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141. 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

142. Distinguishing and phenotype monitoring of traumatic brain injury and post-concussion syndrome including chronic migraine in serum of Iraq and Afghanistan war veterans. Full Text available with Trip Pro

Distinguishing and phenotype monitoring of traumatic brain injury and post-concussion syndrome including chronic migraine in serum of Iraq and Afghanistan war veterans. Traumatic Brain Injury (TBI) and persistent post-concussion syndrome (PCS) including chronic migraine (CM) are major health issues for civilians and the military. It is important to understand underlying biochemical mechanisms of these conditions, and be able to monitor them in an accurate and minimally invasive manner

2019 PLoS ONE

143. Socioecological influences on concussion reporting by NCAA Division 1 athletes in high-risk sports. Full Text available with Trip Pro

Socioecological influences on concussion reporting by NCAA Division 1 athletes in high-risk sports. Concussion among athletes is an issue of growing concern, with efforts underway to improve detection, diagnosis, and treatment. Success depends on communication by athletes, as brain-related symptoms are often not outwardly visible. Education programs to increase reporting behavior have not been successful to date. In accordance with the socioecological approach to health, we argue that multiple (...) levels of influence on student athletes must be addressed, and report a multi-dimensional, mixed-methods research project conducted to identify possible points of intervention into changing the culture of concussion-injury reporting among collegiate athletes. Using quantitative, qualitative and interpretive methods, we examine the individual-level vested interests athletes have in reporting or not reporting concussion symptoms, and how these interests interact with community-level team culture

2019 PLoS ONE

144. Injuries and concussions among young children, ages 5-11, playing sports in recreational leagues in Florida. Full Text available with Trip Pro

Injuries and concussions among young children, ages 5-11, playing sports in recreational leagues in Florida. The specific research aims of this study included: 1) Conduct an epidemiologic analysis of recreational sports injuries among 1500 children, ages 5-11 in Florida: and 2) Utilize the computerized pediatric concussion tool from ImPACT Applications, Inc. for baseline and follow-up testing to better understand these injuries. This research followed a prospective surveillance design utilizing (...) concussion tool developed by ImPACT Applications, Inc for baseline/follow-up concussion data.Over the course of the project, 26 RIO-reported injuries were reported. Football and soccer produced the greatest rate of injuries. There were 12 concussions which comprised nearly half of all the RIO injuries (46%). We conducted 882 baseline concussion tests and 13 follow-up tests over the 2 years.To the best of our knowledge, this is the first time data have been collected and reported on sports injuries

2019 PLoS ONE

145. The Sport Concussion Assessment Tool (SCAT2) for evaluating civilian mild traumatic brain injury. A pilot normative study. Full Text available with Trip Pro

The Sport Concussion Assessment Tool (SCAT2) for evaluating civilian mild traumatic brain injury. A pilot normative study. Self-report measures, particularly symptom inventories, are critical tools for identifying patients with persistent post-concussion symptoms and their follow-up. Unlike in military or sports-related assessment, in general civilian settings pre-injury levels of concussion-like symptoms are lacking. Normative data are available in adolescent and college populations (...) , but no reference data exist to guide clinical adult explorations. The purpose of this study was to use the second edition of the Sport Concussion Assessment Tool (SCAT2) to profile a cohort of 60 healthy community volunteers who had not sustained a head injury. Participating volunteers underwent MRI scanning and were evaluated with the Hospital Anxiety and Depression Scale (HADS). Participants reported a median of 3 concussion-like symptoms and the 97.5 percentile score was found at 10.5 symptoms, out

2019 PLoS ONE

146. Concussion. (Abstract)

Concussion. Concussions are a common injury for which patients often present first to primary care physicians. They can affect the day-to-day function of patients in school and work, as well as in sports and recreational activities. Recognizing common physical signs and symptoms after injury facilitates timely diagnosis and treatment, permitting initiation of an active management approach to recovery while preventing secondary injury. For persons with persistent symptoms, active rehabilitation

