Reliable Change in Postconcussive Symptoms and Its Functional Consequences Among Children With Mild Traumatic Brain Injury

Yeates, Keith Owen; Kaizar, Eloise; Rusin, Jerome; Bangert, Barbara; Dietrich, Ann; Nuss, Kathryn E.; Wright, Martha; Taylor, H. Gerry

doi:10.1001/archpediatrics.2011.1082

Cited by 151 publications

(123 citation statements)

References 42 publications

Supporting

Mentioning

120

Contrasting

Order By: Relevance

“…Some of these symptoms, as well as headaches, dizziness, and poor memory or concentration, may persist for days to weeks in patients after minor head injuries. 8,20,21 While these symptoms do not typically portend the need for neurosurgical intervention in patients who are neurologically intact and do not have intracranial hemorrhage or other injury, practitioners are understandably reluctant to send patients home who are symptomatic soon after a head trauma. Some emergency medicine guidelines suggest that children less than 2 years of age should be observed for 4 to 6 hours in the hospital and discharged if asymptomatic and neurologically intact after this period of observation.…”

Section: Discussionmentioning

confidence: 99%

Linear nondisplaced skull fractures in children: who should be observed or admitted?

Arrey

Kerr

Fletcher

et al. 2015

PED

View full text Add to dashboard Cite

OBJECT In this study the authors reviewed clinical management and outcomes in a large series of children with isolated linear nondisplaced skull fractures (NDSFs). Factors associated with hospitalization of these patients and costs of management were also reviewed. METHODS After institutional review board approval, the authors retrospectively reviewed clinical records and imaging studies for patients between the ages of 0 and 16 years who were evaluated for NDSFs at a single children’s hospital between January 2009 and December 2013. Patients were excluded if the fracture was open or comminuted. Additional exclusion criteria included intracranial hemorrhage, more than 1 skull fracture, or pneumocephalus. RESULTS Three hundred twenty-six patients met inclusion criteria. The median patient age was 19 months (range 2 weeks to 15 years). One hundred ninety-three patients (59%) were male and 133 (41%) were female. One hundred eighty-four patients (56%) were placed under 23-hour observation, 87 (27%) were admitted to the hospital, and 55 patients (17%) were discharged from the emergency department. Two hundred seventy-eight patients (85%) arrived by ambulance, 36 (11%) arrived by car, and 12 (4%) were airlifted by helicopter. Two hundred fifty-seven patients (79%) were transferred from another institution. The mean hospital stay for patients admitted to the hospital was 46 hours (range 7–395 hours). The mean hospital stay for patients placed under 23-hour observation status was 18 hours (range 2–43 hours). The reasons for hospitalization longer than 1 day included Child Protective Services involvement in 24 patients and other injuries in 11 patients. Thirteen percent (n = 45) had altered mental status or loss of consciousness by history. No patient had any neurological deficits on examination, and none required neurosurgical intervention. Less than 16% (n = 50) had subsequent outpatient follow-up. These patients were all neurologically intact at the follow-up visit. CONCLUSIONS Hospitalization is not necessary for many children with NDSFs. Patients with mental status changes, additional injuries, or possible nonaccidental injury may require observation.

show abstract

Section: Discussionmentioning

confidence: 99%

Linear nondisplaced skull fractures in children: who should be observed or admitted?

Arrey

Kerr

Fletcher

et al. 2015

PED

View full text Add to dashboard Cite

show abstract

“…[11][12][13] Persistent symptoms following concussion can have a devastating impact. 14,15 Consequences of concussion can include school absenteeism, depression, loss of social activities, and lower quality of life. 16 Children and adolescents may miss weeks or even months of their school year, which can affect marks and jeopardize a promotion to the next grade level.…”

Section: Introductionmentioning

confidence: 99%

“…17,18 Slowed cognition, decreased attention, and memory impairment may make schoolwork a challenge upon return and require educational interventions. 12,15,19,20 Given the serious short-and long-term effects following mild traumatic brain injury, the application of appropriate initial management practices is essential. [21][22][23][24][25][26] Numerous guidelines for the management of concussion have been released from specialty groups (including sports medicine, neurology, pediatrics, and family medicine) and from large medical associations.…”

