References

2016

Williams, J M; Langdon, J L; McMillan, J L; Buckley, T A

English professional football players concussion knowledge and attitude Journal Article

In: Journal of Sport and Health Science, vol. 5, no. 2, pp. 197–204, 2016.

Abstract | Links | BibTeX | Tags: accuracy, adult, Article, attitude, behavior, Concussion, Concussion recovery, Concussion reporting, controlled study, education program, follow up, football, human, human experiment, injury severity, knowledge, mild traumatic brain injury, normal human, priority journal, psychometry, questionnaire, RISK assessment, RoCKAS, Rosenbaum Concussion Knowledge and Attitudes Surve, scoring system, semi structured interview, Young Adult

@article{Williams2016,

title = {English professional football players concussion knowledge and attitude},

author = {Williams, J M and Langdon, J L and McMillan, J L and Buckley, T A},

doi = {10.1016/j.jshs.2015.01.009},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Sport and Health Science},

volume = {5},

number = {2},

pages = {197--204},

abstract = {Background: Concussions are a common pathology in football and multiple misconceptions exist amongst the players and managers. To address these misconceptions, and potentially reduce concussion associated sequela, effective educational interventions need to be developed. However, the current knowledge and attitude status must be ascertained to appropriately develop these interventions. The purpose of this study was to assess the concussion knowledge and attitude of English professional footballers. Methods: Twenty-six participants from one English Football League Championship club completed the study. A mixed methods approach included the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) and a semi-structured interview. The RoCKAS contains separate knowledge (0-25) and attitude (15-75) scores and was followed by a semi-structured interview consisting of concussion knowledge, attitude, and behavior related questions. Results: The mean score on the RoCKAS knowledge was 16.4 ± 2.9 (range 11-22) and the attitude score was 59.6 ± 8.5 (range 41-71). The interview responses identified inconsistencies between the RoCKAS and the intended behaviors, endorsing multiple concussion misconceptions, and revealed barriers to concussion reporting. Conclusion: The results of this study suggest that Championship Level English footballers have moderate concussion knowledge, safe attitudes, and good concussion symptom recognition when assessed with pen and paper questionnaires. However, within the semi-structured interview many respondents reported unsafe concussion behaviors despite accurately identifying the potential risks. Further, multiple barriers to concussion reporting were identified which included perceived severity of the injury, game situations, and the substitution rule. These findings can help form the foundation of educational interventions to potentially improve concussion reporting behaviors amongst professional footballers. © 2016.},

keywords = {accuracy, adult, Article, attitude, behavior, Concussion, Concussion recovery, Concussion reporting, controlled study, education program, follow up, football, human, human experiment, injury severity, knowledge, mild traumatic brain injury, normal human, priority journal, psychometry, questionnaire, RISK assessment, RoCKAS, Rosenbaum Concussion Knowledge and Attitudes Surve, scoring system, semi structured interview, Young Adult},

pubstate = {published},

tppubtype = {article}

}

Terwilliger, V K; Pratson, L; Vaughan, C G; Gioia, G A

Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes Journal Article

In: Journal of Neurotrauma, vol. 33, no. 8, pp. 761–765, 2016.

Abstract | Links | BibTeX | Tags: Adolescent, Article, athlete, Athletes, brain concussion, Brain Injury, clinical article, Concussion, controlled study, CONVALESCENCE, Female, human, Male, mTBI, Parent, postconcussion syndrome, retrospective study, risk factor, sport injury

@article{Terwilliger2016,

title = {Additional Post-Concussion Impact Exposure May Affect Recovery in Adolescent Athletes},

author = {Terwilliger, V K and Pratson, L and Vaughan, C G and Gioia, G A},

doi = {10.1089/neu.2015.4082},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurotrauma},

volume = {33},

number = {8},

pages = {761--765},

abstract = {Repeat concussion has been associated with risk for prolonged and pronounced clinical recovery in athletes. In this study of adolescent athletes, we examined whether an additional head impact within 24 h of a sports-related concussion (SRC) is associated with higher symptom burden and prolonged clinical recovery compared with a single-injury group. Forty-two student-athletes (52% male, mean age = 14.9 years) diagnosed with an SRC in a concussion clinic were selected for this study: (1) 21 athletes who sustained an additional significant head impact within 24 h of the initial injury (additional-impact group); (2) 21 single-injury athletes, age and gender matched, who sustained only one discrete concussive blow to the head (single-injury group). Groups did not differ on initial injury characteristics or pre-injury risk factors. The effect of injury status (single-vs. additional-impact) was examined on athlete-and parent-reported symptom burden (at first clinic visit) and length of recovery (LOR). Higher symptom burden was reported by the athletes and parents in the additional-impact group at the time of first visit. The additional-impact group also had a significantly longer LOR compared with the single-injury group. These findings provide preliminary, hypothesis-generating evidence for the importance of immediate removal from play following an SRC to protect athletes from re-injury, which may worsen symptoms and prolong recovery. The retrospective study design from a specialized clinical sample points to the need for future prospective studies of the relationship between single-and additional-impact injuries on symptom burden and LOR. © 2016 Mary Ann Liebert, Inc.},

keywords = {Adolescent, Article, athlete, Athletes, brain concussion, Brain Injury, clinical article, Concussion, controlled study, CONVALESCENCE, Female, human, Male, mTBI, Parent, postconcussion syndrome, retrospective study, risk factor, sport injury},

pubstate = {published},

tppubtype = {article}

}

Haran, F J; Slaboda, J C; King, L A; Wright, W G; Houlihan, D; Norris, J N

Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment Journal Article

In: Journal of Neurotrauma, vol. 33, no. 7, pp. 705–711, 2016.

Abstract | Links | BibTeX | Tags: adult, Afghanistan, Article, Balance Error Scoring System, BESS, body posture, brain injury assessment, controlled study, CONVALESCENCE, human, integration, major clinical study, Male, Military, military deployment, mTBI, scoring system, Sensory Organization Test, SOT, traumatic brain injury, visual disorder, War

O'Sullivan, D; Fife, G P; Pieter, W; Lim, T; Shin, I

Resultant linear acceleration of an instrumented head form does not differ between junior and collegiate taekwondo athletes' kicks Journal Article

In: Journal of Sport and Health Science, vol. 5, no. 2, pp. 226–230, 2016.