2018 Annals of Internal Medicine

147. Self-reported history of concussions is associated with risk factors for suicide completion among high school students. (Abstract)

Self-reported history of concussions is associated with risk factors for suicide completion among high school students. Suicide is the third leading cause of death among adolescents. While research has found concussions to be a risk factor for suicide in adults, this relationship is not well studied in nationally representative samples of youth. This study examines the relationship between self-reported history of sports-related concussion and five risk factors for suicide completion.Data were (...) obtained from the 2017 Youth Risk Behavior Surveillance Survey (n=13,353). Multivariate logistic regression models assessed the relationship between self-reported, sports-related concussion and five risk factors for suicide completion. Analyses controlled for sex, race/ethnicity, grade, bullying victimization, and sexual orientation. Subsample analyses were conducted stratified by sex. Interaction models examined biological sex as a possible effect modifier.Overall, 15.0% of high school students

2020 Journal of Affective Disorders

148. A Prospective Study of Acute Blood-Based Biomarkers for Sport-Related Concussion. (Abstract)

A Prospective Study of Acute Blood-Based Biomarkers for Sport-Related Concussion. Prospectively characterize changes in serum proteins following sport-related concussion and determine whether candidate biomarkers discriminate concussed athletes from controls and are associated with duration of symptoms following concussion.High school and collegiate athletes were enrolled between 2015 and 2018. Blood was collected at preinjury baseline and within 6 hours (early acute) and at 24 to 48 hours (...) (late acute) following concussion in football players (n = 106), matched uninjured football players (n = 84), and non-contact-sport athletes (n = 50). Glial fibrillary acidic protein, ubiquitin c-terminal hydrolase-L1, S100 calcium binding protein B, alpha-II-spectrin breakdown product 150, interleukin 6, interleukin 1 receptor antagonist, and c-reactive protein were measured in serum. Linear models assessed changes in protein concentrations over time. Receiver operating curves quantified

2020 Annals of Neurology

149. Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department. (Abstract)

Reliability of the visio-vestibular examination for concussion among providers in a pediatric emergency department. Visio-vestibular examination (VVE) deficits are common following pediatric concussion. Guidelines recommend assessing these deficits on all potentially concussed youth given their diagnostic and prognostic value, however test psychometrics of the VVE in the emergency department (ED) setting are unknown. Our objective was to determine the inter-rater (IRR) and test-retest (...) and moderate to substantial agreement among the same provider in the ED setting. These findings suggest a role in the VVE in evaluating concussion acutely, particularly given its previously demonstrated ability to assist in risk stratification of concussed youth and the importance of early diagnosis for improved outcomes.Copyright © 2020 Elsevier Inc. All rights reserved.

2020 American Journal of Emergency Medicine

150. Concussion Care in the Emergency Department: A Prospective Observational Brief Report. (Abstract)

Concussion Care in the Emergency Department: A Prospective Observational Brief Report. Emergency physicians are often the initial-and only-clinical providers for patients who have sustained a mild traumatic brain injury. This prospective observational study seeks to examine the practice patterns of clinicians in an academic Level I trauma center as they relate to the evaluation of patients who were presumed to be at high risk for mild traumatic brain injury. Specifically, we describe

2020 Annals of Emergency Medicine

152. An Examination of 4 Questions Assessing Self-reported Concussions Among High School Students Participating in Team Sports. (Abstract)

An Examination of 4 Questions Assessing Self-reported Concussions Among High School Students Participating in Team Sports. Current prevalence estimates of youth sports-related concussions are inconsistent because of variation in methodology and potentially unreported concussions.In 2013, Connecticut, Ohio, and Utah each added different questions that assessed self-reported concussions to the Youth Risk Behavior Survey. Two questions referenced recognition of a concussion by the student, 1 (...) referenced identification by a doctor, and 1 referenced suspicion by a coach. Chi-square analyses were used to identify whether there was an association between demographic characteristics and the concussion questions among high school students who played on at least 1 sports team.The percentage of students who reported concussions ranged from 17.6% to 20.1%.These estimates are higher than rates of concussions diagnosed in emergency departments or reported by athletic trainers but were similar across

