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161. Posterior tibial bone bruising associated with posterior-medial meniscal tear in patients with acute anterior cruciate ligament injury. (Abstract)

Posterior tibial bone bruising associated with posterior-medial meniscal tear in patients with acute anterior cruciate ligament injury. To evaluate whether medial-sided bone bruising was associated with postero-medial meniscal tears in patients with an acute rupture of their anterior cruciate ligament (ACL).A retrospective analysis of 150 consecutive patients who had an MRI scan within 8 weeks of their ACL rupture that underwent an ACL reconstruction was performed. Based on the intra-operative (...) findings, two groups were identified: Group A (N = 75) had no postero-medial meniscal tear associated with the acute ACL rupture and Group B (N = 75) had a postero-medial meniscal tear found at time of reconstruction. All patients' pre-operative MRI scans were reviewed for bone bruising in the following anatomic sites: lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP).MTP bone bruising was found to be more prevalent in cases

2019 Knee Surgery, Sports Traumatology, Arthroscopy

162. Association Between Statin Use and Risk of Dementia After a Concussion. (Abstract)

Association Between Statin Use and Risk of Dementia After a Concussion. Concussions are an acute injury that may lead to chronic disability, while statin use might improve neurologic recovery.To test whether statin use is associated with an increased or decreased risk of subsequent dementia after a concussion.Large extended population-based double cohort study in Ontario, Canada, from April 1, 1993, to April 1, 2013 (enrollment), and continued until March 31, 2016 (follow-up). Dates of analysis (...) were April 28, 2014, through March 21, 2019. Participants were older adults diagnosed as having a concussion, excluding severe cases resulting in hospitalization, individuals with a prior diagnosis of dementia or delirium, and those who died within 90 days.Statin prescription within 90 days after a concussion.Long-term incidence of dementia.This study identified 28 815 patients diagnosed as having a concussion (median age, 76 years; 61.3% female), of whom 7058 (24.5%) received a statin, and 21 757

2019 JAMA neurology

163. Elevated cerebrospinal fluid total tau in former professional athletes with multiple concussions. (Abstract)

Elevated cerebrospinal fluid total tau in former professional athletes with multiple concussions. To identify CSF biomarkers that are related to decreased white matter (WM) integrity and poor cognitive performance in former professional athletes with a history of multiple concussions.Concentrations of phosphorylated tau181, total tau (t-tau), and β-amyloid in the CSF were measured in 3 groups: 22 former professional athletes with multiple concussions (mean ± SD age 55.9 ± 12.2 years), 5 healthy (...) that former athletes with multiple concussions are at increased risk of elevated levels of CSF t-tau and that high CSF t-tau is associated with reduced WM integrity and worse scores on the TMT Part B.© 2019 American Academy of Neurology.

2019 Neurology

164. Risk of Repeat Concussion Among Patients Diagnosed at a Pediatric Care Network. Full Text available with Trip Pro

Risk of Repeat Concussion Among Patients Diagnosed at a Pediatric Care Network. To quantify the risk of repeat concussions for children and identify demographic and clinical aspects of the index concussion associated with repeat injury.For this retrospective cohort study, we queried the Children's Hospital of Philadelphia healthcare network's unified electronic health record to identify all 5- to 15-year-old patients who had their first clinical visit for an index concussion at a Children's (...) Hospital of Philadelphia location from July 2012 through June 2013. A 25% random sample (n = 536) were selected. Clinical data were abstracted for their index concussion and all concussion-related visits for 2 years following the index concussion.Overall, 16.2% (n = 87) of patients experienced at least 1 repeat concussion within 2 years of their index concussion. The risk of repeat concussion increased with patient age (9.5% for ages 5-8 years; 10.7% for ages 9-11 years; and 19.8% for ages 12-15 years

2019 Journal of Pediatrics

165. Medical assessment of potential concussion in elite football: video analysis of the 2016 UEFA European championship. Full Text available with Trip Pro

Medical assessment of potential concussion in elite football: video analysis of the 2016 UEFA European championship. The objective is to determine if suspected concussions in elite football are medically assessed according to the International Conferences on Concussion in Sport consensus statement recommendations.Men's Union of European Football Association (UEFA) Football Championship.All professional football players in the UEFA 2016 Championship Tournament.Observational study.Potential (...) concussive events (PCEs) were defined as direct head collision incidents resulting in the athlete being unable to immediately resume play following impact. PCEs identified and description of PCE assessment and outcome were accomplished through direct standardised observation of video footage by trained observers in 51 games played in the Men's UEFA European Championship (10 June-10 July 2016).Sixty-nine total PCEs (1.35 per match) were identified in 51 games played during the 2016 Men's UEFA European