Section: Introductionmentioning

confidence: 99%

Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management

Zemek

Eady

Farion

et al. 2015

CJEM

View full text Add to dashboard Cite

Introduction: The diagnosis of concussion is a critical step in the appropriate management of patients following minor head trauma. The authors hypothesized that wide practice variation exists among pediatric emergency medicine physicians in the application of physical and cognitive rest recommendations following an acute concussion. Methods: The authors developed a 35-item questionnaire incorporating case vignettes to examine pediatric emergency physician knowledge of concussion diagnosis, understanding of initial management using return-to-play/school/work guidelines, use of existing concussion protocols, and perceived barriers to protocol use. Using a modified Dillman technique, the authors distributed an online survey to members of Pediatric Emergency Research Canada, a national association of pediatric emergency physicians. Results: Of 176 potential participants, 115 (65%) responded to the questionnaire, 89% (95% confidence interval [CI]: 0.81, 0.93) of whom reported having diagnosed 20 or more concussions annually. Although 90% (95% CI: 0.83, 0.94) of respondents adequately diagnosed concussion, only 64% (95% CI: 0.54, 0.72) correctly applied graduated return-to-play guidelines. Cognitive rest recommendations were also frequently limited: 40% (95% CI: 0.31, 0.49) did not recommend school absence, 30% (95% CI: 0.22, 0.39) did not recommend schoolwork reduction, and 35% (95% CI: 0.27, 0.45) did not recommend limiting screen time. Eighty percent (95% CI: 0.72, 0.87) of respondents reported having used guidelines frequently or always to guide clinical decisions regarding concussion. Conclusion: Despite a proficiency in the diagnosis of concussion, pediatric emergency physicians exhibit wide variation in recommending the graduated return to play and cognitive rest following concussion.

show abstract

“…However, most pediatric DTI studies have examined moderate-to-severe (Hanten et al, 2008;Babikian et al, 2010;McCauley et al, 2011) or mixed (Akpinar et al, 2007;Wozniak et al, 2007;Galloway et al, 2008;Babikian et al, 2009) injury populations at more chronic injury times, reporting decreased fractional anisotropy (FA). Few studies have examined pmTBI during the semi-acute injury phase or prospectively.…”

Section: Introductionmentioning

confidence: 99%

Diffusion Abnormalities in Pediatric Mild Traumatic Brain Injury

et al. 2012

View full text Add to dashboard Cite

Pediatric mild traumatic brain injury (pmTBI) is the most prevalent neurological insult in children and is associated with both acute and chronic neurobehavioral sequelae. However, little is known about underlying pathophysiology and how injuries change as a function of recovery. Fractional anisotropy, axial diffusivity, and radial diffusivity were examined in 15 semi-acute pmTBI patients and 15 wellmatched controls, with a subset of participants returning for a second visit. A novel analytic strategy was applied to capture spatially heterogeneous white matter injuries (lesions) in addition to standard analyses. Evidence of cognitive dysfunction after pmTBI was observed in the domains of attention (p ϭ 0.02, d ϭ Ϫ0.92) and processing speed (p ϭ 0.05, d ϭ Ϫ0.73) semi-acutely. Region of interest (ROI) and voxelwise analyses indicated increased anisotropic diffusion for pmTBI patients, with an elevated number of clusters with high anisotropy. Metrics of increased anisotropy were able to objectively classify pmTBI from healthy controls at 90% accuracy but were not associated with neuropsychological deficits. Little evidence of recovery in white matter abnormalities was observed over a 4-month interval in returning patients, indicating that physiological recovery may lag behind subjective reports of normality. Increased anisotropic diffusion has been previously linked with cytotoxic edema after TBI, and the magnitude and duration of these abnormalities appear to be greater in pediatric patients. Current findings suggest that developing white matter may be more susceptible to initial mechanical injury forces and that anisotropic diffusion provides an objective biomarker of pmTBI.

show abstract

Reliable Change in Postconcussive Symptoms and Its Functional Consequences Among Children With Mild Traumatic Brain Injury

Cited by 151 publications

References 42 publications

Linear nondisplaced skull fractures in children: who should be observed or admitted?

Linear nondisplaced skull fractures in children: who should be observed or admitted?

Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management

Diffusion Abnormalities in Pediatric Mild Traumatic Brain Injury

Contact Info

Product

Resources

About