R D and Ferguson, D and Johnston, J M},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {491--496},
abstract = {OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (\> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score \< 80 (aOR 5.58, 95% CI 2.61-11.93), and female sex (aOR 3.48, 95% CI 1.43-8.49) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days. For patients without SCAT2 scores, female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery (aOR 4.41, 95% CI 1.93-10.07 and aOR 3.87, 95% CI 1.13-13.24, respectively). Concussions resulting from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores (OR 2.59, 95% CI 1.28-5.26 and OR 2.17, 95% CI 0.99-7.73, respectively). Amnesia, balance abnormalities, and a history of migraines were not associated with symptoms lasting longer than 28 days. CONCLUSIONS This case-control study suggests candidate risk factors for predicting prolonged recovery following sports-related concussion. Large prospective cohort studies of youth athletes examined and treated with standardized protocols will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Odom, M J; Lee, Y M; Zuckerman, S L; Apple, R P; Germanos, T; Solomon, G S; Sills, A K
Balance Assessment in Sports-Related Concussion: Evaluating Test-Retest Reliability of the Equilibrate System Journal Article
In: J Surg Orthop Adv, vol. 25, no. 2, pp. 93–98, 2016.
@article{Odom2016,
title = {Balance Assessment in Sports-Related Concussion: Evaluating Test-Retest Reliability of the Equilibrate System},
author = {Odom, M J and Lee, Y M and Zuckerman, S L and Apple, R P and Germanos, T and Solomon, G S and Sills, A K},
year = {2016},
date = {2016-01-01},
journal = {J Surg Orthop Adv},
volume = {25},
number = {2},
pages = {93--98},
abstract = {This study evaluated the test-retest reliability of a novel computer-based, portable balance assessment tool, the Equilibrate System (ES), used to diagnose sports-related concussion. Twenty-seven students participated in ES testing consisting of three sessions over 4 weeks. The modified Balance Error Scoring System was performed. For each participant, test-retest reliability was established using the intraclass correlation coefficient (ICC). The ES test-retest reliability from baseline to week 2 produced an ICC value of 0.495 (95% CI, 0.123-0.745). Week 2 testing produced ICC values of 0.602 (95% CI, 0.279-0.803) and 0.610 (95% CI, 0.299-0.804), respectively. All other single measures test-retest reliability values produced poor ICC values. Same-day ES testing showed fair to good test-retest reliability while interweek measures displayed poor to fair test-retest reliability. Testing conditions should be controlled when using computerized balance assessment methods. ES testing should only be used as a part of a comprehensive assessment.},
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}
}
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 = {},
pubstate = {published},
tppubtype = {article}
}
Kostyun, R
Sleep Disturbances in Concussed Athletes: A Review of the Literature Journal Article
In: Connecticut Medicine, vol. 79, no. 3, pp. 161–165, 2015.
@article{Kostyun2015a,
title = {Sleep Disturbances in Concussed Athletes: A Review of the Literature},
author = {Kostyun, R},
year = {2015},
date = {2015-01-01},
journal = {Connecticut Medicine},
volume = {79},
number = {3},
pages = {161--165},
abstract = {Adolescents and young adults recovering from a concussion may experience subjective changes in their normal sleeping patterns. These subjective sleep complaints may influence a patient's perceived concussion symptoms and negatively impact cognition and school function. Clinicians should be cognizant of these changes in normal sleeping patterns for adolescent and young adult concussion patient and familiarize themselves with available treatment options.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Bieniek, K F; Ross, O A; Cormier, K A; Walton, R L; Soto-Ortolaza, A; Johnston, A E; DeSaro, P; Boylan, K B; Graff-Radford, N R; Wszolek, Z K; Rademakers, R; Boeve, B F; McKee, A C; Dickson, D W
Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank Journal Article
In: Acta Neuropathologica, vol. 130, no. 6, pp. 877–889, 2015.