Abstract | Links | BibTeX | Tags: accelerometer, Adolescent, age distribution, analytical parameters, Article, athlete, Biomechanics, body mass, Concussion, controlled study, head injury, high school student, human, injury, Male, Martial Arts, middle school student, priority journal, resultant linear acceleration, taekwondo, university student

Abaji, J P; Curnier, D; Moore, R D; Ellemberg, D

Persisting effects of concussion on heart rate variability during physical exertion Journal Article

In: Journal of Neurotrauma, vol. 33, no. 9, pp. 811–817, 2016.

Abstract | Links | BibTeX | Tags: adult, Article, athlete, brain concussion, cardiac autonomic modulation, clinical article, Concussion, controlled study, cross-sectional study, electrocardiogram, exercise, hand grip, heart rate variability, human, isometric hand grip contraction, Male, muscle isometric contraction, PHYSICAL ACTIVITY

@article{Abaji2016,

title = {Persisting effects of concussion on heart rate variability during physical exertion},

author = {Abaji, J P and Curnier, D and Moore, R D and Ellemberg, D},

doi = {10.1089/neu.2015.3989},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Neurotrauma},

volume = {33},

number = {9},

pages = {811--817},

abstract = {The purpose of this study was to evaluate cardiac autonomic modulation in university athletes during the post-acute to late phase (mean, 95 days ±63) of injury at rest and during physical exertion. We also sought to evaluate the effect of time since injury and number of injuries on heart rate variability (HRV). We hypothesized that physical exertion would reveal persisting modifications in HRV following a concussion. We included, in a cross-sectional design, athletes who sustained a concussion and matched controls. Concussions were identified by a medical doctor using established criteria. Twelve male concussed and 12 control athletes took part in the study. Control participants were teammates who were chosen to match the concussed athletes with regard to their height, weight, education, and age. The beat-to-beat electrocardiogram intervals of the participants were measured at rest and during physical exertion (isometric hand grip contraction; IHGC), which was sustained for 3 minutes at 30% of the participants' maximum. Linear and nonlinear parameters of HRV were calculated. The ratio between low and high frequency (LF/HF) bands was calculated to assess the sympathovagal balance. During the IHGC, but not at rest, concussed athletes presented significantly lower power in HF bands, leading to a significantly higher LF/HF ratio (p ≤ 0.05). Thus, asymptomatic athletes still may exhibit modifications in cardiac autonomic modulation weeks to months following injury. These modifications may only become apparent during physical exertion. Monitoring HRV may aid diagnosis and provide insight about safe return to play. © Mary Ann Liebert, Inc. 2016.},

keywords = {adult, Article, athlete, brain concussion, cardiac autonomic modulation, clinical article, Concussion, controlled study, cross-sectional study, electrocardiogram, exercise, hand grip, heart rate variability, human, isometric hand grip contraction, Male, muscle isometric contraction, PHYSICAL ACTIVITY},

pubstate = {published},

tppubtype = {article}

}

Papa, L; Brophy, G M; Welch, R D; Lewis, L M; Braga, C F; Tan, C N; Ameli, N J; Lopez, M A; Haeussler, C A; Mendez Giordano, D I; Silvestri, S; Giordano, P; Weber, K D; Hill-Pryor, C; Hack, D C

Time course and diagnostic accuracy of glial and neuronal blood biomarkers GFAP and UCH-L1 in a large cohort of trauma patients with and without mild traumatic brain injury Journal Article

In: JAMA Neurology, vol. 73, no. 5, pp. 551–560, 2016.

Abstract | Links | BibTeX | Tags: adult, aged, American Indian, amnesia, area under the curve, Article, Asian, assault, bicycle, Black person, blood sampling, blunt trauma, brain concussion, Caucasian, cohort analysis, computer assisted tomography, controlled study, diagnostic accuracy, diagnostic test accuracy study, disorientation, emergency ward, falling, Female, Glasgow Coma Scale, glial fibrillary acidic protein, Hispanic, human, limit of detection, limit of quantitation, major clinical study, Male, mild to moderate traumatic brain injury, neurosurgery, pedestrian, priority journal, prospective study, sport injury, traffic accident, traumatic brain injury, traumatic intracranial lesion, ubiquitin, ubiquitin carboxy terminal hydrolase L1, unclassified drug, unconsciousness, very elderly

@article{Papa2016a,

title = {Time course and diagnostic accuracy of glial and neuronal blood biomarkers GFAP and UCH-L1 in a large cohort of trauma patients with and without mild traumatic brain injury},

author = {Papa, L and Brophy, G M and Welch, R D and Lewis, L M and Braga, C F and Tan, C N and Ameli, N J and Lopez, M A and Haeussler, C A and {Mendez Giordano}, D I and Silvestri, S and Giordano, P and Weber, K D and Hill-Pryor, C and Hack, D C},

