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281. Unexpected Diagnosis in an Adolescent With Bruises and Ecchymosis: Celiac Disease. (Abstract)

Unexpected Diagnosis in an Adolescent With Bruises and Ecchymosis: Celiac Disease. Acquired coagulopathy is a rare but challenging diagnosis for pediatric emergency physicians. Although the coagulopathy usually presents with mild skin and mucosal hemorrhages, it also can lead to life-threatening events. Thus, accurate interpretation of hints obtained from a detailed history, physical examination, and laboratory findings is essential for the prompt diagnosis and management. This case (...) demonstrates an uncommon cause of coagulopathy; celiac disease that presented with spontaneous bruises and ecchymosis in an adolescent.

2018 Pediatric Emergency Care

282. Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada. Full Text available with Trip Pro

Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada. To examine the association between meeting physical activity (PA) volume recommendations and concussion rates in male ice hockey players aged 11-17 years.Pooled prospective injury surveillance cohort data from the 2011-2012, 2013-2014 and 2014-2015 youth ice hockey seasons.Male Alberta-based Pee Wee (aged 11-12 years), Bantam (aged 13-14 years) and Midget (aged 15-17 (...)  years) ice hockey players participating in any of the three cohorts were eligible (n=1726). A total of 1208 players were included after the exclusion criteria were applied (ie, players with new/unhealed injuries within 6 weeks of study entry, missing 6-week PA history questionnaires, missing game and/or practice participation exposure hours, players who sustained concussions when no participation exposure hours were collected).Dependent variable: medically diagnosed concussion. Independent variable

2018 BMJ open

283. No association between metoclopramide treatment in ED and reduced risk of post-concussion headache. (Abstract)

No association between metoclopramide treatment in ED and reduced risk of post-concussion headache. There is a lack of definitive pediatric literature on effective pharmacotherapy for persistent post-concussion headache symptoms. This study assessed whether acute metoclopramide treatment in the Emergency Department (ED) was associated with a reduction in persistent headache in children at 1- and 4-weeks post-concussion.Children aged 8-17years with acute concussion presenting to 9-Canadian (...) Pediatric EDs were enrolled in a prospective cohort study, from August 2013-June 2015. Primary and secondary outcomes were persistent headache at 1- and 4-week post-injury respectively. Headache persistence was based on the one and four-week headache scores minus recalled pre-injury score using the Post-Concussion Symptom Inventory. The association between metoclopramide and headache persistence at 1- and 4-weeks were examined using unadjusted and adjusted regression and 1:4 propensity score matching

2018 American Journal of Emergency Medicine

284. Concussion diagnoses among adults presenting to three Canadian emergency departments: Missed opportunities. (Abstract)

Concussion diagnoses among adults presenting to three Canadian emergency departments: Missed opportunities. Patients with concussion commonly present to the emergency department (ED) for assessment. Misdiagnosis of concussion has been documented in children and likely impacts treatment and discharge instructions. This study aimed to examine diagnosis of concussion in a general adult population.Patients >17years old presenting meeting the World Health Organization's definition of concussion were (...) of concussion causes were documented. Forty-one (16%) patients were not diagnosed with a concussion despite meeting criteria. Concussion diagnosis was less likely with a longer ED length of stay (OR=0.71; 95% CI: 0.60 to 0.83), presenting to the non-academic centers (Hospital 2: OR=0.21, 95% CI: 0.08 to 0.58; Hospital 3: OR=0.07, 95% CI: 0.02 to 0.24), or involvement in a motor vehicle collision (OR=0.11; 95% CI: 0.03 to 0.46).One in six patients with concussion signs and symptoms were misdiagnosed

2018 American Journal of Emergency Medicine

285. Variations in Mechanisms of Injury for Children with Concussion. Full Text available with Trip Pro

Variations in Mechanisms of Injury for Children with Concussion. To assess the distribution of injury mechanisms and activities among children with concussions in a large pediatric healthcare system.All patients, age 0-17 years, who had at least 1 clinical encounter with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of concussion in the Children's Hospital of Philadelphia's electronic health record system from July 1, 2012 to June 30, 2014, were (...) selected (N = 8233) and their initial concussion-related visit identified. Approximately, 20% of the patients (n = 1625) were randomly selected for manual record review to examine injury mechanisms and activities.Overall, 70% of concussions were sports related; however, this proportion varied by age. Only 18% of concussions sustained by children aged 0-4 were sports related, compared with greater proportions for older children (67% for age 5-11, 77% for age 12-14, and 73% for age 15-17). When

2018 Journal of Pediatrics

286. The effects of early aerobic exercises on adolescents with post-concussion syndrome

The effects of early aerobic exercises on adolescents with post-concussion syndrome Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email

2020 PROSPERO

287. Systematic Review/Meta-Analysis of Prognostic Variables in Adult Concussion

Systematic Review/Meta-Analysis of Prognostic Variables in Adult Concussion Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email

2020 PROSPERO

288. The association between sleep and sports related concussions in athletes: a systematic review

The association between sleep and sports related concussions in athletes: a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated files or external

