Babcock, L; Kurowski, B G
Identifying Children and Adolescents at Risk for Persistent Postconcussion Symptoms Journal Article
In: JAMA, vol. 315, no. 10, pp. 987–988, 2016.
BibTeX | Tags: *Post-Concussion Syndrome/di [Diagnosis], Female, Humans, Male
@article{Babcock2016,
title = {Identifying Children and Adolescents at Risk for Persistent Postconcussion Symptoms},
author = {Babcock, L and Kurowski, B G},
year = {2016},
date = {2016-01-01},
journal = {JAMA},
volume = {315},
number = {10},
pages = {987--988},
keywords = {*Post-Concussion Syndrome/di [Diagnosis], Female, Humans, Male},
pubstate = {published},
tppubtype = {article}
}
Willer, B S; Leddy, J J
Time to Change from a Symptom-based Concussion Assessment to a Structured Physical Examination Journal Article
In: Academic Emergency Medicine, vol. 23, no. 4, pp. 495–496, 2016.
BibTeX | Tags: *Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], Athletic Injuries, Humans, Neuropsychological Tests, Physical Examination
@article{Willer2016,
title = {Time to Change from a Symptom-based Concussion Assessment to a Structured Physical Examination},
author = {Willer, B S and Leddy, J J},
year = {2016},
date = {2016-01-01},
journal = {Academic Emergency Medicine},
volume = {23},
number = {4},
pages = {495--496},
keywords = {*Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], Athletic Injuries, Humans, Neuropsychological Tests, Physical Examination},
pubstate = {published},
tppubtype = {article}
}
Subbian, V; Ratcliff, J J; Korfhagen, J J; Hart, K W; Meunier, J M; Shaw, G J; Lindsell, C J; Beyette Jr., F R
A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up? Journal Article
In: Academic Emergency Medicine, vol. 23, no. 4, pp. 382–392, 2016.
Abstract | BibTeX | Tags: *Brain Injuries/co [Complications], *Emergency Service, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/et [Etiology], *Robotics/mt [Methods], adult, Closed/co [Complications], Diagnostic Techniques, Female, Follow-Up Studies, Head Injuries, Hospital/og [Organization & Ad, Humans, Male, middle aged, Neurological, Observer Variation, Sensitivity and Specificity, Urban Population, Young Adult
@article{Subbian2016,
title = {A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up?},
author = {Subbian, V and Ratcliff, J J and Korfhagen, J J and Hart, K W and Meunier, J M and Shaw, G J and Lindsell, C J and {Beyette Jr.}, F R},
year = {2016},
date = {2016-01-01},
journal = {Academic Emergency Medicine},
volume = {23},
number = {4},
pages = {382--392},
abstract = {OBJECTIVES: Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function. METHODS: All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014. The enrollment criteria were as follows: 1) age of 18 years or greater, 2) ability and willingness to provide written informed consent, 3) blunt head trauma and clinical diagnosis of isolated mild TBI by the treating physician, and 4) blood alcohol level of \<100 mg/dL. Eligible mild TBI patients were enrolled and their neuromotor function was assessed in the ED using a battery of five tests that cover a range of proprioceptive, visuomotor, visuospatial, and executive function performance metrics. At 3 weeks postinjury, participants were contacted via telephone to complete the Rivermead Post-Concussion Symptoms Questionnaire to assess the presence of significant PCS. RESULTS: A total of 66 mild TBI patients were enrolled in the study with 42 of them completing both the ED assessment and the follow-up; 40 patients were included in the analyses. The area under the receiver operating characteristic curve (AUC) for the entire test battery was 0.72 (95% confidence interval [CI] = 0.54 to 0.90). The AUC for tests that primarily measure visuomotor and proprioceptive performance were 0.80 (95% CI = 0.65 to 0.95) and 0.71 (95% CI = 0.53 to 0.89), respectively. CONCLUSIONS: The robotic-assisted test battery has the ability to discriminate between subjects who developed PCS and those who did not. Additionally, poor visuomotor and proprioceptive performance were most strongly associated with subsequent PCS.Copyright © 2016 by the Society for Academic Emergency Medicine.},
keywords = {*Brain Injuries/co [Complications], *Emergency Service, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/et [Etiology], *Robotics/mt [Methods], adult, Closed/co [Complications], Diagnostic Techniques, Female, Follow-Up Studies, Head Injuries, Hospital/og [Organization \& Ad, Humans, Male, middle aged, Neurological, Observer Variation, Sensitivity and Specificity, Urban Population, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Heinmiller, L; Gunton, K B
A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome Journal Article
In: Current Opinion in Ophthalmology, vol. 27, no. 5, pp. 407–412, 2016.