@article{Bieniek2015,
title = {Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank},
author = {Bieniek, K F and Ross, O A and Cormier, K A and Walton, R L and Soto-Ortolaza, A and Johnston, A E and DeSaro, P and Boylan, K B and Graff-Radford, N R and Wszolek, Z K and Rademakers, R and Boeve, B F and McKee, A C and Dickson, D W},
year = {2015},
date = {2015-01-01},
journal = {Acta Neuropathologica},
volume = {130},
number = {6},
pages = {877--889},
abstract = {Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive traumatic brain injury (TBI) and characterized by deposition of hyperphosphorylated tau at the depths of sulci. We sought to determine the presence of CTE pathology in a brain bank for neurodegenerative disorders for individuals with and without a history of contact sports participation. Available medical records of 1721 men were reviewed for evidence of past history of injury or participation in contact sports. Subsequently, cerebral cortical samples were processed for tau immunohistochemistry in cases with a documented history of sports exposure as well as age- and disease-matched men and women without such exposure. For cases with available frozen tissue, genetic analysis was performed for variants in APOE, MAPT, and TMEM106B. Immunohistochemistry revealed 21 of 66 former athletes had cortical tau pathology consistent with CTE. CTE pathology was not detected in 198 individuals without exposure to contact sports, including 33 individuals with documented single-incident TBI sustained from falls, motor vehicle accidents, domestic violence, or assaults. Among those exposed to contact sports, those with CTE pathology did not differ from those without CTE pathology with respect to noted clinicopathologic features. There were no significant differences in genetic variants for those with CTE pathology, but we observed a slight increase in MAPT H1 haplotype, and there tended to be fewer homozygous carriers of the protective TMEM106B rs3173615 minor allele in those with sports exposure and CTE pathology compared to those without CTE pathology. In conclusion, this study has identified a small, yet significant, subset of individuals with neurodegenerative disorders and concomitant CTE pathology. CTE pathology was only detected in individuals with documented participation in contact sports. Exposure to contact sports was the greatest risk factor for CTE pathology. Future studies addressing clinical correlates of CTE pathology are needed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Meehan 3rd, W; Mannix, R; Zafonte, R; Pascual-Leone, A
Chronic traumatic encephalopathy and athletes Journal Article
In: Neurology, vol. 85, no. 17, pp. 1504–1511, 2015.
@article{Meehan3rd2015a,
title = {Chronic traumatic encephalopathy and athletes},
author = {{Meehan 3rd}, W and Mannix, R and Zafonte, R and Pascual-Leone, A},
year = {2015},
date = {2015-01-01},
journal = {Neurology},
volume = {85},
number = {17},
pages = {1504--1511},
abstract = {Recent case reports have described athletes previously exposed to repetitive head trauma while participating in contact sports who later in life developed mood disorders, headaches, cognitive difficulties, suicidal ideation, difficulties with speech, and aggressive behavior. Postmortem discoveries show that some of these athletes have pathologic findings that are collectively termed chronic traumatic encephalopathy (CTE). Current hypotheses suggest that concussions or perhaps blows to the head that do not cause the signs and symptoms necessary for making the diagnosis of concussion, so-called subconcussive blows, cause both the clinical and pathologic findings. There are, however, some athletes who participate in contact sports who do not develop the findings ascribed to CTE. Furthermore, there are people who have headaches, mood disorders, cognitive difficulties, suicidal ideation, and other clinical problems who have neither been exposed to repeated head trauma nor possessed the pathologic postmortem findings of those currently diagnosed with CTE. The current lack of prospective data and properly designed case-control studies limits the current understanding of CTE, leading to debate about the causes of the neuropathologic findings and the clinical observations. Given the potential for referral and recall bias in available studies, it remains unclear whether or not the pathologic findings made postmortem cause the presumed neurobehavioral sequela and whether the presumed risk factors, such as sports activity, cerebral concussions, and subconcussive blows, are solely causative of the clinical signs and symptoms. This article discusses the current evidence and the associated limitations. Copyright © 2015 American Academy of Neurology.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Duenas, M J; Hsu, S N; Jandial, R
Visual screening test for rapid sideline determination of concussive and sub-concussive events Journal Article
In: Neurosurgery, vol. 73, no. 4, pp. N17–8, 2013.
@article{Duenas2013,
title = {Visual screening test for rapid sideline determination of concussive and sub-concussive events},
author = {Duenas, M J and Hsu, S N and Jandial, R},
year = {2013},
date = {2013-01-01},
journal = {Neurosurgery},
volume = {73},
number = {4},
pages = {N17--8},
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}
}
Butcher, I; McHugh, G S; Lu, J; Steyerberg, E W; Hernandez, A V; Mushkudiani, N; Maas, A I; Marmarou, A; Murray, G D
Prognostic value of cause of injury in traumatic brain injury: results from the IMPACT study Journal Article
In: Journal of Neurotrauma, vol. 24, no. 2, pp. 281–286, 2007.