2020 PROSPERO

289. Assessing the accuracy of blood RNA profiles to identify patients with post-concussion syndrome: A pilot study in a military patient population. Full Text available with Trip Pro

Assessing the accuracy of blood RNA profiles to identify patients with post-concussion syndrome: A pilot study in a military patient population. Mild traumatic brain injury (mTBI) is a complex, neurophysiological condition that can have detrimental outcomes. Yet, to date, no objective method of diagnosis exists. Physical damage to the blood-brain-barrier and normal waste clearance via the lymphatic system may enable the detection of biomarkers of mTBI in peripheral circulation. Here we evaluate (...) the accuracy of whole transcriptome analysis of blood to predict the clinical diagnosis of post-concussion syndrome (PCS) in a military cohort. Sixty patients with clinically diagnosed chronic concussion and controls (no history of concussion) were recruited (retrospective study design). Male patients (46) were split into a training set comprised of 20 long-term concussed (> 6 months and symptomatic) and 12 controls (no documented history of concussion). Models were validated in a testing set (control = 9

2017 PLoS ONE

290. Characteristics of the King-Devick test in the assessment of concussed patients in the subacute and later stages after injury. Full Text available with Trip Pro

Characteristics of the King-Devick test in the assessment of concussed patients in the subacute and later stages after injury. Although the King-Devick (K-D) test has been used frequently in assessing sports related concussion early after injury, its characteristics over time after injury and in patients with prolonged persistent symptoms are unknown. The purpose of this paper was to: evaluate the ability of the K-D Test to distinguish patients seen early after concussion from those (...) with symptoms persisting more than 3 months compared to controls, assess changes in the K-D test times over time after concussion, and determine the relationship of K-D times to the Stroop Color and Word Test scores. We performed cross-sectional comparisons of patients with recent concussive brain injury (acute group) and those with symptoms persisting more than 3 months to healthy controls on the K-D test, the Sports Concussion Assessment Tool 3 (SCAT3), and the Stroop Color and Word Test. Longitudinal

2017 PLoS ONE

291. Utility of serum IGF-1 for diagnosis of growth hormone deficiency following traumatic brain injury and sport-related concussion. Full Text available with Trip Pro

Utility of serum IGF-1 for diagnosis of growth hormone deficiency following traumatic brain injury and sport-related concussion. Growth hormone deficiency (GHD) is a potential consequence of traumatic brain injury (TBI), including sport-related concussion (SRC). GH stimulation testing is required for definitive diagnosis; however, this is resource intensive and can be associated with adverse symptoms or risks. Measurement of serum IGF-1 is more practical and accessible, and pituitary tumour

2018 BMC Endocrine Disorders

292. A pilot educational intervention for headache and concussion: The headache and arts program. Full Text available with Trip Pro

A pilot educational intervention for headache and concussion: The headache and arts program. Using a science, technology, engineering, arts, and mathematics (STEAM) curriculum, we developed, piloted, and tested the Headache and Arts Program. This program seeks to increase knowledge and awareness of migraine and concussion among high school students through a visual arts-based curriculum.We developed a 2-week Headache and Arts Program with lesson plans and art assignments for high school visual (...) arts classes and an age-appropriate assessment to assess students' knowledge of migraine and concussion. We assessed students' knowledge through (1) the creation of artwork that depicted the experience of a migraine or concussion, (2) the conception and implementation of methods to transfer knowledge gained through the program, and (3) preassessment and postassessment results. The assessment was distributed to all students prior to the Headache and Arts Program. In a smaller sample, we distributed

2018 Neurology

293. Neurofilament light and tau as blood biomarkers for sports-related concussion. Full Text available with Trip Pro

Neurofilament light and tau as blood biomarkers for sports-related concussion. To compare neurofilament light (NfL) and tau as blood-based biomarkers for acute sports-related concussion (SRC) and determine whether their concentrations at different time points after the injury are associated with prolonged time to return to play (RTP).A total of 288 professional hockey players were followed longitudinally from September 1, 2012, to April 30, 2015. Data collection and biomarker analyses were

2018 Neurology

294. The London sign (patterned bruising of blunt abdominal trauma). (Abstract)

The London sign (patterned bruising of blunt abdominal trauma). Patterned bruising of abdominal wall in blunt trauma is called London sign. It indicates that the impacting force is sharp and severe enough to cause visceral injury. Despite its practical significance this sign is seldom described in textbooks and there are no journal articles about it. This communication is intended to draw the attention of pediatric surgeons to this useful clinical sign.Copyright © 2018 Elsevier Inc. All rights

2018 Journal of Pediatric Surgery

295. Using artificial neural networks to identify patients with concussion and postconcussion syndrome based on antisaccades. Full Text available with Trip Pro