Abstract | BibTeX | Tags: *Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], *Vision Disorders/di [Diagnosis], Brain Concussion/th [Therapy], Humans, Ocular Motility Disorders/di [Diagnosis], Ocular Motility Disorders/th [Therapy], Post-Concussion Syndrome/th [Therapy], Risk Factors, Vision Disorders/th [Therapy]
@article{Heinmiller2016,
title = {A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome},
author = {Heinmiller, L and Gunton, K B},
year = {2016},
date = {2016-01-01},
journal = {Current Opinion in Ophthalmology},
volume = {27},
number = {5},
pages = {407--412},
abstract = {PURPOSE OF REVIEW: Concussions and their related sequelae have received significant attention given the high-profile media coverage from professional sports and recreational leagues. A better understanding of the diagnosis and symptom management may limit the long-term impact these injuries have on the affected individual. The aim of this review is to provide updated information for both diagnosis and ongoing management for visual symptoms of concussions. RECENT FINDINGS: New testing including a brief vestibular/ocular motor screening assessment and the importance of near point of convergence measurements may prove beneficial to the diagnosis and identification of patients at greater risk for developing postconcussion syndrome. Additionally, the development of postconcussion syndrome is more likely when symptom burden is greater upon presentation. SUMMARY: Currently, there is not a single testing method that can universally identify all individuals with concussion. Current management of concussion focuses on targeted treatment based upon symptoms and signs present at onset to decrease disease burden and help restore baseline functioning as soon as possible.},
keywords = {*Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], *Vision Disorders/di [Diagnosis], Brain Concussion/th [Therapy], Humans, Ocular Motility Disorders/di [Diagnosis], Ocular Motility Disorders/th [Therapy], Post-Concussion Syndrome/th [Therapy], Risk Factors, Vision Disorders/th [Therapy]},
pubstate = {published},
tppubtype = {article}
}
Custer, A; Sufrinko, A; Elbin, R J; Covassin, T; Collins, M; Kontos, A
High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes Journal Article
In: Journal of Athletic Training, vol. 51, no. 2, pp. 136–141, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], Adolescent, Athletes, Cohort Studies, Female, Humans, Male, Memory, Neuropsychological Tests, Prognosis, reaction time, Risk Factors, Students
@article{Custer2016,
title = {High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes},
author = {Custer, A and Sufrinko, A and Elbin, R J and Covassin, T and Collins, M and Kontos, A},
year = {2016},
date = {2016-01-01},
journal = {Journal of Athletic Training},
volume = {51},
number = {2},
pages = {136--141},
abstract = {CONTEXT: Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined. OBJECTIVE: To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC. DESIGN: Cohort study. SETTING: High school and collegiate athletic programs. PATIENTS OR OTHER PARTICIPANTS: A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], Adolescent, Athletes, Cohort Studies, Female, Humans, Male, Memory, Neuropsychological Tests, Prognosis, reaction time, Risk Factors, Students},
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}
}
Dretsch, M N; Silverberg, N D; Iverson, G L
Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers Journal Article
In: Journal of Neurotrauma, vol. 32, no. 17, pp. 1301–1306, 2015.
