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181. Adverse events and blinding in two randomized trials of hyperbaric oxygen for persistent post-concussive symptoms. (Abstract)

Adverse events and blinding in two randomized trials of hyperbaric oxygen for persistent post-concussive symptoms. Safety monitoring and successful blinding are important features of randomized, blinded clinical trials. We report chamber- and protocol-related adverse events (AEs) for participants enrolled in two randomized, double-blind clinical trials of hyperbaric oxygen (HBO2) for persistent post-concussive symptoms clinicaltrials.gov identifiers NCT01306968, HOPPS, and NCT01611194, BIMA

2019 Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc Controlled trial quality: uncertain

182. Eye tracker outcomes in a randomized trial of 40 sessions of hyperbaric oxygen or sham in participants with persistent post concussive symptoms. (Abstract)

Eye tracker outcomes in a randomized trial of 40 sessions of hyperbaric oxygen or sham in participants with persistent post concussive symptoms. Eye movements may offer a sensitive method to measure response to intervention in mild traumatic brain injury (mTBI).The Brain Injury and Mechanisms of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury Study (BIMA) randomized 71 participants to 40 sessions of hyperbaric oxygen or sham. A companion

2019 Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc Controlled trial quality: uncertain

183. Comparison of Rest to Aerobic Exercise and Placebo-like Treatment of Acute Sport-Related Concussion in Male and Female Adolescents. (Abstract)

Comparison of Rest to Aerobic Exercise and Placebo-like Treatment of Acute Sport-Related Concussion in Male and Female Adolescents. To compare a sample of adolescents with sport-related concussion (SRC) who were prescribed rest with 2 arms of a randomized controlled trial comparing aerobic exercise with placebo-like stretching. We also compared sex differences across the 3 approaches to treatment.Quasi-experimental trial.University concussion management clinics.Adolescent athletes (aged 13-18

2019 Archives of physical medicine and rehabilitation Controlled trial quality: predicted high

184. Extended follow-up in a randomized trial of hyperbaric oxygen for persistent post-concussive symptoms. (Abstract)

Extended follow-up in a randomized trial of hyperbaric oxygen for persistent post-concussive symptoms. To date, several Department of Defense (DoD) and civilian studies have evaluated hyperbaric oxygen for mild forms of traumatic brain injury. Prior to the DoD-sponsored "Brain Injury and Mechanisms of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA)" trial, none included post-intervention follow-up beyond three to six months (...) . Post-hoc attempts at long-term follow-up were complicated by low participation and potential self-selection bias. BIMA planned for follow-up through 12 months but was amended to add post-concussive and post-traumatic stress disorder, quality of life, pain, depression, anxiety, and alcohol use assessments at 24 and 36 months. A total of 42 of 71 BIMA participants consented to extendedfollow-up, and 40 and 14 completed a 24- or 36-month visit, respectively, representing an overall response rate of 59

2019 Undersea & hyperbaric medicine : journal of the Undersea and Hyperbaric Medical Society, Inc Controlled trial quality: uncertain

185. Recommendations for the Emergency Department Prevention of Sport-Related Concussion. (Abstract)

Recommendations for the Emergency Department Prevention of Sport-Related Concussion. Sport-related concussion refers to the subset of concussive injuries occurring during sport activities. Similar to concussion from nonsport mechanisms, sport-related concussion is associated with significant morbidity, including migrainous headaches, disruption in normal daily activities, and long-term depression and cognitive deficits. Unlike nonsport concussions, sport-related concussion may be uniquely (...) amenable to prevention efforts to mitigate these problems. The emergency department (ED) visit for sport-related concussion represents an opportunity to reduce morbidity by timely diagnosis and management using best practices, and through education and counseling to prevent a subsequent sport-related concussion. This article provides recommendations to reduce sport-related concussion disability through primary, secondary, and tertiary preventive strategies enacted during the ED visit. Although many

2019 Annals of Emergency Medicine

186. Changes in volumetric and metabolic parameters relate to differences in exposure to sub-concussive head impacts. Full Text available with Trip Pro