Using artificial neural networks to identify patients with concussion and postconcussion syndrome based on antisaccades. OBJECTIVEArtificial neural networks (ANNs) have shown considerable promise as decision support tools in medicine, including neurosurgery. However, their use in concussion and postconcussion syndrome (PCS) has been limited. The authors explore the value of using an ANN to identify patients with concussion/PCS based on their antisaccade performance.METHODSStudy participants (...) were further explored with receiver operating characteristic (ROC) curves and a logistic regression analysis.RESULTSControl (n = 15), concussion (n = 32), and PCS (n = 25) groups were matched by age and level of education. The authors examined 11 saccade parameters and found that the prosaccade error rate (p = 0.04) and median antisaccade latency (p = 0.02) were significantly different between control and concussion/PCS groups. When used to distinguish concussion and PCS participants from controls

2018 Journal of Neurosurgery

296. Early Microglial Activation Following Closed-Head Concussive Injury Is Dominated by Pro-Inflammatory M-1 Type Full Text available with Trip Pro

Early Microglial Activation Following Closed-Head Concussive Injury Is Dominated by Pro-Inflammatory M-1 Type Microglial activation is a pathological hallmark of traumatic brain injury (TBI). Following brain injury, activated microglia/macrophages adopt different phenotypes, generally categorized as M-1, or classically activated, and M-2, or alternatively activated. While the M-1, or pro-inflammatory phenotype is detrimental to recovery, M-2, or the anti-inflammatory phenotype, aids in brain (...) repair. Recent findings also suggest the existence of mixed phenotype following brain injury, where activated microglia simultaneously express both M-1 and M-2 markers. The present study sought to determine microglial activation states at early time points (6-72 h) following single or repeated concussive injury in rats. Closed-head concussive injury was modeled in rats using projectile concussive impact injury, with either single or repeated impacts (4 impacts, 1 h apart). Brain samples were examined

2018 Frontiers in neurology

297. A video review of multiple concussion signs in National Rugby League match play Full Text available with Trip Pro

A video review of multiple concussion signs in National Rugby League match play Video review has been introduced in many professional sports worldwide to help recognize concussions. However, to date, there has been very little research on the accuracy of using video analysis to identify signs of concussion and the various combinations of observed signs.The objective of the study is to determine the accuracy of combinations of clinical signs of concussion identified using video analysis (...) to identify concussions in the National Rugby League (NRL). Incidences of players using of the concussion interchange rule (CIR) (n = 156), including those where athletes were diagnosed with a concussion (n = 60), were used to calculate sensitivity and specificity of various combinations of concussion signs (unresponsiveness, slow to get up, clutching/shaking head, gait ataxia, vacant stare, and apparent seizure) and their independent association with an eventual diagnosis of concussion.Using video

2018 Sports medicine - open

298. Frequency of Self-Reported Concussion Amongst Professional and Semi-Professional Footballers in Ireland During the 2014 Season: a Cross-Sectional Study Full Text available with Trip Pro

Frequency of Self-Reported Concussion Amongst Professional and Semi-Professional Footballers in Ireland During the 2014 Season: a Cross-Sectional Study This paper examines the occupational risk of concussion amongst professional and semi-professional footballers in Ireland during the 2014 League of Ireland season. As part of a broader nationally representative study examining occupational safety and health (OSH) awareness amongst professional footballers, this empirical quantitative study (...) , utilising a convenience sample is the first and largest investigation of the frequency of, and attitudes towards, concussion and concussion reporting amongst Irish senior professional and semi-professional footballers.A census survey using an anonymous questionnaire was provided to available League of Ireland clubs between March and May 2015. Permission to access players was provided by the Professional Footballers Association of Ireland. This convenience sample was determined by club availability

2018 Sports medicine - open

299. Using concurrent gait and cognitive assessments to identify impairments after concussion: a narrative review Full Text available with Trip Pro

Using concurrent gait and cognitive assessments to identify impairments after concussion: a narrative review Understanding how a concussion affects an individual is oftentimes difficult for clinicians due to the varying symptom profiles reported by the patient and the multifaceted and heterogeneous nature of the injury. Accordingly, the interpretation of postconcussion performance can be challenging, because many different testing paradigms have been reported as potentially useful (...) in the literature. Among the types of tests clinicians use to understand how concussion affects an individual, both gait and neurocognitive evaluations have demonstrated utility. Our purpose is to describe how combined gait and cognitive (i.e., dual task), as well as single-task gait and computerized neurocognitive examinations can assist clinical decision-making.

2018 Concussion

300. Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform Full Text available with Trip Pro

Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform Lightweight and portable devices that objectively measure concussion-related impairments could improve injury detection and critical decision-making in contact sports and the military, where brain injuries commonly occur but remain underreported. Current standard assessments often rely heavily on subjective methods such as symptom self-reporting. Head-mounted (...) wearables, such as smartglasses, provide an emerging platform for consideration that could deliver the range of assessments necessary to develop a rapid and objective screen for brain injury. Standing balance assessment, one parameter that may inform a concussion diagnosis, could theoretically be performed quantitatively using current off-the-shelf smartglasses with an internal accelerometer. However, the validity of balance measurement using smartglasses has not been investigated.This study aimed

2018 JMIR mHealth and uHealth

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