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Concussion Grading

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1. Guidelines for diagnosing and managing pediatric concussion

. Levels of Evidence Levels of evidence are used to guide the reader as to the strength of the individual recommendation. There are many ways to grade levels of evidence. Some emphasize the quality of randomized clinical trials. However, because so few randomized clinical trials have studied pediatric concussion, we used a broader system to rank evidence that also emphasizes the strength of systematic reviews or large studies that may not involve interventions. In our system, A is the strongest level (...) ://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=sort. Accessed May 8, 2014. 2 Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69(3):548-56. Chapter: Tipsheet Guidelines for Diagnosing and Managing Pediatric Concussion 3 Tipsheet / List of Tools Tipsheet for Health Care Professionals In Advance (before the first activity) Number Evidence 0.4 Consider baseline neuro-cognitive testing

2019 CPG Infobase

2. Living Guideline for Diagnosing and Managing Pediatric Concussion

Living Guideline for Diagnosing and Managing Pediatric Concussion LIVING GUIDELINE FOR DIAGNOSING AND MANAGING PEDIATRIC CONCUSSION Reed, N.*, Zemek, R.*, Dawson, J., Ledoux, AA., et al. (2019). Living Guideline for Diagnosing and Managing Pediatric Concussion. Toronto, ON: Ontario Neurotrauma Foundation * These authors contributed equally. 1 Guideline for Diagnosing and Managing Pediatric Concussion – Recommendations / Tools TABLE OF CONTENTS Disclaimer…………………………………………………………………………. 2 Guideline (...) Overview……………………………………………………… 3 List of Recommendations……………………………………………….. 4 Recommendations……………………………………………….………….. 12 List of Tools……….…………………………………….……………………….. 55 References……………………………………………………………………….. 56 2 Guideline for Diagnosing and Managing Pediatric Concussion – Recommendations / Tools DISCLAIMER: The recommendations and resources found within the Living Guideline for Diagnosing and Managing Pediatric Concussion are intended to inform and instruct care providers and other stakeholders who

2019 Ontario Neurotrauma Foundation

3. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Fatigue

Guideline for concussion/mild traumatic brain injury & persistent symptoms - Fatigue Fatigue // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age Fatigue Fatigue has been conceptualized as an experience of weariness or tiredness following mental or physical exertion, often resulting in a reduced capacity for work and limited efficiency (...) to respond to stimuli. Fatigue can be caused by psychological or physiological forces 1 and can be central or peripheral, which in lay terms is experienced as cognitive fatigue and physical fatigue or weariness. 2-4 Fatigue is one of the most pervasive symptoms following concussion/mTBI, with 27.8% of individuals experiencing persistent fatigue at 3 months post-injury. 5 The perception of fatigue can be out of proportion to exertion or may even occur without any exertion. 6 One study reported a level

2018 Ontario Neurotrauma Foundation

4. Guideline for concussion/mild traumatic brain injury & persistent symptoms - General Recommendations Regarding Management of Persistent Symptoms

Guideline for concussion/mild traumatic brain injury & persistent symptoms - General Recommendations Regarding Management of Persistent Symptoms General Recommendations Regarding Management of Persistent Symptoms // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age General Recommendations Regarding Management of Persistent Symptoms (...) Consistent with general expectations of both patients and healthcare professionals, symptoms following mTBI are anticipated to resolve in a timely fashion in the majority of cases; evidence is emerging that some people (15% or greater) continue to have persistent symptoms. 1-3 There is wide variation in how people recover after concussion/mTBI 4 even when experiencing similar injuries. 2 This guideline has been developed to assist in managing those individuals who continue to have persistent symptoms

2018 Ontario Neurotrauma Foundation

5. Guideline for concussion/mild traumatic brain injury & persistent symptoms - Return-to-Activity / Work / School Considerations

