Factors Affecting Recovery Trajectories in Pediatric Female Concussion

Desai, Natasha; Wiebe, Douglas J.; Corwin, Daniel J.; Lockyer, Julia; Grady, Matthew F.; Master, Christina L.

doi:10.1097/jsm.0000000000000646

Cited by 77 publications

(58 citation statements)

References 28 publications

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“…There were no differences in the rate of change over time for girls and boys. This finding is consistent with prior literature suggesting vulnerability of girls after both TBI (10,(69)(70)(71)(72) and the broader category of pediatric acquired brain injury (73). Similarly, increased internalizing and ADHD symptoms were noted in girls compared to boys when assessed during the first year after injury after accounting for pre-injury ratings (5).…”

Section: Discussionsupporting

confidence: 90%

As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

et al. 2021

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Objective: To model pre-injury child and family factors associated with the trajectory of internalizing and externalizing behavior problems across the first 3 years in children with pediatric traumatic brain injury (TBI) relative to children with orthopedic injuries (OI). Parent-reported emotional symptoms and conduct problems were expected to have unique and shared predictors. We hypothesized that TBI, female sex, greater pre-injury executive dysfunction, adjustment problems, lower income, and family dysfunction would be associated with less favorable outcomes.Methods: In a prospective longitudinal cohort study, we examined the level of behavior problems at 12 months after injury and rate of change from pre-injury to 12 months and from 12 to 36 months in children ages 4–15 years with mild to severe TBI relative to children with OI. A structural equation model framework incorporated injury characteristics, child demographic variables, as well as pre-injury child reserve and family attributes. Internalizing and externalizing behavior problems were indexed using the parent-rated Emotional Symptoms and Conduct Problems scales from the Strengths and Difficulties questionnaire.Results: The analysis cohort of 534 children [64% boys, M (SD) 8.8 (4.3) years of age] included 395 with mild to severe TBI and 139 with OI. Behavior ratings were higher after TBI than OI but did not differ by TBI severity. TBI, higher pre-injury executive dysfunction, and lower income predicted the level and trajectory of both Emotional Symptoms and Conduct Problems at 12 months. Female sex and poorer family functioning were vulnerability factors associated with greater increase and change in Emotional Symptoms by 12 months after injury; unique predictors of Conduct Problems included younger age and prior emotional/behavioral problems. Across the long-term follow-up from 12 to 36 months, Emotional Symptoms increased significantly and Conduct Problems stabilized. TBI was not a significant predictor of change during the chronic stage of recovery.Conclusions: After TBI, Emotional Symptoms and Conduct Problem scores were elevated, had different trajectories of change, increased or stayed elevated from 12 to 36 months after TBI, and did not return to pre-injury levels across the 3 year follow-up. These findings highlight the importance of addressing behavioral problems after TBI across an extended time frame.

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Section: Discussionsupporting

confidence: 90%

As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

et al. 2021

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“…In addition, the clinical implications of these findings provide rationale to increase athletic trainer access to all athletes, including females, and also to ensure coaches are trained to properly identify and acutely manage SRC in the absence of an athletic trainer due to the involvement found for the initial evaluation in males (31.4%) and females (43.2%), respectively. Early access to appropriate medical care is demonstrated to influence length of recovery from SRC 28,29 ; therefore, future work should address disparities in athletic trainer coverage that may facilitate seeking proper care and management of SRC.…”

Section: Resultsmentioning

confidence: 99%

Time to Authorized Clearance From Sport-Related Concussion: The Influence of Health Care Provider and Medical Facility