@article{Butcher2007,
title = {Prognostic value of cause of injury in traumatic brain injury: results from the IMPACT study},
author = {Butcher, I and McHugh, G S and Lu, J and Steyerberg, E W and Hernandez, A V and Mushkudiani, N and Maas, A I and Marmarou, A and Murray, G D},
year = {2007},
date = {2007-01-01},
journal = {Journal of Neurotrauma},
volume = {24},
number = {2},
pages = {281--286},
abstract = {We aimed to describe and quantify the relationship between cause of injury and final outcome following traumatic brain injury (TBI). Individual patient data (N = 8708) from eight therapeutic Phase III randomized clinical trials in moderate or severe TBI, and three TBI surveys were used to investigate the relationship between cause of injury and outcome, as assessed by the Glasgow Outcome Scale (GOS) at 6 months. Proportional odds methodology was applied to quantify the strength of the association and expressed as an odds ratio in a meta-analysis. Heterogeneity across studies was assessed and associations with other predictive factors explored. In a univariate analysis, a strong association between the cause of injury and long-term outcome in moderate to severe TBI patients was observed, with consistent results across the studies. Road traffic accidents (OR 0.66, 95% CI 0.60-0.73), assaults (OR 0.66, 95% CI 0.52-0.84), and injuries sustained during sporting or recreational activities (OR 0.45, 95% CI 0.28-0.71) were all associated with better outcomes than the reference category of falls. Falls were found to be associated with an older age and with a higher incidence of mass lesions. Following adjustment for age in the analysis, the relationship between cause of injury and outcome was lost.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Steiger, B
Meet Bennet Omalu, Md: The Physician Leader Whose Research Inspired the Movie Concussion Journal Article
In: Physician Leadership Journal, vol. 3, no. 2, pp. 8–10, 2016.
Abstract | BibTeX | Tags: *Brain Concussion/co [Complications], *Brain Injury, *Football, Athletic Injuries/co [Complications], Brain Injury, Chronic, Chronic/et [Etiology], Humans, Motion Pictures as Topic
@article{Steiger2016,
title = {Meet Bennet Omalu, Md: The Physician Leader Whose Research Inspired the Movie Concussion},
author = {Steiger, B},
year = {2016},
date = {2016-01-01},
journal = {Physician Leadership Journal},
volume = {3},
number = {2},
pages = {8--10},
abstract = {The pathologist who discovered chronic traumatic encephalopathy in professional football players didn't set out to attack America's favorite sport. He didn't even know much about the game.},
keywords = {*Brain Concussion/co [Complications], *Brain Injury, *Football, Athletic Injuries/co [Complications], Brain Injury, Chronic, Chronic/et [Etiology], Humans, Motion Pictures as Topic},
pubstate = {published},
tppubtype = {article}
}
Howell, D R; Mannix, R C; Quinn, B; Taylor, J A; Tan, C O; Meehan 3rd, W P
Physical Activity Level and Symptom Duration Are Not Associated After Concussion Journal Article
In: American Journal of Sports Medicine, vol. 44, no. 4, pp. 1040–1046, 2016.