doi = {10.1001/jamaneurol.2016.0039},

year  = {2016},

date = {2016-01-01},

journal = {JAMA Neurology},

volume = {73},

number = {5},

pages = {551--560},

abstract = {Importance: Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have been widely studied and show promise for clinical usefulness in suspected traumatic brain injury (TBI) and concussion. Understanding their diagnostic accuracy over time will help translate them into clinical practice. Objectives: To evaluate the temporal profiles of GFAP and UCH-L1 in a large cohort of trauma patients seen at the emergency department and to assess their diagnostic accuracy over time, both individually and in combination, for detecting mild to moderate TBI (MMTBI), traumatic intracranial lesions on head computed tomography (CT), and neurosurgical intervention. Design, Setting, and Participants: This prospective cohort study enrolled adult trauma patients seen at a level I trauma center from March 1, 2010, to March 5, 2014. All patients underwent rigorous screening to determine whether they had experienced an MMTBI (blunt head trauma with loss of consciousness, amnesia, or disorientation and a Glasgow Coma Scale score of 9-15). Of 3025 trauma patients assessed, 1030 met eligibility criteria for enrollment, and 446 declined participation. Initial blood samples were obtained in 584 patients enrolled within 4 hours of injury. Repeated blood sampling was conducted at 4, 8, 12, 16, 20, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144, 156, 168, and 180 hours after injury. Main Outcomes and Measures: Diagnosis of MMTBI, presence of traumatic intracranial lesions on head CT scan, and neurosurgical intervention. Results: A total of 1831 blood samples were drawn from 584 patients (mean [SD] age, 40 [16] years; 62.0%[362 of 584] male) over 7 days. Both GFAP and UCH-L1 were detectible within 1 hour of injury. GFAP peaked at 20 hours after injury and slowly declined over 72 hours. UCH-L1 rose rapidly and peaked at 8 hours after injury and declined rapidly over 48 hours. Over the course of 1 week, GFAP demonstrated a diagnostic range of areas under the curve for detecting MMTBI of 0.73 (95%CI, 0.69-0.77) to 0.94 (95%CI, 0.78-1.00), and UCH-L1 demonstrated a diagnostic range of 0.30 (95%CI, 0.02-0.50) to 0.67 (95%CI, 0.53-0.81). For detecting intracranial lesions on CT, the diagnostic ranges of areas under the curve were 0.80 (95%CI, 0.67-0.92) to 0.97 (95%CI, 0.93-1.00)for GFAP and 0.31 (95%CI, 0-0.63) to 0.77 (95%CI, 0.68-0.85) for UCH-L1. For distinguishing patients with and without a neurosurgical intervention, the range for GFAP was 0.91 (95%CI, 0.79-1.00) to 1.00 (95% CI, 1.00-1.00), and the range for UCH-L1 was 0.50 (95%CI, 0-1.00) to 0.92 (95%CI, 0.83-1.00). Conclusions and Relevance: GFAP performed consistently in detecting MMTBI, CT lesions, and neurosurgical intervention across 7 days. UCH-L1 performed best in the early postinjury period. © Copyright 2016 American Medical Association. All rights reserved.},

keywords = {adult, aged, American Indian, amnesia, area under the curve, Article, Asian, assault, bicycle, Black person, blood sampling, blunt trauma, brain concussion, Caucasian, cohort analysis, computer assisted tomography, controlled study, diagnostic accuracy, diagnostic test accuracy study, disorientation, emergency ward, falling, Female, Glasgow Coma Scale, glial fibrillary acidic protein, Hispanic, human, limit of detection, limit of quantitation, major clinical study, Male, mild to moderate traumatic brain injury, neurosurgery, pedestrian, priority journal, prospective study, sport injury, traffic accident, traumatic brain injury, traumatic intracranial lesion, ubiquitin, ubiquitin carboxy terminal hydrolase L1, unclassified drug, unconsciousness, very elderly},

pubstate = {published},

tppubtype = {article}

}

Importance: Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have been widely studied and show promise for clinical usefulness in suspected traumatic brain injury (TBI) and concussion. Understanding their diagnostic accuracy over time will help translate them into clinical practice. Objectives: To evaluate the temporal profiles of GFAP and UCH-L1 in a large cohort of trauma patients seen at the emergency department and to assess their diagnostic accuracy over time, both individually and in combination, for detecting mild to moderate TBI (MMTBI), traumatic intracranial lesions on head computed tomography (CT), and neurosurgical intervention. Design, Setting, and Participants: This prospective cohort study enrolled adult trauma patients seen at a level I trauma center from March 1, 2010, to March 5, 2014. All patients underwent rigorous screening to determine whether they had experienced an MMTBI (blunt head trauma with loss of consciousness, amnesia, or disorientation and a Glasgow Coma Scale score of 9-15). Of 3025 trauma patients assessed, 1030 met eligibility criteria for enrollment, and 446 declined participation. Initial blood samples were obtained in 584 patients enrolled within 4 hours of injury. Repeated blood sampling was conducted at 4, 8, 12, 16, 20, 24, 36, 48, 60, 72, 84, 96, 108, 120, 132, 144, 156, 168, and 180 hours after injury. Main Outcomes and Measures: Diagnosis of MMTBI, presence of traumatic intracranial lesions on head CT scan, and neurosurgical intervention. Results: A total of 1831 blood samples were drawn from 584 patients (mean [SD] age, 40 [16] years; 62.0%[362 of 584] male) over 7 days. Both GFAP and UCH-L1 were detectible within 1 hour of injury. GFAP peaked at 20 hours after injury and slowly declined over 72 hours. UCH-L1 rose rapidly and peaked at 8 hours after injury and declined rapidly over 48 hours. Over the course of 1 week, GFAP demonstrated a diagnostic range of areas under the curve for detecting MMTBI of 0.73 (95%CI, 0.69-0.77) to 0.94 (95%CI, 0.78-1.00), and UCH-L1 demonstrated a diagnostic range of 0.30 (95%CI, 0.02-0.50) to 0.67 (95%CI, 0.53-0.81). For detecting intracranial lesions on CT, the diagnostic ranges of areas under the curve were 0.80 (95%CI, 0.67-0.92) to 0.97 (95%CI, 0.93-1.00)for GFAP and 0.31 (95%CI, 0-0.63) to 0.77 (95%CI, 0.68-0.85) for UCH-L1. For distinguishing patients with and without a neurosurgical intervention, the range for GFAP was 0.91 (95%CI, 0.79-1.00) to 1.00 (95% CI, 1.00-1.00), and the range for UCH-L1 was 0.50 (95%CI, 0-1.00) to 0.92 (95%CI, 0.83-1.00). Conclusions and Relevance: GFAP performed consistently in detecting MMTBI, CT lesions, and neurosurgical intervention across 7 days. UCH-L1 performed best in the early postinjury period. © Copyright 2016 American Medical Association. All rights reserved.

Schulte, S; Rasmussen, N N; McBeth, J W; Richards, P Q; Yochem, E; Petron, D J; Strathmann, F G

Utilization of the clinical laboratory for the implementation of concussion biomarkers in collegiate football and the necessity of personalized and predictive athlete specific reference intervals Journal Article

In: EPMA Journal, vol. 7, no. 1, 2016.

