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161. Barriers to the Implementation of State Concussion Laws Within High Schools. (Abstract)

Barriers to the Implementation of State Concussion Laws Within High Schools. All 50 U.S. states and the District of Columbia enacted concussion laws between 2009 and 2014 to mitigate the consequences of concussion among children and adolescents. In response, many high schools started to implement their respective state law that includes three main tenets: (1) concussion education, (2) removal from play, and (3) return-to-play. We aimed to identify barriers to the implementation of these tenets (...) at the school level.We conducted 64 semistructured telephone interviews with high school athletic trainers from 26 states and the District of Columbia whose school participated in High School Reporting Information Online during the 2014-2015 and 2015-2016 academic years. Data were analyzed using thematic analysis.All 64 high schools employed at least one athletic trainer, and most schools were public schools (90.6%). Implementation barriers to the concussion education tenet were (1) lack of quality

2020 The Journal of Adolescent Health

162. Youth Soccer Parents' Attitudes and Perceptions About Concussions. Full Text available with Trip Pro

Youth Soccer Parents' Attitudes and Perceptions About Concussions. Parents are important figures in properly managing youth sport concussions. Although media attention has predominantly centered on concussions in contact/collision sports, evidence suggests that the concussion rate in soccer is comparable to those found in contact/collision sports. Given the high rate of concussions in youth soccer, this study aimed to examine parents of youth soccer athletes' attitudes and perceptions about (...) concussions and associated factors.A cross-sectional study was conducted by surveying parents of youth soccer athletes from the five largest organized youth soccer programs across the U.S. The researchers developed a questionnaire after an extensive literature review and by modifying previously used instruments.Overall, 419 parents completed the survey. The vast majority (85%) agreed that a concussion is a serious injury, but only 27.9% believed that their child could suffer a concussion during the next

2020 The Journal of Adolescent Health

163. Using the Integrated Behavioral Model to Determine Sport-Related Concussion Reporting Intentions Among Collegiate Athletes. (Abstract)

Using the Integrated Behavioral Model to Determine Sport-Related Concussion Reporting Intentions Among Collegiate Athletes. A significant proportion of sport-related concussions goes unreported among adolescents, which can result in irreversible brain damage. It is critical to identify and intervene on factors that significantly impact concussion reporting.This study tests factors associated with collegiate athletes' intentions to (1) self-report concussion symptoms; (2) report another (...) athlete's concussion symptoms; and (3) encourage others to report. Drawing on the Integrated Behavioral Model, predictors at the athlete level included perceived norms (bystander descriptive norms, injunctive norms, and subjective norms), attitudes (positive and negative expectancies about reporting and playing through a concussion and concussion reporting attitudes), personal agency (self-efficacy to recognize symptoms and communicate), and perceived coach communication. At the team level, coaches

2020 The Journal of Adolescent Health

164. Prevalence of Concussion-Related Policies and Practices Among Public School Districts in the United States, 2012 and 2016. (Abstract)

Prevalence of Concussion-Related Policies and Practices Among Public School Districts in the United States, 2012 and 2016. Beginning in 2009, there was an increase in the number of states with laws addressing 3 different components of youth sports-related concussion prevention and management: concussion education, removal from play, and medical clearance requirements before allowing an athlete to return to play. Schools are an important setting to implement policies and practices related (...) to concussions, as many youth participate in organized sports through school venues.To examine whether the prevalence of concussion-related policies and practices adopted by school districts changed from 2012 to 2016.This study used nationally representative data from the 2012 and 2016 School Health Policies and Practices Study to examine whether the prevalence of 4 concussion-related policies and practices changed during 2012 and 2016 and whether comprehensive policies changed during the same time frame

2020 Journal of Public Health Management and Practice

165. Medico-Legal Aspects of Concussion. (Abstract)

Medico-Legal Aspects of Concussion. Concussion and the sequelae have been controversial medico-legal issues for over 150 years. The following topics which are also important in clinical practice are discussed: definitions of concussion, neuroimaging, onset and prognosis of headaches, cognitive impairment, cognitive rehabilitation, post-traumatic stress disorder, and risk of later development of dementia.© 2020 American Headache Society.