Abstract | BibTeX | Tags: *Brain Concussion/co [Complications], *Cognition Disorders/di [Diagnosis], *Military Personnel/sn [Statistics & Numerical Dat, *Post-Concussion Syndrome/di [Diagnosis], adult, Brain Concussion/ep [Epidemiology], Cognition Disorders/ep [Epidemiology], Cognition Disorders/et [Etiology], Female, Humans, Male, Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], United States/ep [Epidemiology], Young Adult
@article{Dretsch2015,
title = {Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers},
author = {Dretsch, M N and Silverberg, N D and Iverson, G L},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {17},
pages = {1301--1306},
abstract = {The extent to which multiple past concussions are associated with lingering symptoms or mental health problems in military service members is not well understood. The purpose of this study was to examine the association between lifetime concussion history, cognitive functioning, general health, and psychological health in a large sample of fit-for-duty U.S. Army soldiers preparing for deployment. Data on 458 active-duty soldiers were collected and analyzed. A computerized cognitive screening battery (CNS-Vital Signs()) was used to assess complex attention (CA), reaction time (RT), processing speed (PS), cognitive flexibility (CF), and memory. Health questionnaires included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Zung Depression and Anxiety Scales (ZDS; ZAS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Alcohol Use and Dependency Identification Test (AUDIT). Soldiers with a history of multiple concussions (i.e., three or more concussions) had significantly greater post-concussive symptom scores compared with those with zero (d=1.83, large effect), one (d=0.64, medium effect), and two (d=0.64, medium effect) prior concussions. Although the group with three or more concussions also reported more traumatic stress symptoms, the results revealed that traumatic stress was a mediator between concussions and post-concussive symptom severity. There were no significant differences on neurocognitive testing between the number of concussions. These results add to the accumulating evidence suggesting that most individuals recover from one or two prior concussions, but there is a greater risk for ongoing symptoms if one exceeds this number of injuries.},
keywords = {*Brain Concussion/co [Complications], *Cognition Disorders/di [Diagnosis], *Military Personnel/sn [Statistics \& Numerical Dat, *Post-Concussion Syndrome/di [Diagnosis], adult, Brain Concussion/ep [Epidemiology], Cognition Disorders/ep [Epidemiology], Cognition Disorders/et [Etiology], Female, Humans, Male, Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], United States/ep [Epidemiology], Young Adult},
pubstate = {published},
tppubtype = {article}
}
Waldron-Perrine, B; Tree, H A; Spencer, R J; Suhr, J; Bieliauskas, L
Informational literature influences symptom expression following mild head injury: An analog study Journal Article
In: Brain Injury, vol. 29, no. 9, pp. 1051–1055, 2015.
Abstract | BibTeX | Tags: *Brain Injuries/di [Diagnosis], *Brain Injuries/px [Psychology], *Information Dissemination, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/px [Psychology], adult, Female, Health Communication, Humans, Language, Male, middle aged, Neuropsychological Tests, Post-Traumatic/di [Diagnosis], Stress Disorders, Veterans/px [Psychology], Young Adult
@article{Waldron-Perrine2015,
title = {Informational literature influences symptom expression following mild head injury: An analog study},
author = {Waldron-Perrine, B and Tree, H A and Spencer, R J and Suhr, J and Bieliauskas, L},
year = {2015},
date = {2015-01-01},
journal = {Brain Injury},
volume = {29},
number = {9},
pages = {1051--1055},
abstract = {PRIMARY OBJECTIVE: Many Veterans involved in recent OEF/OIF conflicts return with reports of having experienced an mTBI. The Veteran's Affairs (VA) and Department of Defense (DoD) have gone to great lengths to provide information to Veterans regarding possible effects of TBI. Although well intended, this information may possibly have an iatrogenic effect. Conversely, setting positive expectations for recovery from mTBI has been shown to result in decreased symptomatology. RESEARCH DESIGN: One-way ANOVA and Tukey post-hoc analyses were used to determine whether there were significant differences on reported severity and number of PCS symptoms (NSI) among the three experimental groups (recovery focused information; expectation for persistent symptoms; and no information given). METHODS AND PROCEDURES: Undergraduate students, who were told to imagine they had experienced a military-related TBI, reported varying levels of expected symptoms when given either positive or negative information about symptom expectation. MAIN OUTCOMES AND RESULTS: The results indicate that presenting recovery-oriented literature resulted in the lowest report of expected symptoms, whereas presenting no information resulted in the highest report of expected symptoms. CONCLUSIONS: Providing Veterans with information regarding a likely positive trajectory of recovery may result in less symptom persistence during rehabilitation.},
keywords = {*Brain Injuries/di [Diagnosis], *Brain Injuries/px [Psychology], *Information Dissemination, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/px [Psychology], adult, Female, Health Communication, Humans, Language, Male, middle aged, Neuropsychological Tests, Post-Traumatic/di [Diagnosis], Stress Disorders, Veterans/px [Psychology], Young Adult},
pubstate = {published},
tppubtype = {article}
}
Babcock, L; Kurowski, B G
Identifying Children and Adolescents at Risk for Persistent Postconcussion Symptoms Journal Article
In: JAMA, vol. 315, no. 10, pp. 987–988, 2016.
@article{Babcock2016,
title = {Identifying Children and Adolescents at Risk for Persistent Postconcussion Symptoms},
author = {Babcock, L and Kurowski, B G},
year = {2016},
date = {2016-01-01},
journal = {JAMA},
volume = {315},
number = {10},
pages = {987--988},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Willer, B S; Leddy, J J
Time to Change from a Symptom-based Concussion Assessment to a Structured Physical Examination Journal Article
In: Academic Emergency Medicine, vol. 23, no. 4, pp. 495–496, 2016.