Bretzin

Zynda

Wiebe

et al. 2020

Journal of Athletic Training

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Context: Return-to-play following sport-related concussion(SRC) requires authorized clearance from a healthcare provider(HCP). Variability in HCPs and facilities where athletes seek care may influence return time. Objective: Determine the initial examiner, HCPs that authorize clearance, and medical facilities authorizing clearance among high school student-athletes following SRC, and compare authorized clearance time by HCPs and medical facilities. Design: Prospective Cohort Study. Setting: High school. Patients or Other Participants: Student-athletes(n=16,001) with SRC participating in STATE-XXX High School Athletic Association(XHSAA)-sponsored athletics. Main Outcome Measure(s): Frequencies of initial examiner and authorized clearance for each HCP(Doctor of Osteopathic Medicine(DO), Doctor of Medicine(MD), Nurse Practitioner(NP), Physician Assistant(PA)) and medical facility (Neurologist's Office, Team Physician, Primary Care Physician or Pediatrician's Office(PCP), Hospital, Urgent/Ready Care) for each SRC case. Kaplan–Meier curves and Peto tests evaluated differences in median time to authorized clearance between HCPs and facilities. Only cases with a follow-up authorized clearance date(80.3%, n=12,856) were included in authorized clearance and time to return analyses. Results: An athletic trainer was at least one of the initial examiners for 71.3%(n=11,404) of cases; 80.2%(n=12,990) had only one initial examiner. There was an association between initial examiner and medical facility providing clearance for athletic director(χ2=52.6, p≤.001, V=.06), athletic trainer(χ2=172.0, p≤.001, V=.12), coach(χ2=161.5, p≤.001, V=.11), DO(χ2=59.4, p≤.001, V= 07), and NP(χ2=10.0, p .03, V=.12). The majority(n=8,218, 63.9%) received clearance by an MD; 70.8%(n=9,099) were cleared at a PCP. Median time to authorized clearance varied by facility(Urgent/Ready Care: 7 days[4,11], Hospital: 9 days[6,14], PCP: 10 days[6,14], Team Physician: 12 days[8,16], Neurologist Office: 13 days[9,20]; p ≤ .001). Conclusions: Clearance was frequently provided by an MD and at a PCP. Median time to return to unrestricted participation following SRC varied by HCP and medical facility. Future research should elucidate why differences exist and determine why athletes seek care at different medical facilities.

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“…Female sex was the strongest risk factor among all multivariate models associated with prolonged recovery from concussion (>28 days). More recently, Desai et al (2019) 95 analyzed data from 192 patients (75 females and 117 males). On average, females presented to the clinic later postinjury than males (15 vs. 9 days), and they presented with significantly greater symptom scores.…”

Section: Studies Reporting Sex-related Differencesmentioning

confidence: 99%

Sex‐Related Differences in the Effects of Sports‐Related Concussion: A Review

Koerte

Schultz

Sydnor

et al. 2020

Journal of Neuroimaging

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Sports-related concussion is a serious health challenge, and females are at higher risk of sustaining a sports-related concussion compared to males. Although there are many studies that investigate outcomes following concussion, females remain an understudied population, despite representing a large proportion of the organized sports community. In this review, we provide a summary of studies that investigate sex-related differences in outcome following sports-related concussion. Moreover, we provide an introduction to the methods used to study sex-related differences after sports-related concussion, including common clinical and cognitive measures, neuroimaging techniques, as well as biomarkers. A literature search inclusive of articles published to March 2020 was performed using PubMed. The studies were reviewed and discussed with regard to the methods used. Findings from these studies remain mixed with regard to the effect of sex on clinical symptoms, concussion-related alterations in brain structure and function, and recovery trajectories. Nonetheless, there is initial evidence to suggest that sex-related differences following concussion are important to consider in efforts to develop objective biomarkers for the diagnosis and prognosis of concussion. Additional studies on this topic are, however, clearly needed to improve our understanding of sex-related differences following concussion, as well as to understand their neurobiological underpinnings. Such studies will help pave the way toward more personalized clinical management and treatment of sports-related concussion.

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Factors Affecting Recovery Trajectories in Pediatric Female Concussion

Cited by 77 publications

References 28 publications

As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

As Time Goes by: Understanding Child and Family Factors Shaping Behavioral Outcomes After Traumatic Brain Injury

Time to Authorized Clearance From Sport-Related Concussion: The Influence of Health Care Provider and Medical Facility

Sex‐Related Differences in the Effects of Sports‐Related Concussion: A Review

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