Abstract | Links | BibTeX | Tags: adult, Article, athlete-derived reference interval, biological marker, Biomarker panel, Blood test, clinical decision making, clinical laboratory, college, collegiate athletes, Concussion, controlled study, diagnostic test accuracy study, follow up, football, health program, human, Male, neuron specific enolase, NSE, prediction, Predictive diagnostics, priority journal, protein blood level, protein S100B, rating scale, reference value, S100B, Sport-related concussion, Sports-related concussion, traumatic brain injury, validation study

@article{Schulte2016b,

title = {Utilization of the clinical laboratory for the implementation of concussion biomarkers in collegiate football and the necessity of personalized and predictive athlete specific reference intervals},

author = {Schulte, S and Rasmussen, N N and McBeth, J W and Richards, P Q and Yochem, E and Petron, D J and Strathmann, F G},

doi = {10.1186/s13167-016-0050-x},

year  = {2016},

date = {2016-01-01},

journal = {EPMA Journal},

volume = {7},

number = {1},

abstract = {Background: A continued interest in concussion biomarkers makes the eventual implementation of identified biomarkers into routine concussion assessment an eventual reality. We sought to develop and test an interdisciplinary approach that could be used to integrate blood-based biomarkers into the established concussion management program for a collegiate football team. Methods: We used a CLIA-certified laboratory for all testing and chose biomarkers where clinically validated testing was available as would be required for results used in clinical decision making. We summarized the existing methods and results for concussion assessment across an entire season to identify and demonstrate the challenges with the eventual integration of a parallel process using blood-based tests for concussion management. We analyzed the results of the biomarkers chosen for trends consistent with the outcome assessments provided from the current concussion management protocols. Results: Baseline samples were collected with three additional post-concussion samples collected at three separate time points from players with a diagnosed concussion (n = 12). A summary of results from currently used concussion assessment tools were compared to the representative biomarkers S100B and NSE results. Nine sport-related concussions occurred during practice and three during play. For S100B, 50% had follow-up testing results lower than the post-injury result. In contrast, 92% of NSE follow-up results were lower than post-injury. One hundred percent of the results for S100B and NSE were within the athlete-derived reference intervals upon return-to-play and season end. Conclusions: The reported workflow provides a framework for the eventual implementation of biomarkers for concussion assessment into existing assessment protocols and strengthens the need for reliance on clinical laboratory testing. Athlete-specific reference intervals will be required to adequately interpret results. © 2016 Schulte et al.},

keywords = {adult, Article, athlete-derived reference interval, biological marker, Biomarker panel, Blood test, clinical decision making, clinical laboratory, college, collegiate athletes, Concussion, controlled study, diagnostic test accuracy study, follow up, football, health program, human, Male, neuron specific enolase, NSE, prediction, Predictive diagnostics, priority journal, protein blood level, protein S100B, rating scale, reference value, S100B, Sport-related concussion, Sports-related concussion, traumatic brain injury, validation study},

pubstate = {published},

tppubtype = {article}

}

Background: A continued interest in concussion biomarkers makes the eventual implementation of identified biomarkers into routine concussion assessment an eventual reality. We sought to develop and test an interdisciplinary approach that could be used to integrate blood-based biomarkers into the established concussion management program for a collegiate football team. Methods: We used a CLIA-certified laboratory for all testing and chose biomarkers where clinically validated testing was available as would be required for results used in clinical decision making. We summarized the existing methods and results for concussion assessment across an entire season to identify and demonstrate the challenges with the eventual integration of a parallel process using blood-based tests for concussion management. We analyzed the results of the biomarkers chosen for trends consistent with the outcome assessments provided from the current concussion management protocols. Results: Baseline samples were collected with three additional post-concussion samples collected at three separate time points from players with a diagnosed concussion (n = 12). A summary of results from currently used concussion assessment tools were compared to the representative biomarkers S100B and NSE results. Nine sport-related concussions occurred during practice and three during play. For S100B, 50% had follow-up testing results lower than the post-injury result. In contrast, 92% of NSE follow-up results were lower than post-injury. One hundred percent of the results for S100B and NSE were within the athlete-derived reference intervals upon return-to-play and season end. Conclusions: The reported workflow provides a framework for the eventual implementation of biomarkers for concussion assessment into existing assessment protocols and strengthens the need for reliance on clinical laboratory testing. Athlete-specific reference intervals will be required to adequately interpret results. © 2016 Schulte et al.

2015

Ellis, M J; Cordingley, D; Vis, S; Reimer, K; Leiter, J; Russell, K

Vestibulo-ocular dysfunction in pediatric sports-related concussion Journal Article

In: Journal of Neurosurgery: Pediatrics, vol. 16, no. 3, pp. 248–255, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport

@article{Ellis2015,

title = {Vestibulo-ocular dysfunction in pediatric sports-related concussion},

author = {Ellis, M J and Cordingley, D and Vis, S and Reimer, K and Leiter, J and Russell, K},

doi = {10.3171/2015.1.PEDS14524},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery: Pediatrics},

volume = {16},

number = {3},

pages = {248--255},

abstract = {Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.},

keywords = {Adolescent, amnesia, Article, Athletic Injuries, Baseball, BASKETBALL, blurred vision, brain concussion, CANADA, Child, childhood disease, cohort analysis, complication, Concussion, consultation, controlled study, disease duration, Dizziness, Female, follow up, football, Hockey, human, Humans, interdisciplinary communication, major clinical study, Male, Manitoba, migraine, neuroimaging, neuropsychological test, Neuropsychological Tests, ODDS ratio, Pathophysiology, Pediatric, Physical Examination, physiotherapy, Post-Concussion Syndrome, postconcussion syndrome, Prevalence, priority journal, Reflex, Retrospective Studies, retrospective study, return to sport, saccadic eye movement, skating, skiing, Soccer, sport injury, sport related concussion, Sports-related concussion, Trauma, vestibular physiotherapy, Vestibular therapy, vestibulo ocular dysfunction, Vestibulo-Ocular, Vestibulo-ocular dysfunction, vestibuloocular reflex, VOLLEYBALL, Young Adult, youth sport},

pubstate = {published},

tppubtype = {article}

}

Object The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort. Methods The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board. Results A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24 (23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16). Conclusions Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort. © AANS, 2015.

Oeur, R A; Karton, C; Post, A; Rousseau, P; Hoshizaki, T B; Marshall, S; Brien, S E; Smith, A; Cusimano, M D; Gilchrist, M D

A comparison of head dynamic response and brain tissue stress and strain using accident reconstructions for concussion, concussion with persistent postconcussive symptoms, and subdural hematoma Journal Article

In: Journal of Neurosurgery, vol. 123, no. 2, pp. 415–422, 2015.