@article{Willer2016,
title = {Time to Change from a Symptom-based Concussion Assessment to a Structured Physical Examination},
author = {Willer, B S and Leddy, J J},
year = {2016},
date = {2016-01-01},
journal = {Academic Emergency Medicine},
volume = {23},
number = {4},
pages = {495--496},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Subbian, V; Ratcliff, J J; Korfhagen, J J; Hart, K W; Meunier, J M; Shaw, G J; Lindsell, C J; Beyette Jr., F R
A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up? Journal Article
In: Academic Emergency Medicine, vol. 23, no. 4, pp. 382–392, 2016.
@article{Subbian2016,
title = {A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up?},
author = {Subbian, V and Ratcliff, J J and Korfhagen, J J and Hart, K W and Meunier, J M and Shaw, G J and Lindsell, C J and {Beyette Jr.}, F R},
year = {2016},
date = {2016-01-01},
journal = {Academic Emergency Medicine},
volume = {23},
number = {4},
pages = {382--392},
abstract = {OBJECTIVES: Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function. METHODS: All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014. The enrollment criteria were as follows: 1) age of 18 years or greater, 2) ability and willingness to provide written informed consent, 3) blunt head trauma and clinical diagnosis of isolated mild TBI by the treating physician, and 4) blood alcohol level of \<100 mg/dL. Eligible mild TBI patients were enrolled and their neuromotor function was assessed in the ED using a battery of five tests that cover a range of proprioceptive, visuomotor, visuospatial, and executive function performance metrics. At 3 weeks postinjury, participants were contacted via telephone to complete the Rivermead Post-Concussion Symptoms Questionnaire to assess the presence of significant PCS. RESULTS: A total of 66 mild TBI patients were enrolled in the study with 42 of them completing both the ED assessment and the follow-up; 40 patients were included in the analyses. The area under the receiver operating characteristic curve (AUC) for the entire test battery was 0.72 (95% confidence interval [CI] = 0.54 to 0.90). The AUC for tests that primarily measure visuomotor and proprioceptive performance were 0.80 (95% CI = 0.65 to 0.95) and 0.71 (95% CI = 0.53 to 0.89), respectively. CONCLUSIONS: The robotic-assisted test battery has the ability to discriminate between subjects who developed PCS and those who did not. Additionally, poor visuomotor and proprioceptive performance were most strongly associated with subsequent PCS.Copyright © 2016 by the Society for Academic Emergency Medicine.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Heinmiller, L; Gunton, K B
A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome Journal Article
In: Current Opinion in Ophthalmology, vol. 27, no. 5, pp. 407–412, 2016.
@article{Heinmiller2016,
title = {A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome},
author = {Heinmiller, L and Gunton, K B},
year = {2016},
date = {2016-01-01},
journal = {Current Opinion in Ophthalmology},
volume = {27},
number = {5},
pages = {407--412},
abstract = {PURPOSE OF REVIEW: Concussions and their related sequelae have received significant attention given the high-profile media coverage from professional sports and recreational leagues. A better understanding of the diagnosis and symptom management may limit the long-term impact these injuries have on the affected individual. The aim of this review is to provide updated information for both diagnosis and ongoing management for visual symptoms of concussions. RECENT FINDINGS: New testing including a brief vestibular/ocular motor screening assessment and the importance of near point of convergence measurements may prove beneficial to the diagnosis and identification of patients at greater risk for developing postconcussion syndrome. Additionally, the development of postconcussion syndrome is more likely when symptom burden is greater upon presentation. SUMMARY: Currently, there is not a single testing method that can universally identify all individuals with concussion. Current management of concussion focuses on targeted treatment based upon symptoms and signs present at onset to decrease disease burden and help restore baseline functioning as soon as possible.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Custer, A; Sufrinko, A; Elbin, R J; Covassin, T; Collins, M; Kontos, A
High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes Journal Article
In: Journal of Athletic Training, vol. 51, no. 2, pp. 136–141, 2016.
