Temporal profile of care following mild traumatic brain injury: predictors of hospital admission, follow-up referral and six-month outcome

Yue, John K.; Winkler, Ethan A.; Vassar, Mary J.; Ratcliff, Jonathan J.; Korley, Frederick K.; Seabury, Seth A.; Ferguson, Adam R.; Lingsma, Hester F.; Deng, Hansen; Meeuws, Sacha; Adeoye, Opeolu; Rick, Jonathan W.; Robinson, Caitlin; Duarte, Siena M.; Yuh, Esther L.; Mukherjee, Pratik; Dikmen, Sureyya; McAllister, Thomas W.; Valadka, Alex B.; Gordon, Wayne A.; Okonkwo, David O.; Manley, Geoffrey T.

doi:10.1080/02699052.2017.1351000

Cited by 14 publications

(9 citation statements)

References 58 publications

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“…It is increasingly recognized that mTBI/ concussion can cause long-term consequences, for example, functional deficits limiting return to work, and a variety of neurocognitive and neuropsychiatric symptoms. [14][15][16][17] Recent studies show that up to 80% of patients may experience symptomatology and 30% may be functionally impaired at 3 and 6 months. 18 Lack of health care engagement in the setting of persistent symptoms can present significant challenges to have deleterious impacts to socioeconomic self-sufficiency and cause development of maladaptive coping mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

Yue

Upadhyayula

Avalos

et al. 2020

JNRP

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Background Mild-traumatic brain injury (mTBI) and concussions cause significant morbidity. To date, synthesis of specific health care disparities and gaps in care for rural mTBI/concussion patients remains needed. Methods A comprehensive literature search was performed using PubMed database for English articles with keywords "rural" and ("concussion" or "mild traumatic brain injury") from 1991 to 2019. Eighteen articles focusing on rural epidemiology (n = 5), management/cost (n = 5), military (n = 2), and concussion prevention/return to play (n = 6) were included. Results mTBI/concussion incidence was higher in rural compared with urban areas. Compared with urban patients, rural patients were at increased risk for vehicular injuries, lifetime number of concussions, admissions for observation without neuroimaging, and injury-related costs. Rural patients were less likely to utilize ambulatory and mental health services following mTBI/concussion. Rural secondary schools had decreased access to certified personnel for concussion evaluation, and decreased use of standardized assessment instruments/neurocognitive testing. While school coaches were aware of return-to-play laws, mTBI/concussion education rates for athletes and parents were suboptimal in both settings. Rural veterans were at increased risk for postconcussive symptoms and posttraumatic stress. Telemedicine in rural/low-resource areas is an emerging tool for rapid evaluation, triage, and follow-up. Conclusions Rural patients are at unique risk for mTBI/concussions and health care costs. Barriers to care include lower socioeconomic status, longer distances to regional medical center, and decreased availability of neuroimaging and consultants. Due to socioeconomic and distance barriers, rural schools are less able to recruit personnel certified for concussion evaluation. Telemedicine is an emerging tool for remote triage and evaluation. AbstractKeywords ► concussion ► epidemiology ► health disparity ► mild-traumatic brain injury ► rural ► prevention ► return to play

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Section: Introductionmentioning

confidence: 99%

Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

Yue

Upadhyayula

Avalos

et al. 2020

JNRP

Self Cite

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“…From a brain reserve standpoint, older age has been repeatedly shown to be a vulnerability factor for mTBI (Mac Donald et al, ; Yue et al, ). Potentially, this may be related to protective effects of preinjury brain volume associated with younger age and larger TIV.…”

Section: Discussionmentioning

confidence: 99%

Structural neuroimaging in mild traumatic brain injury: A chronic effects of neurotrauma consortium study

Bigler

Abildskov

Eggleston

et al. 2019

Int J Methods Psych Res

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Objectives The chronic effects of neurotrauma consortium (CENC) observational study is a multisite investigation designed to examine the long‐term longitudinal effects of mild traumatic brain injury (mTBI). All participants in this initial CENC cohort had a history of deployment in Operation Enduring Freedom (Afghanistan), Operation Iraqi Freedom (Iraq), and/or their follow‐on conflicts (Operation Freedom's Sentinel). All participants undergo extensive medical, neuropsychological, and neuroimaging assessments and either meet criteria for any lifetime mTBI or not. These assessments are integrated into six CENC core studies—Biorepository, Biostatistics, Data and Study Management, Neuroimaging, and Neuropathology. Methods The current study outlines the quantitative neuroimaging methods managed by the Neuroimaging Core using FreeSurfer automated software for image quantification. Results At this writing, 319 participants from the CENC observational study have completed all baseline assessments including the imaging protocol and tertiary data quality assurance procedures. Conclusions/Discussion The preliminary findings of this initial cohort are reported to describe how the Neuroimaging Core manages neuroimaging quantification for CENC studies.

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“…Novel clinical trial design, such as adaptive designs, where computer-driven randomization algorithms allow for the study of multiple therapies simultaneously and with greatly reduced sample sizes ( 29 , 90 ) and large clinical studies based on big data approaches, are gaining utility in TBI ( 91 , 92 ). Finally, in mild TBI, exciting new phenotype-based approaches are underway, including approaches such as TRACK TBI and TEAM TBI ( 74 , 93 ). The intersection between novel pre-clinical consortia and emerging advanced clinical investigations has potential for breakthroughs in TBI therapy across the spectrum of injury severity.…”

Section: Discussionmentioning

confidence: 99%

Multi-Center Pre-clinical Consortia to Enhance Translation of Therapies and Biomarkers for Traumatic Brain Injury: Operation Brain Trauma Therapy and Beyond

et al. 2018

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Current approaches have failed to yield success in the translation of neuroprotective therapies from the pre-clinical to the clinical arena for traumatic brain injury (TBI). Numerous explanations have been put forth in both the pre-clinical and clinical arenas. Operation Brain Trauma Therapy (OBTT), a pre-clinical therapy and biomarker screening consortium has, to date, evaluated 10 therapies and assessed three serum biomarkers in nearly 1,500 animals across three rat models and a micro pig model of TBI. OBTT provides a unique platform to exploit heterogeneity of TBI and execute the research needed to identify effective injury specific therapies toward precision medicine. It also represents one of the first multi-center pre-clinical consortia for TBI, and through its work has yielded insight into the challenges and opportunities of this approach. In this review, important concepts related to consortium infrastructure, modeling, therapy selection, dosing and target engagement, outcomes, analytical approaches, reproducibility, and standardization will be discussed, with a focus on strategies to embellish and improve the chances for future success. We also address issues spanning the continuum of care. Linking the findings of optimized pre-clinical consortia to novel clinical trial designs has great potential to help address the barriers in translation and produce successes in both therapy and biomarker development across the field of TBI and beyond.

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Temporal profile of care following mild traumatic brain injury: predictors of hospital admission, follow-up referral and six-month outcome

Cited by 14 publications

References 58 publications

Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

Concussion and Mild-Traumatic Brain Injury in Rural Settings: Epidemiology and Specific Health Care Considerations

Structural neuroimaging in mild traumatic brain injury: A chronic effects of neurotrauma consortium study

Multi-Center Pre-clinical Consortia to Enhance Translation of Therapies and Biomarkers for Traumatic Brain Injury: Operation Brain Trauma Therapy and Beyond

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