Changes in volumetric and metabolic parameters relate to differences in exposure to sub-concussive head impacts. Structural and calibrated magnetic resonance imaging data were acquired on 44 collegiate football players prior to the season (PRE), following the first four weeks in-season (PTC) and one month after the last game (POST). Exposure data collected from g-Force accelerometers mounted to the helmet of each player were used to split participants into HIGH (N = 22) and LOW (N = 22 (...) ) exposure groups, based on the frequency of impacts sustained by each athlete. Significant decreases in grey-matter volume specific to the HIGH group were documented at POST (P = 0.009), compared to baseline. Changes in resting cerebral blood flow (CBF0), corrected for partial volume effects, were observed within the HIGH group, throughout the season (P < 0.0001), suggesting that alterations in perfusion may follow exposure to sub-concussive collisions. Co-localized significant increases in cerebral

2019 Journal of Cerebral Blood Flow and Metabolism

187. Outcomes after Concussion Recovery Education: Effects of Litigation and Disability Status on Maintenance of Symptoms. (Abstract)

Outcomes after Concussion Recovery Education: Effects of Litigation and Disability Status on Maintenance of Symptoms. This study examined the hypothesis that people who receive concussion recovery education would have better outcomes than those who received usual discharge paperwork from the emergency department (ED) and tested whether participants who were in litigation or seeking disability compensation had more symptoms than individuals not engaged in these activities. Two hundred and fifty (...) -five persons with a diagnosis of concussion were assigned randomly to a brief education group (one-page double-sided document), a longer education group (10-page document), and usual care (standard ED discharge instructions), and were these documents in the ED. A (non-concussion) trauma comparison group was enrolled to determine the symptom rate unrelated to brain injury. The Concussion Symptom Checklist (CSC) and litigation and disability status questions were completed by telephone at one week

2019 Journal of neurotrauma Controlled trial quality: uncertain

188. Effects of Media Sensationalization on Cognitive Performance and Post Concussive Symptoms. Full Text available with Trip Pro

Effects of Media Sensationalization on Cognitive Performance and Post Concussive Symptoms. The current study aimed to examine if televised media about mild traumatic brain injury (mTBI) framed in a sensationalized manner had a negative impact on cognitive functioning and persistent mTBI symptoms.One hundred two participants (M Age=37.16; SD=22.61) with a history of post-acute mTBI, recruited through a community research registry and an undergraduate recruitment system, were included (...) in this study. Participants were assessed with a measure of health literacy, the Short Test of Functional Health Literacy in Adults (S-TOFHLA), and randomized to watch either a sensationalized or non-sensationalized news clip focused on mTBI. They were then assessed with the Paced Auditory Serial Addition Test (PASAT), Rivermead Post Concussion Symptoms Questionnaire (RPQ), Patient Reported Outcome Measures Information System (PROMIS) Depression scale, and the Posttraumatic Stress Disorder Checklist

2019 Journal of the International Neuropsychological Society : JINS Controlled trial quality: uncertain

189. Specialized interdisciplinary rehabilitation reduces persistent post-concussive symptoms: a randomized clinical trial. (Abstract)

Specialized interdisciplinary rehabilitation reduces persistent post-concussive symptoms: a randomized clinical trial. To compare the effectiveness of a specialized, interdisciplinary rehabilitation (S-REHAB) with standard care (STAND) for people with persistent post-concussive symptoms (PPCS > 6 month).Randomized controlled trial.Eighty-nine adults.22-week programme combining individual and group-based neuropsychological treatment with exercise therapy and physiotherapeutic coaching (S-REHAB

2019 Brain Injury Controlled trial quality: uncertain

190. Brain vital signs detect concussion-related neurophysiological impairments in ice hockey. Full Text available with Trip Pro

Brain vital signs detect concussion-related neurophysiological impairments in ice hockey. There is a growing demand for objective evaluations of concussion. We developed a portable evoked potential framework to extract 'brain vital signs' using electroencephalography. Brain vital signs were derived from well established evoked responses representing auditory sensation (N100), basic attention (P300), and cognitive processing (N400) amplitudes and latencies, converted to normative metrics (six (...) total). The study evaluated whether concussion-related neurophysiological impairments were detected over the duration of ice hockey seasons using brain vital signs. Forty-seven Tier III, Junior A, male ice hockey players were monitored over two seasons. Twelve sustained concussions after baseline testing then completed post-injury and return-to-play assessments. Twenty-three were not diagnosed with a concussion during the season and completed both baseline and post-season testing. Scores were