@article{Custer2016,
title = {High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes},
author = {Custer, A and Sufrinko, A and Elbin, R J and Covassin, T and Collins, M and Kontos, A},
year = {2016},
date = {2016-01-01},
journal = {Journal of Athletic Training},
volume = {51},
number = {2},
pages = {136--141},
abstract = {CONTEXT: Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined. OBJECTIVE: To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC. DESIGN: Cohort study. SETTING: High school and collegiate athletic programs. PATIENTS OR OTHER PARTICIPANTS: A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0},
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}
}
Dretsch, M N; Silverberg, N D; Iverson, G L
Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers Journal Article
In: Journal of Neurotrauma, vol. 32, no. 17, pp. 1301–1306, 2015.
@article{Dretsch2015,
title = {Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers},
author = {Dretsch, M N and Silverberg, N D and Iverson, G L},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {17},
pages = {1301--1306},
abstract = {The extent to which multiple past concussions are associated with lingering symptoms or mental health problems in military service members is not well understood. The purpose of this study was to examine the association between lifetime concussion history, cognitive functioning, general health, and psychological health in a large sample of fit-for-duty U.S. Army soldiers preparing for deployment. Data on 458 active-duty soldiers were collected and analyzed. A computerized cognitive screening battery (CNS-Vital Signs()) was used to assess complex attention (CA), reaction time (RT), processing speed (PS), cognitive flexibility (CF), and memory. Health questionnaires included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Zung Depression and Anxiety Scales (ZDS; ZAS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Alcohol Use and Dependency Identification Test (AUDIT). Soldiers with a history of multiple concussions (i.e., three or more concussions) had significantly greater post-concussive symptom scores compared with those with zero (d=1.83, large effect), one (d=0.64, medium effect), and two (d=0.64, medium effect) prior concussions. Although the group with three or more concussions also reported more traumatic stress symptoms, the results revealed that traumatic stress was a mediator between concussions and post-concussive symptom severity. There were no significant differences on neurocognitive testing between the number of concussions. These results add to the accumulating evidence suggesting that most individuals recover from one or two prior concussions, but there is a greater risk for ongoing symptoms if one exceeds this number of injuries.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Waldron-Perrine, B; Tree, H A; Spencer, R J; Suhr, J; Bieliauskas, L
Informational literature influences symptom expression following mild head injury: An analog study Journal Article
In: Brain Injury, vol. 29, no. 9, pp. 1051–1055, 2015.
@article{Waldron-Perrine2015,
title = {Informational literature influences symptom expression following mild head injury: An analog study},
author = {Waldron-Perrine, B and Tree, H A and Spencer, R J and Suhr, J and Bieliauskas, L},
year = {2015},
date = {2015-01-01},
journal = {Brain Injury},
volume = {29},
number = {9},
pages = {1051--1055},
abstract = {PRIMARY OBJECTIVE: Many Veterans involved in recent OEF/OIF conflicts return with reports of having experienced an mTBI. The Veteran's Affairs (VA) and Department of Defense (DoD) have gone to great lengths to provide information to Veterans regarding possible effects of TBI. Although well intended, this information may possibly have an iatrogenic effect. Conversely, setting positive expectations for recovery from mTBI has been shown to result in decreased symptomatology. RESEARCH DESIGN: One-way ANOVA and Tukey post-hoc analyses were used to determine whether there were significant differences on reported severity and number of PCS symptoms (NSI) among the three experimental groups (recovery focused information; expectation for persistent symptoms; and no information given). METHODS AND PROCEDURES: Undergraduate students, who were told to imagine they had experienced a military-related TBI, reported varying levels of expected symptoms when given either positive or negative information about symptom expectation. MAIN OUTCOMES AND RESULTS: The results indicate that presenting recovery-oriented literature resulted in the lowest report of expected symptoms, whereas presenting no information resulted in the highest report of expected symptoms. CONCLUSIONS: Providing Veterans with information regarding a likely positive trajectory of recovery may result in less symptom persistence during rehabilitation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Babcock, L; Kurowski, B G
Identifying Children and Adolescents at Risk for Persistent Postconcussion Symptoms Journal Article
In: JAMA, vol. 315, no. 10, pp. 987–988, 2016.
BibTeX | Tags: *Post-Concussion Syndrome/di [Diagnosis], Female, Humans, Male
@article{Babcock2016,
title = {Identifying Children and Adolescents at Risk for Persistent Postconcussion Symptoms},
author = {Babcock, L and Kurowski, B G},
year = {2016},
date = {2016-01-01},
journal = {JAMA},
volume = {315},
number = {10},
pages = {987--988},
keywords = {*Post-Concussion Syndrome/di [Diagnosis], Female, Humans, Male},
pubstate = {published},
tppubtype = {article}
}
Willer, B S; Leddy, J J
Time to Change from a Symptom-based Concussion Assessment to a Structured Physical Examination Journal Article
In: Academic Emergency Medicine, vol. 23, no. 4, pp. 495–496, 2016.