2019 BMJ open

166. Characteristics and Costs of Pediatric Emergency Department Visits for Sports- and Recreation-Related Concussions, 2006-2014. (Abstract)

Characteristics and Costs of Pediatric Emergency Department Visits for Sports- and Recreation-Related Concussions, 2006-2014. Although concussion-related emergency department (ED) visits increased after the passage of concussion laws, little is known about how the laws may disproportionately impact ED utilization and associated health care costs among children in different demographic groups.Our aim was to examine the patient and clinical characteristics of pediatric ED visits and associated (...) health care costs for sports- and recreation-related concussions (SRRCs) before and after concussion law enactment.We retrospectively analyzed ED visits for SRRCs by children ages 5-18 years between 2006 and 2014 in the Pediatric Health Information System database (n = 123,220). ED visits were categorized as "pre-law," "immediate post-law," and "post-law" according to the respective state concussion law's effective date. Multinomial logistic regression models were used to assess the impact of the law

2019 Journal of Emergency Medicine

167. Underlying Ehlers-Danlos syndrome discovered during neuro-ophthalmic evaluation of concussion patients: a case series. Full Text available with Trip Pro

Underlying Ehlers-Danlos syndrome discovered during neuro-ophthalmic evaluation of concussion patients: a case series. The Ehlers-Danlos syndromes are a heterogenous group of diseases that cause connective tissue defects. At present, there are no published reports focusing upon the neuro-ophthalmic symptoms that might occur in EDS patients after mild traumatic brain injury. The demographics and clinical course of seven patients with subclinical EDS and mild traumatic brain injury

2019 BMC Ophthalmology

168. Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction in Former Professional US-Style Football Players. Full Text available with Trip Pro

Association of Concussion Symptoms With Testosterone Levels and Erectile Dysfunction in Former Professional US-Style Football Players. Small studies suggest that head trauma in men may be associated with low testosterone levels and sexual dysfunction through mechanisms that likely include hypopituitarism secondary to ischemic injury and pituitary axonal tract damage. Athletes in contact sports may be at risk for pituitary insufficiencies or erectile dysfunction (ED) because of the high number (...) of head traumas experienced during their careers. Whether multiple symptomatic concussive events are associated with later indicators of low testosterone levels and ED is unknown.To explore the associations between concussion symptom history and participant-reported indicators of low testosterone levels and ED.This cross-sectional study of former professional US-style football players was conducted in Boston, Massachusetts, from January 2015 to March 2017. Surveys on past football exposures

2019 JAMA neurology

169. Investigation into repetitive concussion in sport (RECOS): study protocol of a prospective, exploratory, observational cohort study. Full Text available with Trip Pro

Investigation into repetitive concussion in sport (RECOS): study protocol of a prospective, exploratory, observational cohort study. Sport-related concussion management remains a diagnostic dilemma to clinicians in all strata of care, coaching staff and players alike. The lack of objective diagnostic and prognostic biomarkers and over-reliance on subjective clinical assessments carries a significant health risk of undiagnosed concussive episodes and early return to play before full recovery (...) increasing the risk of sustaining additional concussion, and leading to long-term sequelae and/or unfavourable outcome.To identify a set of parameters (neuroimaging with neurophysiological, biological and neuropsychological tests) that may support pitch-side and outpatient clinical decision-making in order to objectively diagnose concussion, determine the severity of injury, guide a safe return to play and identify the potential predictors of the long-term sequelae of concussion.An exploratory

2019 BMJ open

170. A New Game Plan for Concussion Education. (Abstract)

A New Game Plan for Concussion Education. Despite state laws requiring concussion education for youth sport stakeholders and a proliferation of educational programs, there has been little demonstrated impact on concussion reporting behaviors. We propose that this is because of four key limitations to existing approaches to concussion education: (1) deliberative decision making by the injured athlete is assumed, (2) interventions are often targeted at individuals rather than social systems, (3 (...) ) education occurs once during preseason and is forgotten, and (4) dissemination challenges exacerbate health inequalities. Addressing these limitations, we propose a novel theoretic framework that situates individual behavior within a sport system's culture and their broader structural context. Concussion education programs should seek to facilitate safety-supportive interpersonal communication within and between stakeholder groups and influence attributes of groups that drive behavior, including shared