2019 Brain

191. Parental concern about concussion risk for their children. (Abstract)

Parental concern about concussion risk for their children. Assess demographic patterns of parental concern or worry about concussion for their children; compare parent worry about concussion to worry about other health threats.Survey data were obtained using a probability-based nationally representative cross-sectional online survey of parents (n = 1025, 52% response rate). The association between family demographic characteristics and parent worry about concussion was assessed using (...) multivariate logistic regression. The extent to which parents were worried about concussion was compared to worry about 14 other pediatric health threats. Patterns of worry about all measured health threats were modeled using latent class analyses, with comparisons made by parent demographic characteristics.Around half of parents (51%) were worried about child's risk of concussion (responses of "very worried" or "somewhat worried"), statistically indistinguishable to the amount worried about risk of car

2019 Social Science & Medicine

192. Patterned Bruises From Abusive Squeezing. (Abstract)

Patterned Bruises From Abusive Squeezing. Bruising is the most common presentation of child physical abuse. Many patterns of abusive bruising result in positive or negative imprints of the implement used (eg, fingertips in "grab mark" contusions or hand in slap injury). However, bruising may also form along the lines of greatest anatomical stress (eg, gluteal cleft or pinna bruising). Bruising due to abusive squeezing also forms along lines of greatest anatomical stress, resulting in a negative (...) imprint of the flexural folds of the hand. Four cases of children with this unique pattern of bruising due to abusive squeezing are presented. Recognition of these bruises as inflicted represents an opportunity for early identification and intervention in cases of child physical abuse.

2019 Pediatric Emergency Care

193. Tibiofemoral bone bruise volume is not associated with meniscal injury and knee laxity in patients with anterior cruciate ligament rupture. (Abstract)

Tibiofemoral bone bruise volume is not associated with meniscal injury and knee laxity in patients with anterior cruciate ligament rupture. This study aimed at evaluating the association between the volume of the bone bruises and the magnitude of knee sagittal laxity and presence of meniscal injury in patients with anterior cruciate ligament (ACL) rupture. It was hypothesized that higher volumes of bone bruises will be associated with increased knee laxity and the presence of meniscal (...) injury.Patients with clinical diagnosis of ACL injury were referred for magnetic resonance imaging (MRI) and knee sagittal laxity measurement with a mechanical instrumented device (Porto-Knee Testing Device). The femoral and tibial bone bruises were assessed by MRI and the volume measured by manually contouring the bone bruise using a computerized software and computed by a mathematical algorithm combining all measured areas. The ACL rupture type (partial or total), meniscal tear (medial or lateral

2019 Knee Surgery, Sports Traumatology, Arthroscopy

194. Rest-Based Concussion Management of Pediatric Emergency Medicine Providers. (Abstract)

Rest-Based Concussion Management of Pediatric Emergency Medicine Providers. This study aimed to survey pediatric emergency medicine (PEM) providers on their management of 2 hypothetical acute concussion scenarios. We hypothesized that most providers would recommend a management strategy based on cognitive and physical rest.Fifty-nine percent (46/78) of PEM providers that were surveyed completed the study. The survey consisted of 2 clinical scenarios-a female patient with a mild concussion (...) and a male patient with a moderate concussion. Practitioners were asked questions regarding how they would hypothetically manage these patients in terms of recommendations for returning to school and returning to sports.Eighty-six percent of providers recommended moderate time off from school for the moderate concussion scenario compared with 67% of providers in the mild concussion scenario (P = 0.008). In regard to return to sports, all providers recommended moderate time off in both scenarios

2019 Pediatric Emergency Care

195. Prevalence of Concussion Among US Adolescents and Correlated Factors Full Text available with Trip Pro

Prevalence of Concussion Among US Adolescents and Correlated Factors 28973604 2017 10 19 2018 11 13 1538-3598 318 12 2017 09 26 JAMA JAMA Prevalence of Concussion Among US Adolescents and Correlated Factors. 1180-1182 10.1001/jama.2017.9087 Veliz Phil P Institute for Research on Women and Gender, University of Michigan, Ann Arbor. McCabe Sean E SE Institute for Research on Women and Gender, University of Michigan, Ann Arbor. Eckner James T JT Department of Physical Medicine and Rehabilitation (...) , University of Michigan, Ann Arbor. Schulenberg John E JE Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor. eng R01 DA001411 DA NIDA NIH HHS United States R01 CA203809 CA NCI NIH HHS United States K23 HD078502 HD NICHD NIH HHS United States R01 DA031160 DA NIDA NIH HHS United States L40 DA042452 DA NIDA NIH HHS United States Journal Article United States JAMA 7501160 0098-7484 AIM IM Adolescent Brain Concussion epidemiology Child Cross-Sectional Studies Female

