The Diagnosis and Management of Concussion in Children and Adolescents

Rose, Sean C.; Weber, Kurt; Collen, James B.; Heyer, Geoffrey L.

doi:10.1016/j.pediatrneurol.2015.04.003

Cited by 67 publications

(57 citation statements)

References 158 publications

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“…For children and adolescents, mTBI resulting from sports‐related events and accidental falls, are the most common form of neurological insult, accounting for approximately 80–90% of all brain injuries 2. Although many of these children recover without incident, a significant portion, especially those exposed to repeated mTBIs (RmTBI), go on to suffer from lingering symptoms (i.e., postconcussion syndrome; PCS) 3. Despite extensive and ongoing research, clinicians still struggle with PCS prognosis, with no reliable process for distinguishing between those that will develop PCS and those that will not.…”

Section: Introductionmentioning

confidence: 99%

Sex matters: repetitive mild traumatic brain injury in adolescent rats

Wright

O’Brien

Shultz

et al. 2017

Ann Clin Transl Neurol

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ObjectiveWhether sex differences contribute to the heterogeneity of mild traumatic brain injury (mTBI) and repeated mTBI (RmTBI) outcomes in adolescents is unknown. Therefore, this study examined changes in, and differences between, male and female rats following single mTBI and RmTBI.MethodsRats were given a single mTBI, RmTBI (i.e., 3x), or sham injuries. Injuries were administered using a lateral impact model that mimics forces common in human mTBI. After the final injury, rats underwent extensive behavioral testing to examine cognition, motor function, and anxiety‐ and depressive‐like behavior. Postmortem analyses investigated gene expression and structural changes in the brain.ResultsMany of the outcomes exhibited a sex‐dependent response to RmTBI. While all rats given RmTBI had deficits in balance, motor coordination, locomotion, and anxiety‐like behavior, only male rats given RmTBI had short‐term working memory deficits, whereas only females given RmTBI had increased depressive‐like behavior. Volumetric and diffusion weighted MRI analyses found that while RmTBI‐induced atrophy of the prefrontal cortex was greater in female rats, only the male rats exhibited worse white matter integrity in the corpus callosum following RmTBI. Sex‐dependent changes in brain expression of mRNA for glial fibrillary acidic protein, myelin basic protein, and tau protein were also observed following injury.InterpretationThese findings suggest that in adolescent mTBI, sex matters; and future studies incorporating both male and females are warranted to provide a greater understanding of injury prognosis and better inform clinical practice.

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Section: Introductionmentioning

confidence: 99%

Sex matters: repetitive mild traumatic brain injury in adolescent rats

Wright

O’Brien

Shultz

et al. 2017

Ann Clin Transl Neurol

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“…13,36,38 Thus, persistent postconcussion symptoms have long-term implications for disability and mortality rates. 43 Most athletic endeavors involve some risk for TBI. The highest-risk sports are those that involve interpersonal contact and collisions such as football, hockey, rugby, wrestling, and boxing.…”

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confidence: 99%

Pediatric sports-related traumatic brain injury in United States trauma centers

Winkler

Yue

Burke

et al. 2016

FOC

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Neurosurg Focus 40 (4):E3, 2016S portS-related traumatic brain injury (TBI) is an important public health concern that is increasingly in the spotlight of both the lay press and the general public. Recent estimates suggest that 300,000 to 3.8 million sports-related TBIs occur in the United States annually, 11,17,32,40,49 resulting in more than 500,000 emergency department (ED) visits and over 60,000 hospitalizations. 31,44 In children older than 1 year, TBI is the leading cause of death and disability, 27 and roughly 60%-80% of sportsrelated TBI ED visits are by pediatric patients-predomiAbbreviAtioNs CCI = Charlson Comorbidity Index; ED = emergency department; FIC = fall or interpersonal contact; GCS = Glasgow Coma Scale; ICD-9 = International Classification of Diseases, Ninth Revision; ICU = intensive care unit; ISS = Injury Severity Score; LOS = length of stay; NSP = National Sample Program; NTDB = National Trauma Data Bank; TBI = traumatic brain injury. obJeCtive Traumatic brain injury (TBI) in children is a significant public health concern estimated to result in over 500,000 emergency department (ED) visits and more than 60,000 hospitalizations in the United States annually. Sports activities are one important mechanism leading to pediatric TBI. In this study, the authors characterize the demographics of sports-related TBI in the pediatric population and identify predictors of prolonged hospitalization and of increased morbidity and mortality rates. MethoDs Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from children (age 0-17 years) across 5 sports categories: fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged length of stay (LOS) in the hospital or intensive care unit (ICU), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at a < 0.05, and the Bonferroni correction (set at significance threshold p = 0.01) for multiple comparisons was applied in each outcome analysis. resUlts From 2003 to 2012, in total 3046 pediatric sports-related TBIs were recorded in the NTDB, and these injuries represented 11,614 incidents nationally after sample weighting. Fall or interpersonal contact events were the greatest contributors to sports-related TBI (47.4%). Mild TBI represented 87.1% of the injuries overall. Mean (± SEM) LOSs in the hospital and ICU were 2.68 ± 0.07 days and 2.73 ± 0.12 days, respectively. The overall mortality rate was 0.8%, and the prevalence of medical complications was 2.1% across all patients. Severities of head and extracranial injuries were significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Hypotension on admission to the ED was a significant predictor of failure to discharge to home (OR 0.05, 95% CI 0.03-0.07, p < 0.001). ...