). 12.4 C If a person’s normal activity involves significant physical activity and there are concerns about resuming daily activities, exertion testing can be conducted that includes stressing the body (e.g., graded treadmill exercise test). If exertion testing results in symptoms, the symptom threshold should be identified and a progressive return to activity based on sub-symptom threshold activities should be encouraged. Adapted from the VA/DoD Management of Concussion/Mild Traumatic Brain Injury (...) the student’s courses to audit status, allowing them to participate in some academic activity without significant pressure from course requirements and examination. Review whether the student should continue in the program for that term if there will be substantially negative consequences to their grades and program participation. Community Re-Integration and Future Vocational Planning New Key Section Level of evidence A B C Updated Evidence 12.9 B When persistent post-concussive symptoms impede return

2018 Ontario Neurotrauma Foundation

6. Guideline for concussion/mild traumatic brain injury & persistent symptoms - General Recommendations Regarding Diagnosis/Assessment of Persistent Symptoms

. Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome. Rehabil Res Pract. 2012;2012:705309. Country: USA Design: Retrospective Chart Review Quality Rating: DOWNS & BLACK: 14/32 *4 of the sections were not applicable Leddy J, Hinds A, Sirica D, Willer B. The Role of Controlled Exercise in Concussion Management. PM R. 2016;8(3 Suppl):S91-S100. Country: USA Design: Discussion/Review Article Quality Rating: N/A *No checklists were (...) Guideline for concussion/mild traumatic brain injury & persistent symptoms - General Recommendations Regarding Diagnosis/Assessment of Persistent Symptoms General Recommendations Regarding Diagnosis/Assessment of Persistent Symptoms // Brain Injury Guidelines Toggle navigation NAVIGATION > > > > > > > > > > > > > > > > > > Guideline For Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition, for Adults over 18 years of age General Recommendations Regarding Diagnosis/Assessment

2018 Ontario Neurotrauma Foundation

7. Bruising

in developing and updating this topic. Further details on the full process can be found in the section and on the website. Search strategy Scope of search A literature search was conducted for guidelines, systematic reviews and randomized controlled trials on primary care management of bruising and purpura. Search dates November 2010 - March 2016 Key search terms Various combinations of searches were carried out. The terms listed below are the core search terms that were used for Medline. exp Contusions (...) Bruising Prodigy Toggle navigation Topics Specialities A B C D E F G H I J K L M N O P Q R S T U V W X Y Z Allergies Cancer Cardiovascular Child health Drugs and devices Ear, nose and throat Endocrine and metabolic Eyes Gastroenterology Gastrointestinal Haematology Immunizations Infections and infestations Injuries Kidney disease and urology Men's health Mental health Musculoskeletal Neurological Oral health Palliative care Poisoning Pregnancy Preventative medicine Respiratory Sexual health

2017 Prodigy

8. Concussion Grading

Concussion Grading Concussion Grading Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Concussion Grading Concussion Grading Aka (...) : Concussion Grading , Grade 1 Concussion , Grade 2 Concussion , Grade 3 Concussion From Related Chapters II. Grading Grade 1 Concussion ("Ding" ) Confusion symptoms resolve within 15 minutes No Loss of Consciousness Grade 2 Concussion Confusion symptoms persist beyond 15 minutes No Loss of Consciousness Grade 3 Concussion Confusion symptoms persist beyond 15 minutes Any Loss of Consciousness Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search

2018 FP Notebook

9. Concussion in adolescent rugby union players: comprehensive acute assessment protocol and development of the SSC concussion passport to monitor long-term health Full Text available with Trip Pro

Concussion in adolescent rugby union players: comprehensive acute assessment protocol and development of the SSC concussion passport to monitor long-term health Sports-related concussion (SRC) can be challenging to diagnose, assess and manage. Much of the SRC research is conducted on adults. The assessment of SRC should aim to identify deficits using a detailed multimodal assessment; however, most studies investigating the effects of SRC use diagnostic tools in isolation. It is likely (...) that a combination of diagnostic tests will improve diagnostic accuracy. In this study, we aim to investigate how concussion affects adolescent rugby players and how a variety of diagnostic tools interact with each other as participants recover from their injury. The study will also determine the logistics of recording an individual's concussion history on a virtual 'Concussion Passport' that would remain with the individual throughout their sporting career to allow monitoring of long-term health.All rugby