2019 Health Education & Behavior

171. Randomized Evaluation of the National Collegiate Athletic Association's Concussion Education Fact Sheet for Coaches. (Abstract)

Randomized Evaluation of the National Collegiate Athletic Association's Concussion Education Fact Sheet for Coaches. Background. Concussion education for coaches is being increasingly recommended by leading sports organizations, yet the effectiveness of available materials has not often been assessed. This study evaluated the impact of the National Collegiate Athletic Association's (2017) publication: "Concussion safety: What coaches need to know" (the "NCAA Fact Sheet for Coaches (...) ") on participants' concussion knowledge and safety supportive intentions. Method. NCAA head coaches (n = 779) were randomized to view the NCAA Fact Sheet for Coaches either before (intervention condition) or after (control condition) responding to questions assessing concussion knowledge and intentions to engage in three behaviors (talk to team about concussion safety; allow symptomatic athlete to continue play; encourage medical staff to return athlete as quickly as possible). Results. Knowledge scores were

2019 Health Education & Behavior

172. The Indirect Influence of Organizational Safety Climate on Football Players' Concussion Reporting Intentions. (Abstract)

The Indirect Influence of Organizational Safety Climate on Football Players' Concussion Reporting Intentions. Most of the health interventions designed to increase athletes' reporting of potential concussion symptoms have focused only on the individual athlete. Unfortunately, interventions targeted at athletes' knowledge and understanding of concussion risk has not reliably increased their reporting behavior, leading to increased calls for "changing the culture of concussion reporting." To date (...) , no studies have examined the role of organizational safety climate has on concussion-symptom reporting behavior. We hypothesized that players' perception of organizational safety climate would be indirectly related to their concussion symptom reporting intentions, via the influence of safety culture on supportive social norms and self-efficacy, two well-known predictors of concussion reporting intentions. We used structural equation modeling techniques to create robust latent measures of our model

2019 Health Education & Behavior

173. Bleeding and bruising in Osteogenesis Imperfecta: International Society on Thrombosis and Haemostasis bleeding assessment tool and haemostasis laboratory assessment in 22 individuals. (Abstract)

Bleeding and bruising in Osteogenesis Imperfecta: International Society on Thrombosis and Haemostasis bleeding assessment tool and haemostasis laboratory assessment in 22 individuals. Osteogenesis imperfecta (OI) is characterized by susceptibility to bone fractures. Other symptoms, such as easy bruising and bleeding complications during surgery necessitating transfusions, have also been reported. The aim of the cross-sectional pilot study was to assess the bleeding and bruising tendency in OI

2019 British journal of haematology

174. Differences in corpus callosum injury between cerebral concussion and diffuse axonal injury. Full Text available with Trip Pro

Differences in corpus callosum injury between cerebral concussion and diffuse axonal injury. We investigated differences in corpus callosum (CC) injuries between patients with concussion and those with diffuse axonal injury (DAI) by using diffusion tensor tractography (DTT).Twenty-nine patients with concussion, 21 patients with DAI, and 25 control subjects were recruited. We reconstructed the whole CC and 5 regions of the CC after applying Hofer classification (I, II, III, IV, and V). The whole (...) CC and each region of the CC were analyzed to measure DTT parameters (fractional anisotropy [FA], apparent diffusion coefficient [ADC], and fiber number [FN]).In the whole CC, significant differences were observed in all DTT parameters between the concussion and control groups and the DAI and control groups (P < .05). Among the 5 regions of the CC, significant differences were observed in FA and ADC between the concussion and control groups and the DAI and control groups (P < .05). Significant

2019 Medicine

175. A Technology Enabled Concussion Care Pathway Reduces Costs and Enhances Care. (Abstract)

A Technology Enabled Concussion Care Pathway Reduces Costs and Enhances Care. The standardization of care along disease lines is recommended to improve outcomes and reduce healthcare costs. The multiple disciplines involved in concussion management often results in fragmented and disparate care. A fundamental gap exists in the effective utilization of rehabilitation services for individuals with concussion.The purpose of this project was to (1) characterize changes in healthcare utilization (...) following implementation of a concussion carepath, and (2) present an economic evaluation of patient charges following carepath implementation.This was a retrospective cohort study.A review of electronic medical and financial records was conducted of individuals (N = 3937), ages 18-45, with primary diagnosis of concussion who sought care in the outpatient or emergency department settings over a 7-year period (2010-2016). Outcomes including encounter length, resource utilization, and charges were