Abstract | BibTeX | Tags: *Motor Activity, *Post-Concussion Syndrome/et [Etiology], Adolescent, adult, Athletic Injuries/co [Complications], Child, Cohort Studies, Female, Humans, Male, self report, Surveys and Questionnaires, Time Factors, Young Adult
@article{Howell2016,
title = {Physical Activity Level and Symptom Duration Are Not Associated After Concussion},
author = {Howell, D R and Mannix, R C and Quinn, B and Taylor, J A and Tan, C O and {Meehan 3rd}, W P},
year = {2016},
date = {2016-01-01},
journal = {American Journal of Sports Medicine},
volume = {44},
number = {4},
pages = {1040--1046},
abstract = {BACKGROUND: Physical rest after a concussion has been described as a key component in the management of the injury. Evidence supporting this recommendation, however, is limited. PURPOSE: To examine the association between physical activity and symptom duration in a cohort of patients after a concussion. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This study included 364 patients who were diagnosed with a concussion, were seen by a physician within 3 weeks of injury, and completed a questionnaire at the initial clinic visit. The questionnaire assessed the postconcussion symptom scale (PCSS) score, previous number of concussions, presence of the loss of consciousness or amnesia at the time of injury, and prior treatment for headaches. During each follow-up clinic visit, physical activity level was self-reported. A Cox proportional hazard model was constructed to determine the association between symptom duration, initial clinic visit responses, and self-reported physical activity level after the injury. RESULTS: Study participants ranged in age from 8 to 27 years (mean age, 15.0 years) and had sustained a mean of 0.8 prior concussions; 222 patients (61%) were male. On initial examination, the mean PCSS score was 34.7. The mean symptom duration was 48.9 days after the injury. Among the variables included in the model, initial PCSS score and female sex were independently associated with symptom duration, while physical activity level after the injury was not. For participants aged between 13 and 18 years, however, higher levels of physical activity after the injury were associated with a shorter symptom duration. CONCLUSION: Results from this study indicate that physical activity after the injury may not be universally detrimental to the recovery of concussion symptoms.Copyright © 2016 The Author(s).},
keywords = {*Motor Activity, *Post-Concussion Syndrome/et [Etiology], Adolescent, adult, Athletic Injuries/co [Complications], Child, Cohort Studies, Female, Humans, Male, self report, Surveys and Questionnaires, Time Factors, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Miller, J H; Gill, C; Kuhn, E N; Rocque, B G; Menendez, J Y; O'Neill, J A; Agee, B S; Brown, S T; Crowther, M; Davis, R D; Ferguson, D; Johnston, J M
Predictors of delayed recovery following pediatric sports-related concussion: a case-control study Journal Article
In: Journal of Neurosurgery. Pediatrics., vol. 17, no. 4, pp. 491–496, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Outcome Assessment (Health Care)/mt [Methods], Adolescent, Athletic Injuries/co [Complications], Athletic Injuries/ep [Epidemiology], Brain Concussion/ep [Epidemiology], Brain Concussion/et [Etiology], Case-Control Studies, Child, Female, Humans, Male, Post-Concussion Syndrome/di [Diagnosis], Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], Prognosis, Recovery of Function, Risk Factors
@article{Miller2016,
title = {Predictors of delayed recovery following pediatric sports-related concussion: a case-control study},
author = {Miller, J H and Gill, C and Kuhn, E N and Rocque, B G and Menendez, J Y and O'Neill, J A and Agee, B S and Brown, S T and Crowther, M and Davis, R D and Ferguson, D and Johnston, J M},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurosurgery. Pediatrics.},
volume = {17},
number = {4},
pages = {491--496},
abstract = {OBJECT Pediatric sports-related concussions are a growing public health concern. The factors that determine injury severity and time to recovery following these concussions are poorly understood. Previous studies suggest that initial symptom severity and diagnosis of attention deficit hyperactivity disorder (ADHD) are predictors of prolonged recovery (\> 28 days) after pediatric sports-related concussions. Further analysis of baseline patient characteristics may allow for a more accurate prediction of which patients are at risk for delayed recovery after a sports-related concussion. METHODS The authors performed a single-center retrospective case-control study involving patients cared for at the multidisciplinary Concussion Clinic at Children's of Alabama between August 2011 and January 2013. Patient demographic data, medical history, sport concussion assessment tool 2 (SCAT2) and symptom severity scores, injury characteristics, and patient balance assessments were analyzed for each outcome