2020 Journal of Public Health Management and Practice

153. Putting Policy Into Practice: School-Level Compliance With and Implementation of State Concussion Laws. Full Text available with Trip Pro

Putting Policy Into Practice: School-Level Compliance With and Implementation of State Concussion Laws. Each year, approximately 2 million US children 18 years or younger sustain a concussion, a type of mild traumatic brain injury (TBI). Concussions can have detrimental effects on physical, cognitive, emotional, or sleep health.Between 2009 and 2014, all 50 US states and Washington, District of Columbia, enacted state concussion laws aimed to increase awareness about concussion and reduce (...) the prevalence and severity of this injury. Most state laws include the following core tenets: (1) immediate removal from play after an actual or suspected concussion; (2) medical clearance before an athlete can return to play (RTP); and (3) concussion education for athletes, parents, and coaches.State concussion laws allow for substantial interpretation at the school level, resulting in considerable variation in the content of school written concussion policies and the level of implementation of state law

2020 Journal of Public Health Management and Practice

154. Effect of a concussion on subsequent baseline SCAT performance in professional rugby players: a retrospective cohort study in global elite Rugby Union. Full Text available with Trip Pro

Effect of a concussion on subsequent baseline SCAT performance in professional rugby players: a retrospective cohort study in global elite Rugby Union. This study assessed whether concussion affects subsequent baseline performance in professional rugby players. Annual baseline screening tests are used to guide return-to-play decisions and concussion diagnosis during subsequent screens. It is important that baseline performances are appropriate and valid for the duration of a season (...) and unaffected by factors unrelated to the current head impact event. One such factor may be a concussion following baseline assessment.The World Rugby concussion management database for global professional Rugby Union.501 professional rugby players with two baseline Sports Concussion Assessment Tools (SCATs) and an intervening concussion (CONC) were compared with 1190 control players with successive annual SCAT5s and no diagnosed concussion (CONT).Symptom endorsement, cognitive and balance performance

2020 BMJ open

155. Analyzing the impact of a state concussion law using an autoregressive integrated moving average intervention analysis. Full Text available with Trip Pro

Analyzing the impact of a state concussion law using an autoregressive integrated moving average intervention analysis. Existing studies analyzing the impact of state concussion laws have found an increase in concussion-related medical encounters post-law, in some instances, such increases were observed during the pre-law period due to a potential "spillover" effect. This study assessed the effects of Ohio's concussion law, while accounting for such a "spillover" effect, on the trends (...) in monthly rates of concussion-related medical encounters in Medicaid insured children using autoregressive integrated moving average (ARIMA) analysis.We analyzed claim data obtained from the Partners For Kids database, a pediatric accountable care organization in Ohio. Concussion-related medical encounters for Medicaid-insured children (ages 0-18 years) treated between April 1, 2008 to December 31, 2016 were selected and analyzed. We assessed pre- and post-law trends in concussion-related medical

2020 BMC health services research

156. The North Texas Concussion Registry (ConTex). Full Text available with Trip Pro

The North Texas Concussion Registry (ConTex). The North Texas Concussion Registry (ConTex) was established in 2015 as a multi-institutional collaboration intended to study risk factors, recovery patterns and clinical outcomes associated with concussion across the lifespan, with a particular emphasis on sport-related concussion.Prospective enrolment of individuals who sustained a concussion within the past 6 months who were seen at one of four North Texas ConTex concussion clinics which employ (...) common diagnostic criteria and assessment metrics to evaluate effects of a concussion as well as longitudinal tracking of recovery.The ConTex database and multidisciplinary oversight team has been established, and over 1700 participants aged 5-88 years have been enrolled. A majority of concussions were sport-related (60%), with a mean age of 17.5 years and similar numbers of males and females. Three-month follow-up compliance has been excellent (86%), with a majority of subjects reporting good