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“…22 More recently, this has been extended to non-military mild TBI with an emphasis on sports-related concussion. 9,19,24,33–34 …”

Section: Discussionmentioning

confidence: 99%

“…Post-concussion light sensitivity has been reported in 15–52% of pediatric patients, with blurred vision reported in 23–39%. 9 Fewer reports are available of post-concussion clinical vision assessment post-concussion in children. Master et.…”

Section: Discussionmentioning

confidence: 99%

“…3 Reports of symptoms lingering longer than a month in the pediatric population vary widely from 1 to 38%, with longer duration often resulting in academic difficulty. 4–9 In a sample of children with concussion aged 5 to 18 years, a majority of children who were symptomatic for more than four weeks were prescribed school accommodations and reported a decline in grades. 10 The same children required a median time of over one month to return to school without accommodations and a median time of over two months before they were symptom-free.…”

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Academic Difficulty and Vision Symptoms in Children with Concussion

Swanson

Weise

Dreer³

et al. 2017

Optom Vis Sci

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Purpose Academic difficulty is reported in children with prolonged post-concussive symptoms. Despite growing evidence that vestibular-ocular and vision-specific dysfunction are common in children following concussion, vision is rarely mentioned in return-to-learn protocols. The purpose of this project was to evaluate a cohort of children with prolonged post-concussive symptoms to determine if vision symptoms are associated with those reporting academic difficulty. Methods Data was obtained from the Children’s of Alabama Concussion Clinic REDCap dataset from the period January 2007 to October 2013. From this dataset of 1,033 concussion events, a cohort of 276 children aged 5–18 years with three or more concussion-related symptoms present for 10 days or more was identified. A cross-sectional cohort study was undertaken to evaluate the association of concussion symptoms, SCAT2 scores, demographic and concussion severity markers to reported educational difficulty among children with prolonged post-concussive symptoms. Univariate and multivariate logistic regression techniques were used to model the association of reported educational difficulty to self-reported vision abnormalities. Results Mean age was 13.8 years. Median time since the concussive event was 21 days, with 33% (95/276) reporting their concussion more than thirty days prior to data collection. Academic difficulty was reported by 29% (79/270) and vision abnormalities in 46% (128/274). After model reduction, vision symptoms (OR 2.17, 95% CI 1.02, 4.62), hearing disturbance (OR 2.39, 95% CI 1.06, 5.36) and concentration difficulty (OR 21.62, 95% CI 9.50, 44.47) remained associated with academic difficulty. For those with symptoms 30 days or more after concussion, only vision (OR 3.15, 95% CI 1.06, 9.38) and concentration difficulty (OR 15.33, 95% CI 4.99, 47.05) remained statistically significant. Conclusions Vision problems were commonly reported in children with concussions and were independently associated with those reporting academic difficulty. Comprehensive vision assessment should be considered in children reporting academic difficulty and in the development of return-to-learn protocols.

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The Diagnosis and Management of Concussion in Children and Adolescents

Cited by 67 publications

References 158 publications

Sex matters: repetitive mild traumatic brain injury in adolescent rats

Sex matters: repetitive mild traumatic brain injury in adolescent rats

Pediatric sports-related traumatic brain injury in United States trauma centers

Academic Difficulty and Vision Symptoms in Children with Concussion

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