2018 BMJ Open Sport — Exercise Medicine

10. Creation of an intramedullary cavity by hemorrhagic necrosis removal 24 h after spinal cord contusion in rats for eventual intralesional implantation of restorative materials. Full Text available with Trip Pro

. Removal of hemorrhagic necrosis has been attempted before with variable results. The invasive nature of these procedures carries the risk of exacerbating damage to the injured cord. The overall objective for this study was to test several strategies for non-damaging removal of hemorrhagic necrosis and characterize the resulting cavity looking for a space for future intralesional therapeutic implants in rats with acute cord injury. Rats were subjected to graded cord contusion, and hemorrhagic necrosis (...) Creation of an intramedullary cavity by hemorrhagic necrosis removal 24 h after spinal cord contusion in rats for eventual intralesional implantation of restorative materials. Intramedullary hemorrhagic necrosis occurs early after spinal cord injury at the site of injury and adjacent segments. It is considered harmful because of its potential to aggravate secondary injury, and to interfere with axonal regeneration; it might also lead to an unfavorable environment for intralesional implants

2017 PLoS ONE

11. Graded Exercise Testing Predicts Recovery Trajectory of Concussion in Children and Adolescents. (Abstract)

Graded Exercise Testing Predicts Recovery Trajectory of Concussion in Children and Adolescents. To determine whether graded exercise testing can predict recovery trajectory of concussion in children and adolescents.Prospective study.Children's Hospital, Westmead, Australia.One hundred thirty-nine children aged 12 to 16 years at 5 to 7 days after an acute concussive injury.Graded exercise testing on a treadmill at the subacute phase to assess symptom provocation and determine clinical recovery (...) indicating readiness to commence a return to activity (RTA) protocol. Exercise time to symptom exacerbation and clinical recovery were measured.Standard concussion assessment and clinical testing (neurocognitive, vestibular/ocular, and balance) were conducted to determine major clinical drivers/indicators.Participants (mean age 12.4 ± 2.8 years, 73% male) had a confirmed sport-related concussion. The main clinical drivers identified on exercise testing were headache, balance, and vestibular dysfunction

2018 Clinical Journal of Sport Medicine

12. Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury

be contributing to symptoms. Autonomic/Exertional T olerance Impairments B Physical therapists should test for orthostatic hypoten- sion and autonomic dysfunction (eg, resting and postural tachycardia or fast rise in heart rate with positional changes) by evaluating heart rate and blood pressure in supine, sitting, and standing positions. B Physical therapists should conduct a symptom-guided, graded exertional tolerance test for patients who have expe- rienced a concussive event and report exertional (...) Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury Clinical Practice Guidelines CATHERINE C. QUATMAN-YATES, PT , DPT , PhD • AIRELLE HUNTER-GIORDANO, PT , DPT KATHY K. SHIMAMURA, PT , DPT , NCS, OCS, CSCS, FAAOMPT • ROB LANDEL, PT , DPT , FAPTA BARA A. ALSALAHEEN, PT , PhD • TIMOTHY A. HANKE, PT , PhD • KAREN L. McCULLOCH, PT , PhD, FAPTA Physical Therapy Evaluation and Treatment After Concussion/ Mild Traumatic Brain Injury Clinical Practice Guidelines