group. The control group consisted of patients whose symptoms resolved within 28 days. The case group included patients whose symptoms persisted for more than 28 days. The presence or absence of the SCAT2 assessment had a modifying effect on the risk for delayed recovery; therefore, stratum-specific analyses were conducted for patients with recorded SCAT2 scores and for patients without SCAT2 scores. Unadjusted ORs and adjusted ORs (aORs) for an association of delayed recovery outcome with specific risk factors were calculated with logistic regression analysis. RESULTS A total of 294 patients met the inclusion criteria of the study. The case and control groups did not statistically significantly differ in age (p = 0.7). For the patients who had received SCAT2 assessments, a previous history of concussion (aOR 3.67, 95% CI 1.51-8.95), presenting SCAT2 score \< 80 (aOR 5.58, 95% CI 2.61-11.93), and female sex (aOR 3.48, 95% CI 1.43-8.49) were all associated with a higher risk for postconcussive symptoms lasting more than 28 days. For patients without SCAT2 scores, female sex and reporting a history of ADHD significantly increased the odds of prolonged recovery (aOR 4.41, 95% CI 1.93-10.07 and aOR 3.87, 95% CI 1.13-13.24, respectively). Concussions resulting from playing a nonhelmet sport were also associated with a higher risk for prolonged symptoms in patients with and without SCAT2 scores (OR 2.59, 95% CI 1.28-5.26 and OR 2.17, 95% CI 0.99-7.73, respectively). Amnesia, balance abnormalities, and a history of migraines were not associated with symptoms lasting longer than 28 days. CONCLUSIONS This case-control study suggests candidate risk factors for predicting prolonged recovery following sports-related concussion. Large prospective cohort studies of youth athletes examined and treated with standardized protocols will be needed to definitively establish these associations and confirm which children are at highest risk for delayed recovery.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Outcome Assessment (Health Care)/mt [Methods], Adolescent, Athletic Injuries/co [Complications], Athletic Injuries/ep [Epidemiology], Brain Concussion/ep [Epidemiology], Brain Concussion/et [Etiology], Case-Control Studies, Child, Female, Humans, Male, Post-Concussion Syndrome/di [Diagnosis], Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], Prognosis, Recovery of Function, Risk Factors},
pubstate = {published},
tppubtype = {article}
}
Odom, M J; Lee, Y M; Zuckerman, S L; Apple, R P; Germanos, T; Solomon, G S; Sills, A K
Balance Assessment in Sports-Related Concussion: Evaluating Test-Retest Reliability of the Equilibrate System Journal Article
In: J Surg Orthop Adv, vol. 25, no. 2, pp. 93–98, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Postural Balance, *Sensation Disorders/di [Diagnosis], adult, Athletic Injuries/co [Complications], Brain Concussion/co [Complications], Computer-Assisted, DIAGNOSIS, Female, Humans, Male, Reproducibility of Results, Sensation Disorders/et [Etiology], Young Adult
@article{Odom2016,
title = {Balance Assessment in Sports-Related Concussion: Evaluating Test-Retest Reliability of the Equilibrate System},
author = {Odom, M J and Lee, Y M and Zuckerman, S L and Apple, R P and Germanos, T and Solomon, G S and Sills, A K},
year = {2016},
date = {2016-01-01},
journal = {J Surg Orthop Adv},
volume = {25},
number = {2},
pages = {93--98},
abstract = {This study evaluated the test-retest reliability of a novel computer-based, portable balance assessment tool, the Equilibrate System (ES), used to diagnose sports-related concussion. Twenty-seven students participated in ES testing consisting of three sessions over 4 weeks. The modified Balance Error Scoring System was performed. For each participant, test-retest reliability was established using the intraclass correlation coefficient (ICC). The ES test-retest reliability from baseline to week 2 produced an ICC value of 0.495 (95% CI, 0.123-0.745). Week 2 testing produced ICC values of 0.602 (95% CI, 0.279-0.803) and 0.610 (95% CI, 0.299-0.804), respectively. All other single measures test-retest reliability values produced poor ICC values. Same-day ES testing showed fair to good test-retest reliability while interweek measures displayed poor to fair test-retest reliability. Testing conditions should be controlled when using computerized balance assessment methods. ES testing should only be used as a part of a comprehensive assessment.},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Postural Balance, *Sensation Disorders/di [Diagnosis], adult, Athletic Injuries/co [Complications], Brain Concussion/co [Complications], Computer-Assisted, DIAGNOSIS, Female, Humans, Male, Reproducibility of Results, Sensation Disorders/et [Etiology], Young Adult},
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}
}
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}
}
Kostyun, R
Sleep Disturbances in Concussed Athletes: A Review of the Literature Journal Article