BibTeX | Tags: *Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], Athletic Injuries, Humans, Neuropsychological Tests, Physical Examination
@article{Willer2016,
title = {Time to Change from a Symptom-based Concussion Assessment to a Structured Physical Examination},
author = {Willer, B S and Leddy, J J},
year = {2016},
date = {2016-01-01},
journal = {Academic Emergency Medicine},
volume = {23},
number = {4},
pages = {495--496},
keywords = {*Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], Athletic Injuries, Humans, Neuropsychological Tests, Physical Examination},
pubstate = {published},
tppubtype = {article}
}
Subbian, V; Ratcliff, J J; Korfhagen, J J; Hart, K W; Meunier, J M; Shaw, G J; Lindsell, C J; Beyette Jr., F R
A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up? Journal Article
In: Academic Emergency Medicine, vol. 23, no. 4, pp. 382–392, 2016.
Abstract | BibTeX | Tags: *Brain Injuries/co [Complications], *Emergency Service, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/et [Etiology], *Robotics/mt [Methods], adult, Closed/co [Complications], Diagnostic Techniques, Female, Follow-Up Studies, Head Injuries, Hospital/og [Organization & Ad, Humans, Male, middle aged, Neurological, Observer Variation, Sensitivity and Specificity, Urban Population, Young Adult
@article{Subbian2016,
title = {A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up?},
author = {Subbian, V and Ratcliff, J J and Korfhagen, J J and Hart, K W and Meunier, J M and Shaw, G J and Lindsell, C J and {Beyette Jr.}, F R},
year = {2016},
date = {2016-01-01},
journal = {Academic Emergency Medicine},
volume = {23},
number = {4},
pages = {382--392},
abstract = {OBJECTIVES: Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function. METHODS: All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014. The enrollment criteria were as follows: 1) age of 18 years or greater, 2) ability and willingness to provide written informed consent, 3) blunt head trauma and clinical diagnosis of isolated mild TBI by the treating physician, and 4) blood alcohol level of \<100 mg/dL. Eligible mild TBI patients were enrolled and their neuromotor function was assessed in the ED using a battery of five tests that cover a range of proprioceptive, visuomotor, visuospatial, and executive function performance metrics. At 3 weeks postinjury, participants were contacted via telephone to complete the Rivermead Post-Concussion Symptoms Questionnaire to assess the presence of significant PCS. RESULTS: A total of 66 mild TBI patients were enrolled in the study with 42 of them completing both the ED assessment and the follow-up; 40 patients were included in the analyses. The area under the receiver operating characteristic curve (AUC) for the entire test battery was 0.72 (95% confidence interval [CI] = 0.54 to 0.90). The AUC for tests that primarily measure visuomotor and proprioceptive performance were 0.80 (95% CI = 0.65 to 0.95) and 0.71 (95% CI = 0.53 to 0.89), respectively. CONCLUSIONS: The robotic-assisted test battery has the ability to discriminate between subjects who developed PCS and those who did not. Additionally, poor visuomotor and proprioceptive performance were most strongly associated with subsequent PCS.Copyright © 2016 by the Society for Academic Emergency Medicine.},
keywords = {*Brain Injuries/co [Complications], *Emergency Service, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/et [Etiology], *Robotics/mt [Methods], adult, Closed/co [Complications], Diagnostic Techniques, Female, Follow-Up Studies, Head Injuries, Hospital/og [Organization \& Ad, Humans, Male, middle aged, Neurological, Observer Variation, Sensitivity and Specificity, Urban Population, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Heinmiller, L; Gunton, K B
A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome Journal Article
In: Current Opinion in Ophthalmology, vol. 27, no. 5, pp. 407–412, 2016.