2020 Headache

166. Anesthesia and the brain after concussion. Full Text available with Trip Pro

Anesthesia and the brain after concussion. To provide an overview of acute and chronic repeated concussion. We address epidemiology, pathophysiology, anesthetic utilization, and provide some broad-based care recommendations.Acute concussion is associated with altered cerebral hemodynamics. These aberrations can persist despite resolution of signs and symptoms. Multiple repeated concussions can cause chronic traumatic encephalopathy, a disorder associated with pathologic findings similar to some (...) organic dementias. Anesthetic utilization is common following concussion, especially soon after injury, a time when the brain may be most vulnerable to secondary injury.Brain physiology may be abnormal following concussion and these abnormalities may persist despite resolutions of clinical manifestations. Those with recent concussion or chronic repeated concussion may be susceptible to secondary injury in the perioperative period. Clinicians should suspect concussion in any patient with recent trauma

2020 Current Opinion in Anaesthesiology

167. Improving symptom burden in adults with persistent post-concussive symptoms: a randomized aerobic exercise trial protocol. Full Text available with Trip Pro

Improving symptom burden in adults with persistent post-concussive symptoms: a randomized aerobic exercise trial protocol. Persistent post-concussive symptoms (PPCS) affect up to 30% of individuals following mild traumatic brain injury. PPCS frequently includes exercise intolerance. Sub-symptom threshold aerobic exercise has been proposed as a treatment option for symptom burden and exercise intolerance in this population. The primary aim of this study is to evaluate whether a progressive, sub (...) % of heart rate at the point of symptom exacerbation achieved on a treadmill test with heart rate monitoring. Exercise prescription will be updated every 3-weeks with a repeat treadmill test. The Rivermead Post-concussion Symptom Questionnaire will be the primary outcome measure at 6 and 12-weeks of intervention. Secondary outcomes include assessments of specific symptoms (headache, quality of life, mood, anxiety, fatigue, dizziness, sleep parameters, daytime sleepiness) in addition to blood biomarkers

2020 BMC Neurology

168. Interleukin-6 is associated with acute concussion in military combat personnel. Full Text available with Trip Pro

Interleukin-6 is associated with acute concussion in military combat personnel. Concussion is the most common type of TBI, yet reliable objective measures related to these injuries and associated recovery processes remain elusive, especially in military personnel. The purpose of this study was to characterize the relationship between cytokines and recovery from acute brain injury in active duty service members. Inflammatory cytokines (IL-6, IL-10, and TNFα) were measured acutely in blood (...) samples within 8 h following a medically diagnosed concussion and then 24 h later.Participants (n = 94) were categorized into two groups: 1) military personnel who sustained provider-diagnosed concussion, without other major medical diagnosis (n = 45) and 2) healthy control participants in the same deployment environment who did not sustain concussion or other illness or injuries (n = 49). IL-6, IL-10, and TNFα concentrations were measured using an ultrasensitive single-molecule enzyme-linked

2020 BMC Neurology

169. Symptom Burden, School Function, and Physical Activity One Year Following Pediatric Concussion. (Abstract)

Symptom Burden, School Function, and Physical Activity One Year Following Pediatric Concussion. To characterize symptom burden, school function, and physical activity in youth 1 year following acute concussion and those with subsequent repeat concussion.Secondary analysis of Predicting Persistent Postconcussive Problems in Pediatrics prospective, multicenter cohort study conducted in 9 Canadian emergency departments. Participants were children between ages 5 and 18 years who presented (...) consecutively ≤48 hours of concussion and agreed to participate in a post hoc electronic survey 1 year after injury. Outcomes were assessed using a standardized 25-question symptom scale derived from the Post-Concussion Symptom Inventory-Parent; school function and physical activity outcomes were queried. The primary outcome was total symptom score 1 year following concussion, defined as the number of symptoms experienced more than before injury.Of 3052 youth enrolled in the Predicting Persistent

2020 Journal of Pediatrics

170. Characteristics of Concussion in Elementary School-Aged Children: Implications for Clinical Management. Full Text available with Trip Pro

Characteristics of Concussion in Elementary School-Aged Children: Implications for Clinical Management. To comprehensively characterize the clinical presentation and course of care for concussion among 5- to 11-year-old children, identifying preinjury and injury factors potentially influencing clinical outcomes.A single-institution retrospective cohort study using electronic health record data from children ages 5- to 11 years with a concussion from July 1, 2014, through June 30, 2015 (...) . Electronic health record data were abstracted for a 20% random sample of 292 patients.Three-fourths of patients (74.3%) presenting for concussion care had a standardized visiovestibular assessment performed. Almost all of those who eventually sought specialty care (92.9%) also had such an assessment, and only 42.9% patients initially seen in the emergency department or urgent care were examined in this manner. Of those assessed, 62.7% (n = 136) demonstrated deficits, with children ages 9-11 years more

2020 Journal of Pediatrics

171. A Longitudinal Investigation of Symptom Recovery following Concussion in Youth Soccer. (Abstract)

A Longitudinal Investigation of Symptom Recovery following Concussion in Youth Soccer. To prospectively evaluate symptom outcomes after youth soccer-related concussion.Using a prospective cohort design, we enrolled male and female competitive soccer players age 8-17 years into 3 groups: concussed (n = 23), matched control (n = 23), and orthopedic injury (n = 24). Postconcussive symptoms were monitored serially via both athlete and parent report at days 1-2, 4, 7, 10, 30, and 90.Repeated (...) -measures analyses revealed a significant time by group interaction (F [12, 402] = 19.91, P < .001). In the initial days postinjury, the concussed group reported greater symptoms than the comparison groups, with more symptoms reported by athletes on average than parents. By 10 days, concussed athletes did not differ from the matched controls by either rater's report, but they did differ from the orthopedic injury group by parent report. At 30 days, no differences were apparent among groups. At 30 days