Abstract | Links | BibTeX | Tags: accident, Accident reconstruction, accidental injury, Accidents, Adolescent, adult, Article, Biomechanical Phenomena, Biomechanics, brain, brain concussion, brain stem, brain tissue, Cerebellum, clinical article, comparative study, Concussion, controlled study, Female, finite element analysis, Finite element modelling, gray matter, Hematoma, human, Humans, Hybrid iii headform, injury severity, laboratory test, Male, Mechanical, mechanical stress, middle aged, pathology, Pathophysiology, Persistent postconcussive symptoms, PHYSIOLOGY, Post Hoc Analysis, Post-Concussion Syndrome, postconcussion syndrome, priority journal, shear stress, simulation, SPORTS medicine, STATISTICAL significance, Stress, stress strain relationship, Subdural, subdural hematoma, traumatic brain injury, white matter, Young Adult

@article{Oeur2015,

title = {A comparison of head dynamic response and brain tissue stress and strain using accident reconstructions for concussion, concussion with persistent postconcussive symptoms, and subdural hematoma},

author = {Oeur, R A and Karton, C and Post, A and Rousseau, P and Hoshizaki, T B and Marshall, S and Brien, S E and Smith, A and Cusimano, M D and Gilchrist, M D},

doi = {10.3171/2014.10.JNS14440},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurosurgery},

volume = {123},

number = {2},

pages = {415--422},

abstract = {Object Concussions typically resolve within several days, but in a few cases the symptoms last for a month or longer and are termed persistent postconcussive symptoms (PPCS). These persisting symptoms may also be associated with more serious brain trauma similar to subdural hematoma (SDH). The objective of this study was to investigate the head dynamic and brain tissue responses of injury reconstructions resulting in concussion, PPCS, and SDH. Methods Reconstruction cases were obtained from sports medicine clinics and hospitals. All subjects received a direct blow to the head resulting in symptoms. Those symptoms that resolved in 9 days or fewer were defined as concussions (n = 3). Those with symptoms lasting longer than 18 months were defined as PPCS (n = 3), and 3 patients presented with SDHs (n = 3). A Hybrid III headform was used in reconstruction to obtain linear and rotational accelerations of the head. These dynamic response data were then input into the University College Dublin Brain Trauma Model to calculate maximum principal strain and von Mises stress. A Kruskal-Wallis test followed by Tukey post hoc tests were used to compare head dynamic and brain tissue responses between injury groups. Statistical significance was set at p \< 0.05. Results A significant difference was identified for peak resultant linear and rotational acceleration between injury groups. Post hoc analyses revealed the SDH group had higher linear and rotational acceleration responses (316 g and 23,181 rad/sec2, respectively) than the concussion group (149 g and 8111 rad/sec2, respectively; p \< 0.05). No significant differences were found between groups for either brain tissue measures of maximum principal strain or von Mises stress. Conclusions The reconstruction of accidents resulting in a concussion with transient symptoms (low severity) and SDHs revealed a positive relationship between an increase in head dynamic response and the risk for more serious brain injury. This type of relationship was not found for brain tissue stress and strain results derived by finite element analysis. Future research should be undertaken using a larger sample size to confirm these initial findings. Understanding the relationship between the head dynamic and brain tissue response and the nature of the injury provides important information for developing strategies for injury prevention. © AANS, 2015.},

keywords = {accident, Accident reconstruction, accidental injury, Accidents, Adolescent, adult, Article, Biomechanical Phenomena, Biomechanics, brain, brain concussion, brain stem, brain tissue, Cerebellum, clinical article, comparative study, Concussion, controlled study, Female, finite element analysis, Finite element modelling, gray matter, Hematoma, human, Humans, Hybrid iii headform, injury severity, laboratory test, Male, Mechanical, mechanical stress, middle aged, pathology, Pathophysiology, Persistent postconcussive symptoms, PHYSIOLOGY, Post Hoc Analysis, Post-Concussion Syndrome, postconcussion syndrome, priority journal, shear stress, simulation, SPORTS medicine, STATISTICAL significance, Stress, stress strain relationship, Subdural, subdural hematoma, traumatic brain injury, white matter, Young Adult},

pubstate = {published},

tppubtype = {article}

}

Object Concussions typically resolve within several days, but in a few cases the symptoms last for a month or longer and are termed persistent postconcussive symptoms (PPCS). These persisting symptoms may also be associated with more serious brain trauma similar to subdural hematoma (SDH). The objective of this study was to investigate the head dynamic and brain tissue responses of injury reconstructions resulting in concussion, PPCS, and SDH. Methods Reconstruction cases were obtained from sports medicine clinics and hospitals. All subjects received a direct blow to the head resulting in symptoms. Those symptoms that resolved in 9 days or fewer were defined as concussions (n = 3). Those with symptoms lasting longer than 18 months were defined as PPCS (n = 3), and 3 patients presented with SDHs (n = 3). A Hybrid III headform was used in reconstruction to obtain linear and rotational accelerations of the head. These dynamic response data were then input into the University College Dublin Brain Trauma Model to calculate maximum principal strain and von Mises stress. A Kruskal-Wallis test followed by Tukey post hoc tests were used to compare head dynamic and brain tissue responses between injury groups. Statistical significance was set at p < 0.05. Results A significant difference was identified for peak resultant linear and rotational acceleration between injury groups. Post hoc analyses revealed the SDH group had higher linear and rotational acceleration responses (316 g and 23,181 rad/sec2, respectively) than the concussion group (149 g and 8111 rad/sec2, respectively; p < 0.05). No significant differences were found between groups for either brain tissue measures of maximum principal strain or von Mises stress. Conclusions The reconstruction of accidents resulting in a concussion with transient symptoms (low severity) and SDHs revealed a positive relationship between an increase in head dynamic response and the risk for more serious brain injury. This type of relationship was not found for brain tissue stress and strain results derived by finite element analysis. Future research should be undertaken using a larger sample size to confirm these initial findings. Understanding the relationship between the head dynamic and brain tissue response and the nature of the injury provides important information for developing strategies for injury prevention. © AANS, 2015.