Abstract | BibTeX | Tags: *Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], *Vision Disorders/di [Diagnosis], Brain Concussion/th [Therapy], Humans, Ocular Motility Disorders/di [Diagnosis], Ocular Motility Disorders/th [Therapy], Post-Concussion Syndrome/th [Therapy], Risk Factors, Vision Disorders/th [Therapy]
@article{Heinmiller2016,
title = {A review of the current practice in diagnosis and management of visual complaints associated with concussion and postconcussion syndrome},
author = {Heinmiller, L and Gunton, K B},
year = {2016},
date = {2016-01-01},
journal = {Current Opinion in Ophthalmology},
volume = {27},
number = {5},
pages = {407--412},
abstract = {PURPOSE OF REVIEW: Concussions and their related sequelae have received significant attention given the high-profile media coverage from professional sports and recreational leagues. A better understanding of the diagnosis and symptom management may limit the long-term impact these injuries have on the affected individual. The aim of this review is to provide updated information for both diagnosis and ongoing management for visual symptoms of concussions. RECENT FINDINGS: New testing including a brief vestibular/ocular motor screening assessment and the importance of near point of convergence measurements may prove beneficial to the diagnosis and identification of patients at greater risk for developing postconcussion syndrome. Additionally, the development of postconcussion syndrome is more likely when symptom burden is greater upon presentation. SUMMARY: Currently, there is not a single testing method that can universally identify all individuals with concussion. Current management of concussion focuses on targeted treatment based upon symptoms and signs present at onset to decrease disease burden and help restore baseline functioning as soon as possible.},
keywords = {*Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], *Vision Disorders/di [Diagnosis], Brain Concussion/th [Therapy], Humans, Ocular Motility Disorders/di [Diagnosis], Ocular Motility Disorders/th [Therapy], Post-Concussion Syndrome/th [Therapy], Risk Factors, Vision Disorders/th [Therapy]},
pubstate = {published},
tppubtype = {article}
}
Custer, A; Sufrinko, A; Elbin, R J; Covassin, T; Collins, M; Kontos, A
High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes Journal Article
In: Journal of Athletic Training, vol. 51, no. 2, pp. 136–141, 2016.
Abstract | BibTeX | Tags: *Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], Adolescent, Athletes, Cohort Studies, Female, Humans, Male, Memory, Neuropsychological Tests, Prognosis, reaction time, Risk Factors, Students
@article{Custer2016,
title = {High Baseline Postconcussion Symptom Scores and Concussion Outcomes in Athletes},
author = {Custer, A and Sufrinko, A and Elbin, R J and Covassin, T and Collins, M and Kontos, A},
year = {2016},
date = {2016-01-01},
journal = {Journal of Athletic Training},
volume = {51},
number = {2},
pages = {136--141},
abstract = {CONTEXT: Some healthy athletes report high levels of baseline concussion symptoms, which may be attributable to several factors (eg, illness, personality, somaticizing). However, the role of baseline symptoms in outcomes after sport-related concussion (SRC) has not been empirically examined. OBJECTIVE: To determine if athletes with high symptom scores at baseline performed worse than athletes without baseline symptoms on neurocognitive testing after SRC. DESIGN: Cohort study. SETTING: High school and collegiate athletic programs. PATIENTS OR OTHER PARTICIPANTS: A total of 670 high school and collegiate athletes participated in the study. Participants were divided into groups with either no baseline symptoms (Postconcussion Symptom Scale [PCSS] score = 0},
keywords = {*Athletic Injuries/di [Diagnosis], *Brain Concussion/di [Diagnosis], *Post-Concussion Syndrome/di [Diagnosis], Adolescent, Athletes, Cohort Studies, Female, Humans, Male, Memory, Neuropsychological Tests, Prognosis, reaction time, Risk Factors, Students},
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}
}
Dretsch, M N; Silverberg, N D; Iverson, G L
Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers Journal Article
In: Journal of Neurotrauma, vol. 32, no. 17, pp. 1301–1306, 2015.
