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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. Contact Sports-related Concussion in Amateur Athletes, Primary Prevention of

, 2018 Correspondence to: Dr Toby M Enniss, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; Abstract Background Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years. Our objective is to conduct a prospectively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions. Methods Using the Grading of Recommendations Assessment, Development (...) (EAST) conducted a systematic review of the evidence addressing prevention of contact sports-related concussions. Our seven questions were formulated a priori in the PICO format (patient population, intervention, comparator, and outcome) per the GRADE methodology over three rounds using a modified Delphi method. This systematic review was prospectively registered with PROSPERO (#42016043019). Identification of references The literature search was performed by a university-affiliated research

2018 Eastern Association for the Surgery of Trauma

3. 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

4. Concussion in adolescent rugby union players: comprehensive acute assessment protocol and development of the SSC concussion passport to monitor long-term health (PubMed)

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

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2018 BMJ Open Sport — Exercise Medicine

5. Graded Exercise Testing Predicts Recovery Trajectory of Concussion in Children and Adolescents. (PubMed)

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

6. Light Physical Activity and Improving Symptoms of Sport-Related Concussions in Pediatrics

Light Physical Activity and Improving Symptoms of Sport-Related Concussions in Pediatrics "Light Physical Activity and Improving Symptoms of Sport-Related Concus" by Brittany Wilson and Kai Dechape < > > > > > Title Author Date of Graduation Summer 8-12-2017 Degree Type Capstone Project Rights . Abstract Background: The current guidelines for managing a sport-related concussion include physical and cognitive rest until acute symptoms resolve, followed by a graded program of exertion before (...) modality for children and adolescents who are slow to recover from a sport-related concussion. Methods: An exhaustive literature search using MEDLINE-Ovid, MEDLINE-PubMed, Web of Science, and Google Scholar was conducted using keywords: brain concussion and exercise therapy . Articles were screened with eligibility criteria and the resulting studies were then appraised and assessed for quality with GRADE. Results: Two pilot studies were included in this systematic review that met the inclusion criteria

2017 Pacific University EBM Capstone Project

7. 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

8. Use of Graded Exercise Testing in Concussion and Return-to-Activity Management. (PubMed)

Use of Graded Exercise Testing in Concussion and Return-to-Activity Management. Concussion is a physiologic brain injury that produces systemic and cognitive symptoms. The metabolic and physiologic changes of concussion result in altered autonomic function and control of cerebral blood flow. Evaluation and treatment approaches based upon the physiology of concussion may therefore add a new dimension to concussion care. In this article, we discuss the use of a standard treadmill test (...) , the Buffalo Concussion Treadmill Test (BCTT), in acute concussion and in postconcussion syndrome (PCS). The BCTT has been shown to diagnose physiologic dysfunction in concussion safely and reliably, differentiate it from other diagnoses (e.g., cervical injury), and quantify the clinical severity and exercise capacity of concussed patients. It is used in PCS to establish a safe aerobic exercise treatment program to help speed recovery and return to activity. The use of a provocative exercise test

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2017 Current Sports Medicine Reports

9. Do we need to reframe our narrative regarding concussion to avoid the mistakes we made with chronic lower back pain?

Do we need to reframe our narrative regarding concussion to avoid the mistakes we made with chronic lower back pain? Do we need to reframe our narrative regarding concussion to avoid the mistakes we made with chronic lower back pain? | BJSM blog - social media's leading SEM voice by By Myles Murphy Sport-related concussion (SRC) has drawn a substantial level of media attention and is a significant concern for health-care professionals and athletes. While the decision to retire based (...) on a history of multiple concussions is complex, 1 as the stigma grows around concussion history and potential long-term brain health deterioration, anecdotal evidence suggests that every year more professional athletes have retired from competition due to concerns pertaining to this issue. All elite level sports have guidelines for SRC, with clear procedures in place to inform practice and assist decision making for treating clinicians. 2-5 Fear and concern related to the risk of suffering head impacts

2019 British Journal of Sports Medicine Blog

10. Academic outcomes following adolescent sport-related concussion or fracture injury: A prospective cohort study. (PubMed)

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.