Vassilyadi, M; Macartney, G; Barrowman, N; Anderson, P; Dube, K

Symptom experience and quality of life in children after sport-related head injuries: A cross-sectional study Journal Article

In: Pediatric Neurosurgery, vol. 50, no. 4, pp. 196–203, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, adult, affect, Article, Athletic Injuries, behavior disorder, brain concussion, Child, clinical article, clinical assessment, cognitive defect, Cognitive Efficiency Index, complication, Concussion, Concussion Symptom Scale, controlled study, Craniocerebral Trauma, Cross-Sectional Studies, cross-sectional study, fatigue, Female, head injury, headache, human, Humans, Immediate Postconcussion Assessment and Cognitive, Likert scale, Male, memory disorder, mild traumatic brain injury, neuropsychological test, noise, Paediatric patients, Pediatric Quality of Life Inventory, postconcussion syndrome, priority journal, psychology, quality of life, rating scale, scoring system, Sport, sport injury, Sports, symptom, time factor, Time Factors, traumatic brain injury, trends

@article{Vassilyadi2015,

title = {Symptom experience and quality of life in children after sport-related head injuries: A cross-sectional study},

author = {Vassilyadi, M and Macartney, G and Barrowman, N and Anderson, P and Dube, K},

doi = {10.1159/000431232},

year  = {2015},

date = {2015-01-01},

journal = {Pediatric Neurosurgery},

volume = {50},

number = {4},

pages = {196--203},

abstract = {Background: Sports are a major cause of concussions, and little is known about the symptom experience and health-related quality of life (HRQL) in children who remain symptomatic for over 3 months following such head injuries. Methods: A cross-sectional study of children aged 10-18 years was performed who were referred to the Neurosurgery Clinic at our centre following a head injury. Symptom experience was measured using the modified Concussion Symptom Scale, and HRQL was measured using the Pediatric Quality of Life Inventory (PedsQL). The Immediate Postconcussion Assessment and Cognitive Test (ImPACT) was administered to assess neurocognitive and neurobehavioural sequelae. Results: Symptoms with the highest mean symptom scores on a Likert scale of 0-6 in 35 children at the time of assessment included headaches (3.1), poor concentration (2.7), memory problems (2.1), fatigue (2.1) and sensitivity to noise (2.0). Compared with normative data, children in this study had ImPACT summary scores between the 28th and 38th percentiles and a comparably low Cognitive Efficiency Index score. Mean scores for females were consistently statistically significantly lower (p \< 0.05) than for males across all of the HRQL domains. Trouble falling asleep and memory problems explained 62% of the variance in the PedsQL total scores. Conclusions: Children continue to experience many symptoms at least 3 months following sport-related head injuries that significantly impact their HRQL and neurocognitive abilities. © 2015 S. Karger AG, Basel.},

keywords = {Adolescent, adult, affect, Article, Athletic Injuries, behavior disorder, brain concussion, Child, clinical article, clinical assessment, cognitive defect, Cognitive Efficiency Index, complication, Concussion, Concussion Symptom Scale, controlled study, Craniocerebral Trauma, Cross-Sectional Studies, cross-sectional study, fatigue, Female, head injury, headache, human, Humans, Immediate Postconcussion Assessment and Cognitive, Likert scale, Male, memory disorder, mild traumatic brain injury, neuropsychological test, noise, Paediatric patients, Pediatric Quality of Life Inventory, postconcussion syndrome, priority journal, psychology, quality of life, rating scale, scoring system, Sport, sport injury, Sports, symptom, time factor, Time Factors, traumatic brain injury, trends},

pubstate = {published},

tppubtype = {article}

}

Alexander, D G; Shuttleworth-Edwards, A B; Kidd, M; Malcolm, C M

Mild traumatic brain injuries in early adolescent rugby players: Long-term neurocognitive and academic outcomes Journal Article

In: Brain Injury, vol. 29, no. 9, pp. 1113–1125, 2015.

Abstract | Links | BibTeX | Tags: academic achievement, Academic performance, ADOLESCENCE, Adolescent, adolescent disease, adult, Article, Athletic Injuries, brain concussion, Brain Injuries, Child, cognition, Concussion, controlled study, Educational Status, football, human, Humans, Injuries, intelligence test, Intelligence Tests, Longitudinal studies, longitudinal study, major clinical study, Male, mild traumatic brain injury, mTBI, neurocognitive, neuropsychological test, Neuropsychological Tests, Pathophysiology, Prospective Studies, prospective study, psychologic test, psychology, rugby, SOUTH Africa, sport injury, TASK performance, traumatic brain injury, treatment outcome

@article{Alexander2015,

title = {Mild traumatic brain injuries in early adolescent rugby players: Long-term neurocognitive and academic outcomes},

author = {Alexander, D G and Shuttleworth-Edwards, A B and Kidd, M and Malcolm, C M},

doi = {10.3109/02699052.2015.1031699},

year  = {2015},

date = {2015-01-01},

journal = {Brain Injury},

volume = {29},

number = {9},

pages = {1113--1125},

abstract = {Background: Information is scant concerning enduring brain injury effects of participation in the contact sport of Rugby Union (hereafter rugby) on early adolescents.Objective: The objective was prospectively to investigate differences between young adolescent male rugby players and non-contact sports controls on neurocognitive test performance over 3 years and academic achievement over 6 years.Method: A sample of boys from the same school and grade was divided into three groups: rugby with seasonal concussions (n = 45), rugby no seasonal concussions (n = 21) and non-contact sports controls (n = 30). Baseline neurocognitive testing was conducted pre-season in Grade 7 and post-season in Grades 8 and 9. Year-end academic grades were documented for Grades 6-9 and 12 (pre-high school to year of school leaving). A mixed model repeated measures ANOVA was conducted to investigate comparative neurocognitive and academic outcomes between the three sub-groups.Results: Compared with controls, both rugby groups were significantly lower on the WISC-III Coding Immediate Recall sub-test. There was a significant interaction effect on the academic measure, with improved scores over time for controls, that was not in evidence for either rugby group.Conclusions: Tentatively, the outcome suggests cognitive vulnerability in association with school level participation in rugby. © 2015 Taylor \& Francis Group, LLC.},

keywords = {academic achievement, Academic performance, ADOLESCENCE, Adolescent, adolescent disease, adult, Article, Athletic Injuries, brain concussion, Brain Injuries, Child, cognition, Concussion, controlled study, Educational Status, football, human, Humans, Injuries, intelligence test, Intelligence Tests, Longitudinal studies, longitudinal study, major clinical study, Male, mild traumatic brain injury, mTBI, neurocognitive, neuropsychological test, Neuropsychological Tests, Pathophysiology, Prospective Studies, prospective study, psychologic test, psychology, rugby, SOUTH Africa, sport injury, TASK performance, traumatic brain injury, treatment outcome},

pubstate = {published},

tppubtype = {article}

}

Hinton-Bayre, A D

Normative Versus Baseline Paradigms for Detecting Neuropsychological Impairment Following Sports-Related Concussion Journal Article

In: Brain Impairment, vol. 16, no. 2, pp. 80–89, 2015.