2020 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

13. Pulmonary Contusion and Flail Chest, Management of

but probably has global pulmonary and systemic effects relating to cytokine expression and immunosuppression when occurring in a sufficient portion of the lung. [56–59] summarizes the reported physiologic effects of lung contusion. Reviewed literature is graded and summarized in the evidentiary tables. Outcome Numerous studies have addressed the outcome of PC-FC but have had difficulty in separating the effects of the chest wall and parenchymal components. [60–63] In terms of mortality, it remains (...) Pulmonary Contusion and Flail Chest, Management of Pulmonary Contusion and Flail Chest, Management of - Practice Management Guideline Search » Pulmonary Contusion and Flail Chest, Management of Published 2012 Citation: Authors Simon, Bruce MD; Ebert, James MD; Bokhari, Faran MD; Capella, Jeannette MD; Emhoff, Timothy MD; Hayward, Thomas III MD; Rodriguez, Aurelio MD; Smith, Lou MD Author Information From the Division of Trauma and Critical Care (B.S., T.E.), University of Massachusetts Medical

2012 Eastern Association for the Surgery of Trauma

14. Normobaric hyperoxia does not improve derangements in diffusion tensor imaging found distant from visible contusions following acute traumatic brain injury Full Text available with Trip Pro

Normobaric hyperoxia does not improve derangements in diffusion tensor imaging found distant from visible contusions following acute traumatic brain injury We have previously shown that normobaric hyperoxia may benefit peri-lesional brain and white matter following traumatic brain injury (TBI). This study examined the impact of brief exposure to hyperoxia using diffusion tensor imaging (DTI) to identify axonal injury distant from contusions. Fourteen patients with acute moderate/severe TBI (...) underwent baseline DTI and following one hour of 80% oxygen. Thirty-two controls underwent DTI, with 6 undergoing imaging following graded exposure to oxygen. Visible lesions were excluded and data compared with controls. We used the 99% prediction interval (PI) for zero change from historical control reproducibility measurements to demonstrate significant change following hyperoxia. Following hyperoxia DTI was unchanged in controls. In patients following hyperoxia, mean diffusivity (MD) was unchanged

2017 Scientific reports

15. A Tissue Displacement-based Contusive Spinal Cord Injury Model in Mice Full Text available with Trip Pro

introduce a novel mouse contusive SCI device, the Louisville Injury System Apparatus (LISA) impactor, which can create a displacement-based SCI with high injury velocity and accuracy. This system utilizes laser distance sensors combined with advanced software to produce graded and highly-reproducible injuries. We performed a contusive SCI at the 10th thoracic vertebral (T10) level in mice to demonstrate the step-by-step procedure. The model can also be applied to the cervical and lumbar spinal levels. (...) A Tissue Displacement-based Contusive Spinal Cord Injury Model in Mice Producing a consistent and reproducible contusive spinal cord injury (SCI) is critical to minimizing behavioral and histological variabilities between experimental animals. Several contusive SCI models have been developed to produce injuries using different mechanisms. The severity of the SCI is based on the height that a given weight is dropped, the injury force, or the spinal cord displacement. In the current study, we

2017 Journal of visualized experiments : JoVE

16. Academic outcomes following adolescent sport-related concussion or fracture injury: A prospective cohort study. Full Text available with Trip Pro

Academic outcomes following adolescent sport-related concussion or fracture injury: A prospective cohort study. The objectives were 1) to compare the effects of adolescent sport-related concussion (SRC) and sport-related extremity fracture (SRF) on academic outcomes including change in school grades and school attendance; and 2) to determine which specific academic accommodations were most helpful during recovery from these injuries.A prospective cohort study was conducted to compare changes (...) an SRC miss significantly more days of school but demonstrate similar changes in school grades post-injury compared to those with an SRF. Future studies are needed to identify the pre- and post-injury factors associated with poor academic functioning following concussion and identify measures that can be taken to help optimize academic outcomes in these patients.