2019 Physical therapy

176. Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion. Full Text available with Trip Pro

Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion. Objective: To evaluate feasibility and acceptability of a sub-threshold exercise program with minimal in-person visits to treat youth with persistent sport-related concussion, and explore efficacy for improving concussive symptoms, health-related quality of life, and fear-avoidance. Study design: We conducted a pilot randomized controlled trial (...) comparing a 6 week sub-threshold exercise program requiring only two in-person visits to active control (stretching) for 12-18 year old youth with persistent sport-related concussion. We measured moderate-to-vigorous physical activity pre- and post-intervention using accelerometry, and increased goals weekly via phone contact. We examined feasibility and acceptability using qualitative interviews. We used exponential regression to model differences in trajectory of concussive symptoms by experimental

2019 Frontiers in neurology Controlled trial quality: uncertain

177. Longitudinal study of hyperbaric oxygen intervention on balance and affective symptoms in military service members with persistent post-concussive symptoms. (Abstract)

Longitudinal study of hyperbaric oxygen intervention on balance and affective symptoms in military service members with persistent post-concussive symptoms. Dizziness and imbalance are common after mild traumatic brain injury (mTBI). Hyperbaric oxygen (HBO2) has been proposed for persistent post-concussive symptoms after mTBI, but its effect on vestibular function is unknown.To describe balance function in military service-members before and after intervention, and to explore the influence

2019 Journal of vestibular research : equilibrium & orientation Controlled trial quality: uncertain

178. Self-efficacy predicts response to cognitive rehabilitation in military service members with post-concussive symptoms. (Abstract)

Self-efficacy predicts response to cognitive rehabilitation in military service members with post-concussive symptoms. This study examined whether self-efficacy differentiated treatment responders from non-responders in a trial of cognitive rehabilitation (CR) for postconcussive symptoms. 126 service members with mild TBI seen on average 9.5 months since injury completed one of four cognitive rehabilitation treatments for 6 weeks. The four treatment arms were: (1) Psychoeducation control, (2 (...) patients' level of self-efficacy may be important for successful treatment of psychological distress in those with remote concussion.

2019 Neuropsychological rehabilitation Controlled trial quality: uncertain

179. Acute elevation of serum inflammatory markers predicts symptom recovery after concussion. (Abstract)

Acute elevation of serum inflammatory markers predicts symptom recovery after concussion. To test the hypothesis that acute elevations in serum inflammatory markers predict symptom recovery after sport-related concussion (SRC).High school and collegiate football players (n = 857) were prospectively enrolled. Forty-one athletes with concussion and 43 matched control athletes met inclusion criteria. Serum levels of interleukin (IL)-6, IL-1β, IL-10, tumor necrosis factor, C-reactive protein (...) , interferon-γ, and IL-1 receptor antagonist and Sport Concussion Assessment Tool, 3rd edition (SCAT3) symptom severity scores were collected at a preinjury baseline, 6 and 24-48 hours postinjury, and approximately 8, 15, and 45 days following concussion. The number of days that athletes were symptomatic following SRC (i.e., duration of symptoms) was the primary outcome variable.IL-6 and IL-1RA were significantly elevated in athletes with concussion at 6 hours relative to preinjury and other postinjury

2019 Neurology

180. Children with Attention-Deficit/Hyperactivity Disorder Perform Differently on Pediatric Concussion Assessment. (Abstract)

Children with Attention-Deficit/Hyperactivity Disorder Perform Differently on Pediatric Concussion Assessment. To compare Child Sport Concussion Assessment Tool Fifth Edition (Child SCAT5) performance between uninjured children with attention-deficit/hyperactivity disorder (ADHD) and precisely matched controls without ADHD.A nested case-control study was conducted within a cohort of middle school athletes (age 11-12 years) who completed preseason testing. Students with ADHD were individually (...) matched to students without ADHD based on age, sex, language spoken at home, number of prior concussions, sport, and school they attended. The final sample included 54 students (27 with ADHD and 27 controls), 38 (70.4%) boys and 16 (29.6%) girls (average age: 11.7 years, SD = 0.5).Children with ADHD reported more symptoms (M = 13.33, SD = 5.69, P < .001) and greater symptom severity (M = 22.59, SD = 1 1.60, P < .001) compared with controls (total symptoms: M = 6.44, SD = 4.96; symptom severity: M

2019 Journal of Pediatrics

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