2020 BMJ open

157. Systemic inflammation moderates the association of prior concussion with hippocampal volume and episodic memory in high school and collegiate athletes. (Abstract)

Systemic inflammation moderates the association of prior concussion with hippocampal volume and episodic memory in high school and collegiate athletes. There is a need to determine why prior concussion has been associated with adverse outcomes in some retired and active athletes. We examined whether serum inflammatory markers moderate the associations of prior concussion with hippocampal volumes and neurobehavioral functioning in active high school and collegiate athletes.Athletes (N = 201 (...) ) completed pre-season clinical testing and serum collection (C-reactive protein [CRP]; Interleukin-6 [IL]-6; IL-1 receptor antagonist [RA]) and in-season neuroimaging. Linear mixed-effects models examined associations of prior concussion with inflammatory markers, self-reported symptoms, neurocognitive function, and hippocampal volumes. Models examined whether inflammatory markers moderated associations of concussion history and hippocampal volume and/or clinical measures.Concussion history

2020 Brain, behavior, and immunity

158. Utility of Pupillary Light Reflex Metrics as a Physiologic Biomarker for Adolescent Sport-Related Concussion. (Abstract)

Utility of Pupillary Light Reflex Metrics as a Physiologic Biomarker for Adolescent Sport-Related Concussion. Concussion diagnosis remains clinical, without objective diagnostic tests available for adolescents. Known deficits in visual accommodation and autonomic function after concussion make the pupillary light reflex (PLR) a promising target as an objective physiological biomarker for concussion.To determine the potential utility of PLR metrics as physiological biomarkers (...) for concussion.Prospective cohort of adolescent athletes between ages 12 and 18 years recruited between August 1, 2017, and December 31, 2018. The study took place at a specialty concussion program and private suburban high school and included healthy control individuals (n = 134) and athletes with a diagnosis of sport-related concussion (SRC) (n = 98). Analysis was completed June 30, 2020.Sports-related concussion and pupillometry assessments.Pupillary light reflex metrics (maximum and minimum pupillary diameter, peak

2020 JAMA ophthalmology

159. Impact of Pre-Existing Migraine and Other Co-Morbid or Co-Occurring Conditions on Presentation and Clinical Course Following Deployment-Related Concussion. (Abstract)

Impact of Pre-Existing Migraine and Other Co-Morbid or Co-Occurring Conditions on Presentation and Clinical Course Following Deployment-Related Concussion. To describe the clinical presentation and early clinical course of a sample of deployed U.S. military service members following concussion, underscoring the impact of pre-existing migraine and other co-occurring conditions. It is important to obtain a comprehensive clinical history to identify evidence of underlying migraine and other health (...) conditions which may contribute to an individual's presenting symptoms influencing early management and outcomes following concussion. Early outcome measures assessed include headache treatment response and fitness for return to duty.Acute concussion is reported to result in an array of somatic, cognitive, and behavioral symptoms. It is well established that these symptoms are not specific for concussion and may result from exacerbation of pre-existing or underlying medical conditions and factors

2020 Headache

160. Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion. (Abstract)

Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion. Recovery after concussion varies, with adolescents taking longer (approximately 30 days) than adults. Many factors have been reported to influence recovery, including preinjury factors, perceptions about recovery, comorbid conditions, and sex. However, 1 factor that may play a role in recovery but has received little attention from researchers is the timeliness of clinical evaluation and care.To (...) investigate the association of time since injury with initiation of clinical care on recovery time following concussion.This retrospective, cross-sectional study was conducted in a sports medicine clinic between August 2016 and March 2018. Eligible participants were aged 12 to 22 years and had a diagnosed, symptomatic concussion; patients were excluded if recovery data were incomplete. Participants were divided into 2 groups: those seen within 7 days of the injury (early) vs between 8 and 20 days

2020 JAMA neurology

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