A Multicenter Look at Multidisciplinary Youth Concussion/Mild Traumatic Brain Injury Programs: The Four Corners Youth Consortium (4CYC)

Choe, Meeryo; Rosenbaum, Philip; Rivara, Frederick P.; Gioia, Gérard A.; Giza, Christopher C.

doi:10.1016/j.pediatrneurol.2020.01.008

Cited by 4 publications

(4 citation statements)

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“…As outlined in a recent publication, the 4CYC registry is a multi-institutional collaboration between 3 academic centers with expertise in youth concussion care and research: the Safe Concussion Outcome, Recovery, and Education (SCORE) program at Children’s National Hospital; Seattle Children’s Hospital and University of Washington Medical Center; and the UCLA Steve Tisch BrainSPORT program at UCLA Mattel Children’s Hospital. The 4CYC is supported by the University of Utah Data Coordinating Center.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

et al. 2021

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IMPORTANCE The Four Corners Youth Consortium was created to fill the gap in our understanding of youth concussion. This study is the first analysis of posttraumatic headache (PTH) phenotype and prognosis in this cohort of concussed youth. OBJECTIVE To describe the characteristics of youth with PTH and determine whether the PTH phenotype is associated with outcome. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined outcomes from patients in a multi-institutional registry of traumatic brain injury (TBI) clinics from December 2017 to June 2019. Inclusion criteria included being between ages 5 and 18 years at enrollment and presentation within 8 weeks of a mild TBI. Data were analyzed between February 2019 and January 2021. EXPOSURE Mild TBI with standard care. MAIN OUTCOMES AND MEASURES Time to recovery and headache 3 months after injury; measurement device is the Postconcussion Symptom Inventory (PCSI). PTH with migraine phenotype was defined as moderate-severe headache that is new or significantly worse compared with baseline and associated with nausea and/or photophobia and phonophobia. RESULTS A total of 612 patients with 625 concussions were enrolled, of whom 387 patients with 395 concussions consented to participate in this study. One hundred nine concussions were excluded (concussions, rather than patients, were the unit of analysis), leaving 281 participants with 286 concussions (168 [58.7%] girls; 195 [75.6%] White; 238 [83.2%] aged 13-18 years). At the initial visit, 133 concussions (46.5%) were from patients experiencing PTH with a migraine phenotype, 57 (20%) were from patients experiencing PTH with a nonmigraine phenotype, and 96 (34%) were from patients with no PTH. Patients with any PTH after concussion were more likely to have prolonged recovery than those without PTH (median [interquartile range], 89 [48-165] days vs 44 [26-96] days; log-rank P < .001). Patients with PTH and a migraine phenotype took significantly longer to recover than those with nonmigraine phenotype (median [interquartile range], 95 [54-195] days vs 70 [46-119] days; log-rank P = .01). Within each phenotype, there was no significant difference between sexes in recovery or PTH at 3 months.

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Section: Methodsmentioning

confidence: 99%

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

et al. 2021

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“…The 4CYC is a multicenter collaborative that aims to build a comprehensive evidence base to promote behaviors that improve brain health among youth . Three contributing member sites, Children’s National Hospital, Seattle Children’s Hospital–University of Washington, and UCLA Mattel Children’s Hospital, have built a prospective, observational registry of pediatric mild TBI.…”

Section: Methodsmentioning

confidence: 99%

“…The 4CYC is a multicenter collaborative that aims to build a comprehensive evidence base to promote behaviors that improve brain health among youth. 13…”

Section: The 4cyc Concussion Registrymentioning

confidence: 99%

“…The Four Corners Youth Consortium (4CYC) was formed through collaboration among academic institutions with expertise and multidisciplinary programs focused on pediatric mild TBI clinical care and research. 13 The 4CYC is unique in that we are focused on the population of youth seen in subspecialty mild TBI and concussion clinics and have been able to capture longer follow-up after injury. This study examined trajectories of symptom recovery in patients presenting to pediatric mild TBI clinics.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population

et al. 2020

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IMPORTANCEPediatric mild traumatic brain injury (TBI) and concussion are a public health challenge with up to 30% of patients experiencing prolonged recovery. Pediatric patients presenting to concussion clinics often have ongoing impairments and may be at increased risk for persistent symptoms. Understanding this population is critical for improved prognostic estimates and optimal treatment. OBJECTIVE To describe pediatric patients presenting to concussion clinics and characterize factors associated with their recovery. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included patients enrolled at multicenter concussion specialty clinics from the Four Corners Youth Consortium from December 2017 to July 2019, with up to 12-month follow-up. Patients were eligible if they were aged 5 to 18.99 years with a diagnosis of mild TBI or concussion presenting to participating clinics within 8 weeks of injury. Patients were excluded if the patient or their parents were unable to read or sign the consent document, or if the patient had a Glasgow Coma Scale score less than 13 or a penetrating injury. Data were analyzed from February 2019 to April 2020. EXPOSURES Diagnosis of mild TBI or concussion. MAIN OUTCOMES AND MEASURES This study used National Institute of Neurological Disorders and Stroke common data elements, including data on demographic characteristics, injury details, history, neurological and neuropsychological assessments, and treatment. RESULTS A total of 600 patients were consecutively enrolled, among whom 324 (54.0%) were female and 435 (72.5%) were adolescents (ie, aged 13-18 years). A higher proportion of girls and women (248 patients [76.5%]) were adolescents compared with boys and men (187 patients [67.8%]) (P = .02), and girls and women reported significantly more preexisting anxiety compared with boys and men (80 patients [26.7%] vs 46 patients [18.7%]; P = .03). Significantly more adolescents reported preexisting migraines compared with preadolescents (82 patients [20.9%] vs 15 patients [10.9%]; P = .01). Girls and women recovered more slowly than boys and men (persistent symptoms after injury: week 4, 217 patients [81.6%] vs 156 patients [71.2%]; week 8, 146 patients [58.9%] vs 89 patients [44.3%]; week 12, 103 patients [42.6%] vs 58 patients [30.2%]; P = .01). Patients with history of migraine or anxiety or depression recovered more slowly than those without, regardless of sex.(continued) Key Points Question What factors are associated with recovery in pediatric patients with mild traumatic brain injury or concussion? Findings In this cohort study of 600 pediatric patients presenting to concussion clinics in 3 centers, girls and women experienced slower recovery and were more likely to have preexisting anxiety compared with boys and men. Independent of sex, patients with anxiety or depression or migraine recovered more slowly than those without these comorbidities. Meaning These findings suggest that factors, such as sex and comorbidities, in pediatric patients with mild traumatic brain ...

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Sport-Related Concussion Guideline Development: Acute Management to Return to Activity

Hutchison

2022

Tackling the Concussion Epidemic

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A Multicenter Look at Multidisciplinary Youth Concussion/Mild Traumatic Brain Injury Programs: The Four Corners Youth Consortium (4CYC)

Cited by 4 publications

References 3 publications

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

Characteristics of Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population

Sport-Related Concussion Guideline Development: Acute Management to Return to Activity

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