Abstract | Links | BibTeX | Tags: adult, Article, athlete, Australian, Concussion, controlled study, data processing, diagnostic test accuracy study, disease association, disease classification, human, major clinical study, Male, medical assessment, mild traumatic brain injury, neurocognitive, neuropsychological test, Patient Assessment, psychopathy, receiver operating characteristic, reference value, reliability, reliable change, rugby, scoring system, sensitivity analysis, Sensitivity and Specificity, sport injury

@article{Hinton-Bayre2015,

title = {Normative Versus Baseline Paradigms for Detecting Neuropsychological Impairment Following Sports-Related Concussion},

author = {Hinton-Bayre, A D},

doi = {10.1017/BrImp.2015.14},

year  = {2015},

date = {2015-01-01},

journal = {Brain Impairment},

volume = {16},

number = {2},

pages = {80--89},

abstract = {Objective: Obtaining baseline neuropsychological (NP) data to assist management of sports-related concussion has been considered the standard of care. The validity of this approach has been questioned, with suggestions that post-concussion testing alone will suffice. The present study compared the sensitivity of baseline and normative paradigms in the setting of sports-related concussion. Method: Baseline NP data were collected for 194 Australian rugby league athletes on a brief battery of paper-and-pencil NP tests. During competition, 27 athletes sustaining concussion referred from a sports physician were retested within two days of injury. Twenty-six uninjured controls were assessed at similar intervals. The baseline paradigm was assessed using a reliable change index for pre- and post-concussion scores. The normative paradigm was assessed comparing the post-concussion score to a normative mean. Results: The baseline paradigm was consistently more sensitive to negative change following concussion than the normative paradigm when using continuous data, despite reasonable agreement. However, when data were categorised as 'impaired' or 'not-impaired', using either 68% or 90% confidence intervals, the difference between paradigms failed to reach significance. Comparison of ROC curves for both paradigms found superior overall classification for one test and the composite score using baseline comparison data. Conclusions: Despite being a time and resource intensive process, the baseline paradigm as a repeated-measures design may be more sensitive than the between-subjects design of the normative paradigm for detecting changes following concussion. Further work is required to determine the validity of normative assessment in sports-related concussion. Copyright © Australasian Society for the Study of Brain Impairment 2015.},

keywords = {adult, Article, athlete, Australian, Concussion, controlled study, data processing, diagnostic test accuracy study, disease association, disease classification, human, major clinical study, Male, medical assessment, mild traumatic brain injury, neurocognitive, neuropsychological test, Patient Assessment, psychopathy, receiver operating characteristic, reference value, reliability, reliable change, rugby, scoring system, sensitivity analysis, Sensitivity and Specificity, sport injury},

pubstate = {published},

tppubtype = {article}

}

Maerlender, A; Rieman, W; Lichtenstein, J; Condiracci, C

Programmed physical exertion in recovery from sports-related concussion: A randomized pilot study Journal Article

In: Developmental Neuropsychology, vol. 40, no. 5, pp. 273–278, 2015.

Abstract | Links | BibTeX | Tags: adult, brain concussion, controlled study, CONVALESCENCE, exercise, Female, human, Humans, Male, motor activity, Physical Exertion, Pilot Projects, pilot study, randomized controlled trial, Recovery of Function, Sport, Sports, time, Time Factors, treatment outcome

Mayer, A R; Ling, J M; Dodd, A B; Gasparovic, C; Klimaj, S D; Meier, T B

A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters Journal Article

In: Journal of Neurotrauma, vol. 32, no. 22, pp. 1759–1767, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult

@article{Mayer2015b,

title = {A Longitudinal Assessment of Structural and Chemical Alterations in Mixed Martial Arts Fighters},

author = {Mayer, A R and Ling, J M and Dodd, A B and Gasparovic, C and Klimaj, S D and Meier, T B},

doi = {10.1089/neu.2014.3833},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Neurotrauma},

volume = {32},

number = {22},

pages = {1759--1767},

abstract = {Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p \> 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples. © Mary Ann Liebert, Inc. 2015.},

keywords = {Adolescent, adult, Article, biological marker, Biomarkers, BRAIN chemistry, brain concussion, brain cortex, brain size, Cerebral Cortex, CHOLINE, clinical article, cognition, Concussion, controlled study, cortical thickness (brain), creatine, executive function, Female, follow up, Follow-Up Studies, frontal gyrus, glutamic acid, glutamine, human, Humans, Injuries, inositol, Longitudinal, Longitudinal studies, longitudinal study, Magnetic Resonance Imaging, Male, martial art, Martial Arts, Memory, middle aged, mixed martial art, n acetylaspartic acid, neuropsychological test, Neuropsychological Tests, nuclear magnetic resonance imaging, NUCLEAR magnetic resonance spectroscopy, occipital cortex, pathology, posterior cingulate, psychology, repetitive injury, Spectroscopy, volumetrics, white matter, Young Adult},

pubstate = {published},

tppubtype = {article}

}

Growing evidence suggests that temporally proximal acute concussions and repetitive subconcussive head injuries may lead to long-term neurological deficits. However, the underlying mechanisms of injury and their relative time-scales are not well documented in human injury models. The current study therefore investigated whether biomarkers of brain chemistry (magnetic resonance [MR] spectroscopy: N-acetylaspartate [NAA], combined glutamate and glutamine [Glx], total creatine [Cre], choline compounds [Cho], and myo-inositol [mI]) and structure (cortical thickness, white matter [WM]/subcortical volume) differed between mixed martial artists (MMA; n = 13) and matched healthy controls (HC) without a history of contact sport participation (HC; n = 14). A subset of participants (MMA = 9; HC = 10) returned for follow-up visits, with MMA (n = 3) with clinician-documented acute concussions also scanned serially. As expected, MMA self-reported a higher incidence of previous concussions and significantly more cognitive symptoms during prior concussion recovery. Fighters also exhibited reduced memory and processing speed relative to controls on neuropsychological testing coupled with cortical thinning in the left posterior cingulate gyrus and right occipital cortex at baseline assessment. Over a 1-year follow-up period, MMA experienced a significant decrease in both WM volume and NAA concentration, as well as relative thinning in the left middle and superior frontal gyri. These longitudinal changes did not correlate with self-reported metrics of injury (i.e., fight diary). In contrast, HC did not exhibit significant longitudinal changes over a 4-month follow-up period (p > 0.05). Collectively, current results provide preliminary evidence of progressive changes in brain chemistry and structure over a relatively short time period in individuals with high exposure to repetitive head hits. These findings require replication in independent samples. © Mary Ann Liebert, Inc. 2015.