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2019 PLoS ONE

11. Updated guidelines for the management of sports-related concussion in general practice

pathologies (particularly structural head injury), recognising the presence of any modifying factors (which may increase the risk of complications) and determining when the patient can safely return to competition. The key components of safe return-to-play decisions include rest, neuropsychological testing and a graded program of exertion before return to sport. Keywords brain injuries; central nervous system diseases; brain concussion; sports medicine Concussion is a common problem in many sports (...) as a ‘complex pathophysiological process affecting the brain, induced by biomechanical forces’. 8 It is characterised by a graded set of neurological symptoms and signs that typically arise rapidly and resolve spontaneously over a sequential course. The process of recovery, however, varies from person to person and injury to injury. The pathophysiology of concussion is not well understood. The current consensus is that the injury reflects a physiological disturbance (eg. neurochemical, metabolic or gene

2014 Clinical Practice Guidelines Portal

12. Pilot single-centre cross-sectional study to determine emergency physicians’ knowledge and management of sports concussion: an experience from Singapore (PubMed)

that loss of consciousness was not essential for diagnosis and only 24 (46.2%) knew the most common symptom. 26 (50.0%) incorrectly reported that they would perform brain imaging. Among those who indicated onward referral, 29 (55.8%) would refer concussed patients to neurosurgery. There were no significant differences between clinical grade or training in concussion and positive responses for definition, imaging modality or most common symptom of concussion.Concussion is a common presentation to EDs (...) Pilot single-centre cross-sectional study to determine emergency physicians’ knowledge and management of sports concussion: an experience from Singapore Sports concussion remains challenging to manage despite changes to policy and practice since the 2012 International Consensus Conference on Concussion in Sport. Emergency physicians (EPs) are usually the first line of medical care for athletes in amateur and youth collision sports. This single-centre cross-sectional study aimed to establish

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2018 Singapore medical journal

13. Primary prevention of contact sports-related concussions in amateur athletes: a systematic review from the Eastern Association for the Surgery of Trauma (PubMed)

Primary prevention of contact sports-related concussions in amateur athletes: a systematic review from the Eastern Association for the Surgery of Trauma Awareness of the magnitude of contact sports-related concussions has risen exponentially in recent years. Our objective is to conduct a prospectively registered systematic review of the scientific evidence regarding interventions to prevent contact sports-related concussions.Using the Grading of Recommendations Assessment, Development (...) , and Evaluation methodology, we performed a systematic review of the literature to answer seven population, intervention, comparator, and outcomes (PICO) questions regarding concussion education, head protective equipment, rules prohibiting high-risk activity and neck strengthening exercise for prevention of contact sports-related concussion in pediatric and adult amateur athletes. A query of MEDLINE, PubMed, Scopus, Cumulative Index of Nursing and Allied Health Literature, and Embase was performed. Letters

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2018 Trauma Surgery & Acute Care Open

14. Self-Reported Concussions from Playing a Sport or Being Physically Active Among High School Students — United States, 2017 (PubMed)

Behavior Survey (YRBS). Overall, 15.1% of students (approximately 2.5 million*) reported having at least one of these concussions during the 12 months before the survey, and 6.0% reported two or more concussions. Concussion prevalence was significantly higher among male students than among female students and among students who played on a sports team than among students who did not. Among all sex, grade, and racial/ethnic subgroups, the odds of reporting a concussion increased significantly (...) Self-Reported Concussions from Playing a Sport or Being Physically Active Among High School Students — United States, 2017 Increased susceptibility to concussions and longer recovery times among high school athletes compared with older athletes (1) make concussions among youths playing a sport or being physically active an area of concern. Short-term and long-term sequelae of concussions can include cognitive, affective, and behavioral changes (1). Surveillance methods used to monitor

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2018 Morbidity and Mortality Weekly Report