In: Connecticut Medicine, vol. 79, no. 3, pp. 161–165, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries, *Brain Concussion, *Disease Management, *Sleep Wake Disorders, Adolescent, Athletes/px [Psychology], Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Cognition/ph [Physiology], Humans, Neuropsychological Tests, Sleep Wake Disorders/et [Etiology], Sleep Wake Disorders/pp [Physiopathology], Sleep Wake Disorders/th [Therapy], Young Adult
@article{Kostyun2015a,
title = {Sleep Disturbances in Concussed Athletes: A Review of the Literature},
author = {Kostyun, R},
year = {2015},
date = {2015-01-01},
journal = {Connecticut Medicine},
volume = {79},
number = {3},
pages = {161--165},
abstract = {Adolescents and young adults recovering from a concussion may experience subjective changes in their normal sleeping patterns. These subjective sleep complaints may influence a patient's perceived concussion symptoms and negatively impact cognition and school function. Clinicians should be cognizant of these changes in normal sleeping patterns for adolescent and young adult concussion patient and familiarize themselves with available treatment options.},
keywords = {*Athletic Injuries, *Brain Concussion, *Disease Management, *Sleep Wake Disorders, Adolescent, Athletes/px [Psychology], Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Cognition/ph [Physiology], Humans, Neuropsychological Tests, Sleep Wake Disorders/et [Etiology], Sleep Wake Disorders/pp [Physiopathology], Sleep Wake Disorders/th [Therapy], Young Adult},
pubstate = {published},
tppubtype = {article}
}
Bieniek, K F; Ross, O A; Cormier, K A; Walton, R L; Soto-Ortolaza, A; Johnston, A E; DeSaro, P; Boylan, K B; Graff-Radford, N R; Wszolek, Z K; Rademakers, R; Boeve, B F; McKee, A C; Dickson, D W
Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank Journal Article
In: Acta Neuropathologica, vol. 130, no. 6, pp. 877–889, 2015.
Abstract | BibTeX | Tags: *Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/et [Etiology], *Neurodegenerative Diseases/pa [Pathology], 0 (Apolipoproteins E), 0 (MAPT protein, 0 (Membrane Proteins), 0 (Nerve Tissue Proteins), 0 (tau Proteins), 0 (TMEM106B protein, aged, Apolipoproteins E/ge [Genetics], Athletic Injuries/co [Complications], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/et [Etiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Female, human), Humans, immunohistochemistry, Male, Membrane Proteins/ge [Genetics], Nerve Tissue Proteins/ge [Genetics], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Retrospective Studies, tau Proteins/ge [Genetics], tau Proteins/me [Metabolism], Tissue Banks
@article{Bieniek2015,
title = {Chronic traumatic encephalopathy pathology in a neurodegenerative disorders brain bank},
author = {Bieniek, K F and Ross, O A and Cormier, K A and Walton, R L and Soto-Ortolaza, A and Johnston, A E and DeSaro, P and Boylan, K B and Graff-Radford, N R and Wszolek, Z K and Rademakers, R and Boeve, B F and McKee, A C and Dickson, D W},
year = {2015},
date = {2015-01-01},
journal = {Acta Neuropathologica},
volume = {130},
number = {6},
pages = {877--889},
abstract = {Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative disorder linked to repetitive traumatic brain injury (TBI) and characterized by deposition of hyperphosphorylated tau at the depths of sulci. We sought to determine the presence of CTE pathology in a brain bank for neurodegenerative disorders for individuals with and without a history of contact sports participation. Available medical records of 1721 men were reviewed for evidence of past history of injury or participation in contact sports. Subsequently, cerebral cortical samples were processed for tau immunohistochemistry in cases with a documented history of sports exposure as well as age- and disease-matched men and women without such exposure. For cases with available frozen tissue, genetic analysis was performed for variants in APOE, MAPT, and TMEM106B. Immunohistochemistry revealed 21 of 66 former athletes had cortical tau pathology consistent with CTE. CTE pathology was not detected in 198 individuals without exposure to contact sports, including 33 individuals with documented single-incident TBI sustained from falls, motor vehicle accidents, domestic violence, or assaults. Among those exposed to contact sports, those with CTE pathology did not differ from those without CTE pathology with respect to noted clinicopathologic features. There were no significant differences in genetic variants for those with CTE pathology, but we observed a slight increase in MAPT H1 haplotype, and there tended to be fewer homozygous carriers of the protective TMEM106B rs3173615 minor allele in those with sports exposure and CTE pathology compared to those without CTE pathology. In conclusion, this study has identified a small, yet significant, subset of individuals with neurodegenerative disorders and concomitant CTE pathology. CTE pathology was only detected in individuals with documented participation in contact sports. Exposure to contact sports was the greatest risk factor for CTE pathology. Future studies addressing clinical correlates of CTE pathology are needed.},