2020 Journal of Pediatrics

172. Slow versus fast subcutaneous heparin injections for prevention of bruising and site-pain intensity. (Abstract)

Slow versus fast subcutaneous heparin injections for prevention of bruising and site-pain intensity. Heparin is an anticoagulant medication that is normally injected subcutaneously. Subcutaneous administration of heparin may result in complications such as bruising, haematoma and pain at the injection site. One of the factors that may affect pain, haematoma and bruising is injection speed.To assess the effects of the duration (speed) of subcutaneous heparin injection on pain, haematoma (...) and bruising at the injection site in people admitted to hospitals or clinics who require treatment with unfractionated heparin or low molecular weight heparin.The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched August 2013) and CENTRAL (2013, Issue 7). We searched MEDLINE, EMBASE, CINAHL and two Persian databases Iranmedex and SID (August 2013).We sought randomised controlled trials (RCTs) comparing the effects of different durations

2014 Cochrane

173. Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999-2001) and CARE Consortium (2014-2017). (Abstract)

Return to play and risk of repeat concussion in collegiate football players: comparative analysis from the NCAA Concussion Study (1999-2001) and CARE Consortium (2014-2017). We compared data from the National Collegiate Athletic Association (NCAA) Concussion Study (1999-2001) and the NCAA-Department of Defense Concussion Assessment, Research and Education (CARE) Consortium (2014-2017) to examine how clinical management, return to play (RTP) and risk of repeat concussion in collegiate football (...) players have changed over the past 15 years.We analysed data on reported duration of symptoms, symptom-free waiting period (SFWP), RTP and occurrence of within-season repeat concussion in collegiate football players with diagnosed concussion from the NCAA Study (n=184) and CARE (n=701).CARE athletes had significantly longer symptom duration (CARE median=5.92 days, IQR=3.02-9.98 days; NCAA median=2.00 days, IQR=1.00-4.00 days), SFWP (CARE median=6.00 days, IQR=3.49-9.00 days; NCAA median=0.98 days, IQR

2019 British Journal of Sports Medicine

174. Concussion Symptoms Predictive of Adolescent Sport-Related Concussion Injury. (Abstract)

Concussion Symptoms Predictive of Adolescent Sport-Related Concussion Injury. To assess the predictive capability of the postconcussion symptom scale (PCSS) of the sport concussion assessment tool (SCAT) III to differentiate concussed and nonconcussed adolescents.Retrospective.Tertiary.Sixty-nine concussed (15.2 ± 1.6 years old) and 55 control (14.4 ± 1.7 years old) adolescents.Postconcussion symptom scale.Two-proportion z-test determined differences in symptom endorsement between groups (...) . To assess the predictive power of the PCSS, we trained an ensemble classifier composed of a forest of 1000 decision trees to classify subjects as concussed, or not concussed, based on PCSS responses. The initial classifier was trained on all 22-concussion symptoms addressed in the PCSS, whereas the second classifier removed concussion symptoms that were not statistically significant between groups.Concussion symptoms common between groups were trouble falling asleep, more emotional, irritability

2019 Clinical Journal of Sport Medicine

175. Does Concussion Affect Perception-Action Coupling Behavior? Action Boundary Perception as a Biomarker for Concussion. (Abstract)

Does Concussion Affect Perception-Action Coupling Behavior? Action Boundary Perception as a Biomarker for Concussion. After a concussion, athletes may be at increased risk of musculoskeletal injuries. Altered perception of action boundaries (ABP), or the limits of one's action capabilities, is one possible mechanism for this increase in injury risk after concussion.To evaluate differences in symptoms, neurocognitive, vestibular/oculomotor, and action boundary function between subjects (...) with no concussion history (NoHx) and concussion history (ConcHX).Cross-sectional study.Laboratory at the University of Pittsburgh.ConcHx (n = 22; age: 21.8 ± 3.0 years, height: 174.0 ± 8.3 cm, and mass: 77.8 ± 14.8 kg) and NoHx athletes (n = 24; age: 21.6 ± 2.0 years, height: 176.0 ± 10.0 cm, and mass: 72.0 ± 15.3 kg).Immediate Postconcussion Assessment and Cognitive Testing (ImPACT) and Post-Concussion Symptom Scale (PCSS), Vestibular-Ocular Motor Screening (VOMS) tool, and the Perception-Action Coupling Task