15. Myelin Imaging in Concussed High School Football Players

age (9th-12th grade), male, right-handed Diagnosed with concussion or mild traumatic brain injury Criteria Inclusion Criteria: Experimental Group Patient age range: 9th through 12th grade (high school) Male Right-handed Diagnosis of mTBI or concussion during a football game or training No significant co-morbidities Able to get an MRI Potential subject must be capable of giving informed consent or assent when applicable • Control Group Patient age range: 9th through 12th grade (high school) Male (...) Myelin Imaging in Concussed High School Football Players Myelin Imaging in Concussed High School Football Players - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Myelin Imaging in Concussed High School

2018 Clinical Trials

16. rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head

rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number (...) of saved studies (100). Please remove one or more studies before adding more. rTMS Treatment of Persistent Headache and Post Concussion Symptoms Attributed to Mild Traumatic Injury to the Head (TOPiCS-rTMS) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03691272 Recruitment Status : Active

2018 Clinical Trials

17. Using sideline concussion tests in the emergency department (PubMed)

Using sideline concussion tests in the emergency department Traumatic brain injury (TBI) is a significant cause of death and disability in the United States. Many patients with TBI are initially treated in the emergency department (ED), but there is no evidence-based method of detecting or grading TBI in patients who have normal structural neuroimaging. This study aims to evaluate the validity of two common sideline concussion tests. The Concussion Symptom Severity Score (CSSS) and modified (...) Balance Error Scoring System (mBESS) tests are well-validated sideline tests for concussion, but have not been validated in the setting of non-sport-related concussion, in settings other than the sideline or athletic training room or in moderate or severe TBI.One hundred forty-eight subjects who had sustained a TBI within the previous 72 hours and 53 healthy control subjects were enrolled. CSSS and mBESS were administered. Clinical outcomes were followed up prospectively.The CSSS was collected in 147

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2018 Open access emergency medicine : OAEM

18. Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants. (PubMed)

˙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

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2018 Journal of athletic training Controlled trial quality: uncertain

19. The effect of concussion or mild traumatic brain injury on academic outcomes: A systematic review. (PubMed)

concerning the effects of concussion or mild traumatic brain injury (mTBI) on academic outcomes. MEDLINE, Embase, Scopus, and CINAHL were searched until June 1, 2016. Studies must have been primary literature examining students enrolled in primary, secondary, or post-secondary education, have received a physician diagnosis of concussion or mTBI, and have post-injury academic outcomes assessed in numeric or alphabet grade/grade point average (GPA), school attendance records, or national examination scores (...) . Data were extracted and checked by a second reviewer for accuracy and completeness. Nine studies were included. Among four studies that examined grades, one found a significant difference in pre- and post-grades only in the subject Afrikaans. Three examined national test scores and no significant differences were found between cases and controls. Four examined school absenteeism and found that students who developed post-concussion syndrome missed significantly more school days and took longer

2017 Journal of neurotrauma

20. Symptom-Guided Emergency Department Discharge Instructions for Children With Concussion. (PubMed)

Symptom-Guided Emergency Department Discharge Instructions for Children With Concussion. The objective was to evaluate the use and utility of a novel set of emergency department discharge instructions (DIs) for concussion based on a child's ongoing symptoms: symptom-guided DIs (symptom DIs). Differences in clinical outcomes were also assessed.A convenience sample of 114 children aged 7 to 17 years presenting to an urban pediatric emergency department with a complaint of concussion was assembled (...) . Children were randomized to standard DIs or symptom DIs. Children completed a graded symptom checklist (GSC) and completed daily the GSC for 1 week. Telephone follow-up was performed at 7 days after enrollment using a standardized survey.Fifty-eight children received the symptom DIs, and 56 received the standard DIs. Rates of use were similar with reported rates of 92% for symptom DIs and 84% for standard DIs. Caregivers with symptom DIs reported that the DIs were more helpful in determining when

2017 Pediatric Emergency Care

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