keywords = {*Brain Injury, *Brain/pa [Pathology], *Neurodegenerative Diseases/et [Etiology], *Neurodegenerative Diseases/pa [Pathology], 0 (Apolipoproteins E), 0 (MAPT protein, 0 (Membrane Proteins), 0 (Nerve Tissue Proteins), 0 (tau Proteins), 0 (TMEM106B protein, aged, Apolipoproteins E/ge [Genetics], Athletic Injuries/co [Complications], Athletic Injuries/ge [Genetics], Athletic Injuries/me [Metabolism], Athletic Injuries/pa [Pathology], Brain Injury, Brain/me [Metabolism], Chronic/et [Etiology], Chronic/ge [Genetics], Chronic/me [Metabolism], Chronic/pa [Pathology], Female, human), Humans, immunohistochemistry, Male, Membrane Proteins/ge [Genetics], Nerve Tissue Proteins/ge [Genetics], Neurodegenerative Diseases/ge [Genetics], Neurodegenerative Diseases/me [Metabolism], Retrospective Studies, tau Proteins/ge [Genetics], tau Proteins/me [Metabolism], Tissue Banks},
pubstate = {published},
tppubtype = {article}
}
Meehan 3rd, W; Mannix, R; Zafonte, R; Pascual-Leone, A
Chronic traumatic encephalopathy and athletes Journal Article
In: Neurology, vol. 85, no. 17, pp. 1504–1511, 2015.
Abstract | BibTeX | Tags: *Athletic Injuries/pa [Pathology], *Brain Concussion/pa [Pathology], *Brain Injury, *Brain/pa [Pathology], *Cognition Disorders/pa [Pathology], *Suicidal Ideation, Aggression/px [Psychology], Athletes, Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Cognition Disorders/et [Etiology], Cognition Disorders/px [Psychology], Headache/et [Etiology], Headache/pa [Pathology], Humans, Mood Disorders/et [Etiology], Mood Disorders/pa [Pathology], Mood Disorders/px [Psychology], Speech Disorders/et [Etiology], Speech Disorders/pa [Pathology], Speech Disorders/px [Psychology]
@article{Meehan3rd2015a,
title = {Chronic traumatic encephalopathy and athletes},
author = {{Meehan 3rd}, W and Mannix, R and Zafonte, R and Pascual-Leone, A},
year = {2015},
date = {2015-01-01},
journal = {Neurology},
volume = {85},
number = {17},
pages = {1504--1511},
abstract = {Recent case reports have described athletes previously exposed to repetitive head trauma while participating in contact sports who later in life developed mood disorders, headaches, cognitive difficulties, suicidal ideation, difficulties with speech, and aggressive behavior. Postmortem discoveries show that some of these athletes have pathologic findings that are collectively termed chronic traumatic encephalopathy (CTE). Current hypotheses suggest that concussions or perhaps blows to the head that do not cause the signs and symptoms necessary for making the diagnosis of concussion, so-called subconcussive blows, cause both the clinical and pathologic findings. There are, however, some athletes who participate in contact sports who do not develop the findings ascribed to CTE. Furthermore, there are people who have headaches, mood disorders, cognitive difficulties, suicidal ideation, and other clinical problems who have neither been exposed to repeated head trauma nor possessed the pathologic postmortem findings of those currently diagnosed with CTE. The current lack of prospective data and properly designed case-control studies limits the current understanding of CTE, leading to debate about the causes of the neuropathologic findings and the clinical observations. Given the potential for referral and recall bias in available studies, it remains unclear whether or not the pathologic findings made postmortem cause the presumed neurobehavioral sequela and whether the presumed risk factors, such as sports activity, cerebral concussions, and subconcussive blows, are solely causative of the clinical signs and symptoms. This article discusses the current evidence and the associated limitations. Copyright © 2015 American Academy of Neurology.},
keywords = {*Athletic Injuries/pa [Pathology], *Brain Concussion/pa [Pathology], *Brain Injury, *Brain/pa [Pathology], *Cognition Disorders/pa [Pathology], *Suicidal Ideation, Aggression/px [Psychology], Athletes, Athletic Injuries/co [Complications], Athletic Injuries/px [Psychology], Brain Concussion/co [Complications], Brain Concussion/px [Psychology], Brain Injury, Chronic/et [Etiology], Chronic/pa [Pathology], Chronic/px [Psychology], Cognition Disorders/et [Etiology], Cognition Disorders/px [Psychology], Headache/et [Etiology], Headache/pa [Pathology], Humans, Mood Disorders/et [Etiology], Mood Disorders/pa [Pathology], Mood Disorders/px [Psychology], Speech Disorders/et [Etiology], Speech Disorders/pa [Pathology], Speech Disorders/px [Psychology]},
pubstate = {published},
tppubtype = {article}
}
Duenas, M J; Hsu, S N; Jandial, R
Visual screening test for rapid sideline determination of concussive and sub-concussive events Journal Article
In: Neurosurgery, vol. 73, no. 4, pp. N17–8, 2013.
BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Vision Screening/mt [Methods], Athletic Injuries/co [Complications], Brain Concussion/et [Etiology], Humans
@article{Duenas2013,
title = {Visual screening test for rapid sideline determination of concussive and sub-concussive events},
author = {Duenas, M J and Hsu, S N and Jandial, R},
year = {2013},
date = {2013-01-01},
journal = {Neurosurgery},
volume = {73},
number = {4},
pages = {N17--8},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Vision Screening/mt [Methods], Athletic Injuries/co [Complications], Brain Concussion/et [Etiology], Humans},
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}
}
Butcher, I; McHugh, G S; Lu, J; Steyerberg, E W; Hernandez, A V; Mushkudiani, N; Maas, A I; Marmarou, A; Murray, G D
Prognostic value of cause of injury in traumatic brain injury: results from the IMPACT study Journal Article
In: Journal of Neurotrauma, vol. 24, no. 2, pp. 281–286, 2007.
Abstract | BibTeX | Tags: *Brain Injuries/di [Diagnosis], *Brain Injuries/et [Etiology], Accidents, adult, Age Factors, Athletic Injuries/co [Complications], Athletic Injuries/di [Diagnosis], Databases, Factual, Glasgow Outcome Scale, Humans, middle aged, Predictive Value of Tests, Prognosis, violence
@article{Butcher2007,
title = {Prognostic value of cause of injury in traumatic brain injury: results from the IMPACT study},
author = {Butcher, I and McHugh, G S and Lu, J and Steyerberg, E W and Hernandez, A V and Mushkudiani, N and Maas, A I and Marmarou, A and Murray, G D},
year = {2007},
date = {2007-01-01},
journal = {Journal of Neurotrauma},
volume = {24},
number = {2},
pages = {281--286},
abstract = {We aimed to describe and quantify the relationship between cause of injury and final outcome following traumatic brain injury (TBI). Individual patient data (N = 8708) from eight therapeutic Phase III randomized clinical trials in moderate or severe TBI, and three TBI surveys were used to investigate the relationship between cause of injury and outcome, as assessed by the Glasgow Outcome Scale (GOS) at 6 months. Proportional odds methodology was applied to quantify the strength of the association and expressed as an odds ratio in a meta-analysis. Heterogeneity across studies was assessed and associations with other predictive factors explored. In a univariate analysis, a strong association between the cause of injury and long-term outcome in moderate to severe TBI patients was observed, with consistent results across the studies. Road traffic accidents (OR 0.66, 95% CI 0.60-0.73), assaults (OR 0.66, 95% CI 0.52-0.84), and injuries sustained during sporting or recreational activities (OR 0.45, 95% CI 0.28-0.71) were all associated with better outcomes than the reference category of falls. Falls were found to be associated with an older age and with a higher incidence of mass lesions. Following adjustment for age in the analysis, the relationship between cause of injury and outcome was lost.},
keywords = {*Brain Injuries/di [Diagnosis], *Brain Injuries/et [Etiology], Accidents, adult, Age Factors, Athletic Injuries/co [Complications], Athletic Injuries/di [Diagnosis], Databases, Factual, Glasgow Outcome Scale, Humans, middle aged, Predictive Value of Tests, Prognosis, violence},
pubstate = {published},
tppubtype = {article}
}