Stone Jr., M E; Safadjou, S; Farber, B; Velazco, N; Man, J; Reddy, S H; Todor, R; Teperman, S

Utility of the Military Acute Concussion Evaluation as a screening tool for mild traumatic brain injury in a civilian trauma population Journal Article

In: Journal of Trauma and Acute Care Surgery, vol. 79, no. 1, pp. 147–151, 2015.

Abstract | Links | BibTeX | Tags: Adolescent, adult, aged, Alcoholic Intoxication, amnesia, Article, assessment of humans, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion screening, Confounding Factors (Epidemiology), controlled study, DATA analysis, Demography, diagnostic test accuracy study, Dizziness, emergency health service, Female, Head, headache, hospital admission, human, Humans, injury severity, irritability, major clinical study, Male, middle aged, mild traumatic brain injury, Military Acute Concussion Evaluation, military medicine, nausea and vomiting, predictive value, priority journal, quality control, receiver operating characteristic, ROC Curve, screening test, Sensitivity and Specificity, traumatic brain injury, unconsciousness, Urban Population, visual disorder, Young Adult

@article{StoneJr.2015,

title = {Utility of the Military Acute Concussion Evaluation as a screening tool for mild traumatic brain injury in a civilian trauma population},

author = {{Stone Jr.}, M E and Safadjou, S and Farber, B and Velazco, N and Man, J and Reddy, S H and Todor, R and Teperman, S},

doi = {10.1097/TA.0000000000000679},

year  = {2015},

date = {2015-01-01},

journal = {Journal of Trauma and Acute Care Surgery},

volume = {79},

number = {1},

pages = {147--151},

abstract = {BACKGROUND: Mild traumatic brain injury (mTBI) constitutes 75% of more than 1.5 million traumatic brain injuries annually. There exists no consensus on point-of-care screening for mTBI. The Military Acute Concussion Evaluation (MACE) is a quick and easy test used by the US Army to screen for mTBI; however, its utility in civilian trauma is unclear. It has two parts: a history section and the Standardized Assessment of Concussion (SAC) score (0-30) previously validated in sports injury. As a performance improvement project, our institution sought to evaluate the MACE as a concussion screening tool that could be used by housestaff in a general civilian trauma population. METHODS: From June 2013 to May 2014, patients 18 years to 65 years old with suspected concussion were given the MACE within 72 hours of admission to our urban Level I trauma center. Patients with a positive head computed tomography were excluded. Demographic data and MACE scores were recorded in prospect. Concussion was defined as loss of consciousness and/or posttraumatic amnesia; concussed patients were compared with those nonconcussed. Sensitivity and specificity for each respective MACE score were used to plot a receiver operating characteristic (ROC) curve. An ROC curve area of 0.8 was set as the benchmark for a good screening test to distinguish concussion from nonconcussion. RESULTS: There were 84 concussions and 30 nonconcussed patients. Both groups were similar; however, the concussion group had a lower mean MACE score than the nonconcussed patients. Data analysis demonstrated the sensitivity and specificity of a range of MACE scores used to generate an ROC curve area of only 0.65. CONCLUSION: The MACE showed a lower mean score for individuals with concussion, defined by loss of consciousness and/or posttraumatic amnesia. However, the ROC curve area of 0.65 highly suggests that MACE alone would be a poor screening test for mTBI in a general civilian trauma population. LEVEL OF EVIDENCE: Diagnostic study, level II. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.},

keywords = {Adolescent, adult, aged, Alcoholic Intoxication, amnesia, Article, assessment of humans, brain concussion, Brain Injuries, clinical assessment tool, computer assisted tomography, Concussion screening, Confounding Factors (Epidemiology), controlled study, DATA analysis, Demography, diagnostic test accuracy study, Dizziness, emergency health service, Female, Head, headache, hospital admission, human, Humans, injury severity, irritability, major clinical study, Male, middle aged, mild traumatic brain injury, Military Acute Concussion Evaluation, military medicine, nausea and vomiting, predictive value, priority journal, quality control, receiver operating characteristic, ROC Curve, screening test, Sensitivity and Specificity, traumatic brain injury, unconsciousness, Urban Population, visual disorder, Young Adult},

pubstate = {published},

tppubtype = {article}

}

BACKGROUND: Mild traumatic brain injury (mTBI) constitutes 75% of more than 1.5 million traumatic brain injuries annually. There exists no consensus on point-of-care screening for mTBI. The Military Acute Concussion Evaluation (MACE) is a quick and easy test used by the US Army to screen for mTBI; however, its utility in civilian trauma is unclear. It has two parts: a history section and the Standardized Assessment of Concussion (SAC) score (0-30) previously validated in sports injury. As a performance improvement project, our institution sought to evaluate the MACE as a concussion screening tool that could be used by housestaff in a general civilian trauma population. METHODS: From June 2013 to May 2014, patients 18 years to 65 years old with suspected concussion were given the MACE within 72 hours of admission to our urban Level I trauma center. Patients with a positive head computed tomography were excluded. Demographic data and MACE scores were recorded in prospect. Concussion was defined as loss of consciousness and/or posttraumatic amnesia; concussed patients were compared with those nonconcussed. Sensitivity and specificity for each respective MACE score were used to plot a receiver operating characteristic (ROC) curve. An ROC curve area of 0.8 was set as the benchmark for a good screening test to distinguish concussion from nonconcussion. RESULTS: There were 84 concussions and 30 nonconcussed patients. Both groups were similar; however, the concussion group had a lower mean MACE score than the nonconcussed patients. Data analysis demonstrated the sensitivity and specificity of a range of MACE scores used to generate an ROC curve area of only 0.65. CONCLUSION: The MACE showed a lower mean score for individuals with concussion, defined by loss of consciousness and/or posttraumatic amnesia. However, the ROC curve area of 0.65 highly suggests that MACE alone would be a poor screening test for mTBI in a general civilian trauma population. LEVEL OF EVIDENCE: Diagnostic study, level II. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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