Abstract | BibTeX | Tags: *Brain Concussion/co [Complications], *Cognition Disorders/di [Diagnosis], *Military Personnel/sn [Statistics & Numerical Dat, *Post-Concussion Syndrome/di [Diagnosis], adult, Brain Concussion/ep [Epidemiology], Cognition Disorders/ep [Epidemiology], Cognition Disorders/et [Etiology], Female, Humans, Male, Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], United States/ep [Epidemiology], Young Adult
@article{Dretsch2015,
title = {Multiple Past Concussions Are Associated with Ongoing Post-Concussive Symptoms but Not Cognitive Impairment in Active-Duty Army Soldiers},
author = {Dretsch, M N and Silverberg, N D and Iverson, G L},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {17},
pages = {1301--1306},
abstract = {The extent to which multiple past concussions are associated with lingering symptoms or mental health problems in military service members is not well understood. The purpose of this study was to examine the association between lifetime concussion history, cognitive functioning, general health, and psychological health in a large sample of fit-for-duty U.S. Army soldiers preparing for deployment. Data on 458 active-duty soldiers were collected and analyzed. A computerized cognitive screening battery (CNS-Vital Signs()) was used to assess complex attention (CA), reaction time (RT), processing speed (PS), cognitive flexibility (CF), and memory. Health questionnaires included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist-Military Version (PCL-M), Zung Depression and Anxiety Scales (ZDS; ZAS), Perceived Stress Scale (PSS), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the Alcohol Use and Dependency Identification Test (AUDIT). Soldiers with a history of multiple concussions (i.e., three or more concussions) had significantly greater post-concussive symptom scores compared with those with zero (d=1.83, large effect), one (d=0.64, medium effect), and two (d=0.64, medium effect) prior concussions. Although the group with three or more concussions also reported more traumatic stress symptoms, the results revealed that traumatic stress was a mediator between concussions and post-concussive symptom severity. There were no significant differences on neurocognitive testing between the number of concussions. These results add to the accumulating evidence suggesting that most individuals recover from one or two prior concussions, but there is a greater risk for ongoing symptoms if one exceeds this number of injuries.},
keywords = {*Brain Concussion/co [Complications], *Cognition Disorders/di [Diagnosis], *Military Personnel/sn [Statistics \& Numerical Dat, *Post-Concussion Syndrome/di [Diagnosis], adult, Brain Concussion/ep [Epidemiology], Cognition Disorders/ep [Epidemiology], Cognition Disorders/et [Etiology], Female, Humans, Male, Post-Concussion Syndrome/ep [Epidemiology], Post-Concussion Syndrome/et [Etiology], United States/ep [Epidemiology], Young Adult},
pubstate = {published},
tppubtype = {article}
}
Waldron-Perrine, B; Tree, H A; Spencer, R J; Suhr, J; Bieliauskas, L
Informational literature influences symptom expression following mild head injury: An analog study Journal Article
In: Brain Injury, vol. 29, no. 9, pp. 1051–1055, 2015.
Abstract | BibTeX | Tags: *Brain Injuries/di [Diagnosis], *Brain Injuries/px [Psychology], *Information Dissemination, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/px [Psychology], adult, Female, Health Communication, Humans, Language, Male, middle aged, Neuropsychological Tests, Post-Traumatic/di [Diagnosis], Stress Disorders, Veterans/px [Psychology], Young Adult
@article{Waldron-Perrine2015,
title = {Informational literature influences symptom expression following mild head injury: An analog study},
author = {Waldron-Perrine, B and Tree, H A and Spencer, R J and Suhr, J and Bieliauskas, L},
year = {2015},
date = {2015-01-01},
journal = {Brain Injury},
volume = {29},
number = {9},
pages = {1051--1055},
abstract = {PRIMARY OBJECTIVE: Many Veterans involved in recent OEF/OIF conflicts return with reports of having experienced an mTBI. The Veteran's Affairs (VA) and Department of Defense (DoD) have gone to great lengths to provide information to Veterans regarding possible effects of TBI. Although well intended, this information may possibly have an iatrogenic effect. Conversely, setting positive expectations for recovery from mTBI has been shown to result in decreased symptomatology. RESEARCH DESIGN: One-way ANOVA and Tukey post-hoc analyses were used to determine whether there were significant differences on reported severity and number of PCS symptoms (NSI) among the three experimental groups (recovery focused information; expectation for persistent symptoms; and no information given). METHODS AND PROCEDURES: Undergraduate students, who were told to imagine they had experienced a military-related TBI, reported varying levels of expected symptoms when given either positive or negative information about symptom expectation. MAIN OUTCOMES AND RESULTS: The results indicate that presenting recovery-oriented literature resulted in the lowest report of expected symptoms, whereas presenting no information resulted in the highest report of expected symptoms. CONCLUSIONS: Providing Veterans with information regarding a likely positive trajectory of recovery may result in less symptom persistence during rehabilitation.},
keywords = {*Brain Injuries/di [Diagnosis], *Brain Injuries/px [Psychology], *Information Dissemination, *Post-Concussion Syndrome/di [Diagnosis], *Post-Concussion Syndrome/px [Psychology], adult, Female, Health Communication, Humans, Language, Male, middle aged, Neuropsychological Tests, Post-Traumatic/di [Diagnosis], Stress Disorders, Veterans/px [Psychology], Young Adult},
pubstate = {published},
tppubtype = {article}
}