2019 PLoS ONE

17. Management of Concussion-mild Traumatic Brain Injury (mTBI)

and Assessment 43 B. Treatment 43 C. Care Delivery 43 Appendix A: Guideline Development Methodology 44 A. Developing the Scope and Key Questions 44 B. Conducting the Systematic Review 45 C. Convening the Face-to-face Meeting 72 D. Grading Recommendations 72 VA/DoD Clinical Practice Guideline for the Management of Concussion-mild Traumatic Brain Injury February 2016 Page 4 of 133 E. Recommendation Categorization 75 F. Drafting and Submitting the Final CPG 77 Appendix B: Clinical Symptom Management 79 (...) /multidisciplinary teams in the management of patients with chronic symptoms attributed to mTBI. N/A Reviewed, New-replaced *For additional information, please refer to Grading Recommendations. †For additional information, please refer to Recommendation Categorization and Appendix E: 2009 Recommendation Categorization. VA/DoD Clinical Practice Guideline for the Management of Concussion-mild Traumatic Brain Injury February 2016 Page 22 of 133 A. Diagnosis and Assessment Recommendation 1. We suggest using

2016 VA/DoD Clinical Practice Guidelines

18. Posterior tibial bone bruising associated with posterior-medial meniscal tear in patients with acute anterior cruciate ligament injury. (Abstract)

that had a postero-medial meniscal tear in the setting of an acute ACL injury (p = 0.046). MTP Grade 2 or 3 bone bruising was more common in patients that had a postero-medial meniscal tear (p = 0.046). There was a slightly higher incidence of grade 2 or 3 MTP bone bruising in cases with a postero-medial meniscal tear, although this did not reach statistical significance (n.s.) There was no difference in LFC, LTP or MFC bone bruising in patients with or without a postero-medial meniscal tear (n.s (...) Posterior tibial bone bruising associated with posterior-medial meniscal tear in patients with acute anterior cruciate ligament injury. To evaluate whether medial-sided bone bruising was associated with postero-medial meniscal tears in patients with an acute rupture of their anterior cruciate ligament (ACL).A retrospective analysis of 150 consecutive patients who had an MRI scan within 8 weeks of their ACL rupture that underwent an ACL reconstruction was performed. Based on the intra-operative

2019 Knee Surgery, Sports Traumatology, Arthroscopy

19. Concussion and Academic Impairment Among U.S. High School Students. (Abstract)

-reported sports- and physical activity-related concussions and symptoms of cognitive impairment (difficulty concentrating, remembering, or making decisions) and self-reported academic grades (mostly A's=4.0, mostly B's=3.0, mostly C's=2.0, mostly D's=1.0, mostly F's=0.0). Adjusted prevalence ratio and the difference in self-reported estimated grade point average were adjusted for sex, race/ethnicity, grade, and athlete status (participation on sports teams) and considered statistically significant if p (...) prevalence ratio=1.37), athletes (adjusted prevalence ratio=1.45), or nonathletes (adjusted prevalence ratio=1.42). Self-reported grade point averagedecreased significantly from 3.14 among students who reported no concussions (referent), to 3.04 among students who reported a single concussion, and 2.81 among students who reported ≥2 concussions.School-based programs are needed to monitor students' academic performance and provide educational support and resources to promote academic success following

2019 American journal of preventive medicine

20. Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants. Full Text available with Trip Pro

˙o2max) across test sessions, while the nontraining group received no intervention.The CNS Vital Signs standardized scores, Vestibular/Ocular Motor Screening near-point convergence distance (cm), and Graded Symptom Checklist, Balance Error Scoring System, and Standardized Assessment of Concussion total scores.An interaction effect was found for total symptom score ( P = .01); the intervention group had improved symptom scores between sessions (session 1: 5.1 ± 5.8; session 2: 1.9 ± 3.6). Cognitive (...) Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants. Aerobic exercise interventions are increasingly being prescribed for concussion rehabilitation, but whether aerobic training protocols influence clinical concussion diagnosis and management assessments is unknown.To investigate the effects of a brief aerobic exercise intervention on clinical concussion outcomes in healthy, active participants.Randomized controlled

2018 Journal of athletic training Controlled trial quality: uncertain

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