2017 JAMA

196. Post-Concussion: Receded Near Point of Convergence is Not Diagnostic of Convergence Insufficiency. (Abstract)

Post-Concussion: Receded Near Point of Convergence is Not Diagnostic of Convergence Insufficiency. To determine the frequency of receded near point of convergence (NPC) in patients with chronic concussion-related symptoms, and among those with receded NPC to enumerate the frequency of convergence insufficiency and other oculomotor disorders.Design: Retrospective cross-sectional study METHODS: Clinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients <21 years (...) old who were >28 days post-concussion, had chronic concussion-related symptoms, had normal visual acuity, and received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined.Of the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only, 21 (28%) had convergence insufficiency and accommodation deficits, and 6 (8%) had convergence insufficiency only. Six (8

2019 American Journal of Ophthalmology

197. Concomitant anti-platelet therapy in warfarin-treated patients undergoing cardiac rhythm device implantation: A secondary analysis of the BRUISE CONTROL trial. (Abstract)

Concomitant anti-platelet therapy in warfarin-treated patients undergoing cardiac rhythm device implantation: A secondary analysis of the BRUISE CONTROL trial. Anti-platelet therapy is commonly used in patients receiving oral anticoagulation and may increase bleeding risk among patients undergoing cardiac implantable electronic device (CIED) surgery. We sought to determine the proportion of anticoagulated patients who are concomitantly receiving anti-platelet therapy, the associated risk (...) of clinically significant hematoma (CSH), and the proportion of patients in whom anti-platelet usage is guideline-indicated.A secondary analysis of the Bridge or Continue Coumadin for Device Surgery Randomized Controlled Trial (BRUISE CONTROL). Patients who were receiving warfarin, had an annual predicted risk of thromboembolism of ≥5% and were scheduled to undergo non-emergent CIED surgery were randomized to continued warfarin versus heparin bridging. In the current analysis, patients were divided

2019 International journal of cardiology Controlled trial quality: predicted high

198. Low Usage of Analgesics for Pediatric Concussion-Related Pain in US Emergency Departments Between 2007 and 2015. (Abstract)

Low Usage of Analgesics for Pediatric Concussion-Related Pain in US Emergency Departments Between 2007 and 2015. To estimate the proportion of pediatric patients with a concussion who received analgesia when presenting with pain to US emergency departments, and to describe the analgesics used.This was a repeated cross-sectional analysis study using the National Hospital Ambulatory Medical Care Survey database of nationally representative emergency department visits from 2007 to 2015. We (...) included children under 18 years old with isolated concussions. Survey weighting procedures were applied to generate population-level estimates and to perform multivariable logistic regression to identify factors associated with analgesic administration.There were an estimated 1.54 million isolated concussion visits during the 9-year study period. Pain at presentation was reported frequently (78%), with the majority rated as moderate (36%) or severe (27%). Among all children reporting pain, 42

2019 Journal of Pediatrics

199. Description of the predictors of persistent post-concussion symptoms and disability after mild traumatic brain injury: the SHEFBIT cohort. (Abstract)

Description of the predictors of persistent post-concussion symptoms and disability after mild traumatic brain injury: the SHEFBIT cohort. Several patients who suffer Mild Traumatic Brain Injury (mTBI) develop Persistent Post-Concussion Symptoms (PPCS) and long-term disability. Current prognostic models for mTBI have a large unexplained variance, which limits their use in a clinical setting.This study aimed to identify background demographics and mTBI details that are associated with PPCS (...) and long-term disability.Patients from the SHEFfield Brain Injury after Trauma (SHEFBIT) cohort with mTBI in the Emergency Department (ED) were analysed as part of the study. PPCS and long-term disability were measured using the Rivermead Post-Concussion Questionnaire and the Rivermead Post-Injury Follow-up Questionnaire respectively, during follow up brain injury clinics.A representative mTBI sample of 647 patients was recruited with a follow-up rate of 89%. Non-attenders were older (p < 0.001

2019 British Journal of Neurosurgery

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

Concussion and Academic Impairment Among U.S. High School Students. Sports and physical activities are a frequent cause of traumatic brain injury, primarily concussions, among adolescents. These concussions may adversely affect students' ability to learn and impair academic achievement in educational settings.The 2017 Youth Risk Behavior Survey, conducted among a nationally representative sample of 14,765 U.S. high school students, was analyzed in 2018 to examine associations between self (...) -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

2019 American journal of preventive medicine

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