2019 Clinical Journal of Sport Medicine

176. The Effect of Sport-Related Concussion Injuries on Concussion Symptoms and Health-Related Quality of Life in Male and Female Adolescent Athletes: A Prospective Study. (Abstract)

The Effect of Sport-Related Concussion Injuries on Concussion Symptoms and Health-Related Quality of Life in Male and Female Adolescent Athletes: A Prospective Study. Sport-related concussions (SRCs) are associated with short-term disablement, characterized as increased concussion symptoms and lower health-related quality of life (HRQoL). However, there are limited longitudinal data detailing how an SRC affects disablement beyond short-term injury recovery.To longitudinally assess the effect (...) of SRCs on symptoms and HRQoL in high school athletes through the 12 months after injury.Cohort study; Level of evidence, 2.The 125 participants included high school athletes who sustained an SRC (female patients, 36%; mean ± SD age, 15.9 ± 1.1 years). The Post-concussion Symptom Scale (PCSS) from the Sport Concussion Assessment Tool-3 and the Pediatric Quality of Life Inventory 4.0 (PedsQL) were completed at enrollment and repeated at 24 to 72 hours (onset) and at 7 days (D7) after the SRC

2019 American Journal of Sports Medicine

177. Understanding the psychiatric effects of concussion on constructed identity in hockey players: Implications for health professionals. Full Text available with Trip Pro

Understanding the psychiatric effects of concussion on constructed identity in hockey players: Implications for health professionals. The following study was undertaken to investigate the effect of concussion and psychiatric illness on athletes and their caregivers.Semi-structured interviews with 20 ice hockey stakeholders (17 men and 3 women) including minor and professional players, coaches, parents, and physicians were conducted over two years (2012-2014). These interviews were analyzed (...) using grounded theory.From this analysis, a common biographical theme emerged whereby the subject's identity as a hockey player, constructed early in life over many years, was disrupted by concussion. Furthermore, some players underwent a biographical deconstruction when they experienced post-concussive mental illness, which was amplified by isolation, stigma from peers, and lack of a clear life trajectory. Many players obtained support from family and peers and were able to recover, as evidenced

2018 PLoS ONE

178. Concussion classification via deep learning using whole-brain white matter fiber strains. Full Text available with Trip Pro

Concussion classification via deep learning using whole-brain white matter fiber strains. Developing an accurate and reliable injury predictor is central to the biomechanical studies of traumatic brain injury. State-of-the-art efforts continue to rely on empirical, scalar metrics based on kinematics or model-estimated tissue responses explicitly pre-defined in a specific brain region of interest. They could suffer from loss of information. A single training dataset has also been used (...) to evaluate performance but without cross-validation. In this study, we developed a deep learning approach for concussion classification using implicit features of the entire voxel-wise white matter fiber strains. Using reconstructed American National Football League (NFL) injury cases, leave-one-out cross-validation was employed to objectively compare injury prediction performances against two baseline machine learning classifiers (support vector machine (SVM) and random forest (RF)) and four scalar

2018 PLoS ONE

179. Association between head injury and concussion with retinal vessel caliber. Full Text available with Trip Pro

Association between head injury and concussion with retinal vessel caliber. The adverse long-term consequences following traumatic brain injury are poorly understood, particularly on the cerebral microvasculature. Retinal vessels are a surrogate marker of cerebral vascular changes. We therefore aimed to examine the cross-sectional association between serious head injury or being knocked unconscious, and/or concussion and retinal microvascular signs, specifically, mean retinal arteriolar (...) and venular calibre, in older adults after accounting for potential confounders. This cohort study involved 2,624 adults with mean age of 66.9 (±9.1) years who self-reported head injury and concussion parameters, and had gradable retinal photographs. Face-to-face interviews with trained interviewers allowed participants to report prior serious head injury or being knocked unconscious, and/or a previous diagnosis of concussion by a medical professional. Fundus photographs were taken and retinal vascular

2018 PLoS ONE

180. Earlier time to aerobic exercise is associated with faster recovery following acute sport concussion. Full Text available with Trip Pro

Earlier time to aerobic exercise is associated with faster recovery following acute sport concussion. To determine whether earlier time to initiation of aerobic exercise following acute concussion is associated with time to full return to (1) sport and (2) school or work.A retrospective stratified propensity score survival analysis of acute (≤14 days) concussion was used to determine whether time (days) to initiation of aerobic exercise post-concussion was associated with, both, time (days (...) ) to full return to (1) sport and (2) school or work.A total of 253 acute concussions [median (IQR) age, 17.0 (15.0-20.0) years; 148 (58.5%) males] were included in this study. Multivariate Cox regression models identified that earlier time to aerobic exercise was associated with faster return to sport and school/work adjusting for other covariates, including quintile propensity strata. For each successive day in delay to initiation of aerobic exercise, individuals had a less favourable recovery

2018 PLoS ONE

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