Characteristics of Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population

Rosenbaum, Philip; Locandro, Christopher; Chrisman, Sara P D; Choe, Meeryo; Richards, Rachel; Pacchia, Christina F.; Cook, Lawrence J.; Rivara, Frederick P.; Gioia, Gérard A.; Giza, Christopher C.

doi:10.1001/jamanetworkopen.2020.21463

Cited by 45 publications

(41 citation statements)

References 42 publications

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“…PTH 3 months and 6 months following injury was more common in those with PTH-M than PTH-NM, but this difference was only significant in the univariable analysis at 3 months ( Table 2 ). Given the strong association between female sex and prolonged recovery in prior studies, 1 , 2 , 17 recovery time and PTH at 3 months was analyzed in each PTH group to compare the sexes. Within each PTH phenotype, there was no significant difference in recovery or rates of PTH at 3 months between the sexes (eTable 5 in the Supplement ).…”

Section: Resultsmentioning

confidence: 99%

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

et al. 2021

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IMPORTANCE The Four Corners Youth Consortium was created to fill the gap in our understanding of youth concussion. This study is the first analysis of posttraumatic headache (PTH) phenotype and prognosis in this cohort of concussed youth. OBJECTIVE To describe the characteristics of youth with PTH and determine whether the PTH phenotype is associated with outcome. DESIGN, SETTING, AND PARTICIPANTS This cohort study examined outcomes from patients in a multi-institutional registry of traumatic brain injury (TBI) clinics from December 2017 to June 2019. Inclusion criteria included being between ages 5 and 18 years at enrollment and presentation within 8 weeks of a mild TBI. Data were analyzed between February 2019 and January 2021. EXPOSURE Mild TBI with standard care. MAIN OUTCOMES AND MEASURES Time to recovery and headache 3 months after injury; measurement device is the Postconcussion Symptom Inventory (PCSI). PTH with migraine phenotype was defined as moderate-severe headache that is new or significantly worse compared with baseline and associated with nausea and/or photophobia and phonophobia. RESULTS A total of 612 patients with 625 concussions were enrolled, of whom 387 patients with 395 concussions consented to participate in this study. One hundred nine concussions were excluded (concussions, rather than patients, were the unit of analysis), leaving 281 participants with 286 concussions (168 [58.7%] girls; 195 [75.6%] White; 238 [83.2%] aged 13-18 years). At the initial visit, 133 concussions (46.5%) were from patients experiencing PTH with a migraine phenotype, 57 (20%) were from patients experiencing PTH with a nonmigraine phenotype, and 96 (34%) were from patients with no PTH. Patients with any PTH after concussion were more likely to have prolonged recovery than those without PTH (median [interquartile range], 89 [48-165] days vs 44 [26-96] days; log-rank P < .001). Patients with PTH and a migraine phenotype took significantly longer to recover than those with nonmigraine phenotype (median [interquartile range], 95 [54-195] days vs 70 [46-119] days; log-rank P = .01). Within each phenotype, there was no significant difference between sexes in recovery or PTH at 3 months.

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Section: Resultsmentioning

confidence: 99%

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

et al. 2021

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“…27 Similarly, pediatric patients, aged 12 to 18 years, with preexisting emotional distress (eg, depression and anxiety) exhibited longer symptom resolution relative to patients without a history of depression or anxiety. 39 Importantly, the authors also reported that girls and women experienced longer recovery times as well as higher percentages of preexisting anxiety compared with men. However, this study included patients presenting to a specialty concussion clinic at a median of 16 days after injury.…”

Section: Discussionmentioning

confidence: 92%

The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion

et al. 2022

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Background: There is growing awareness and clinical interest in athletes with affective symptoms after sport-related concussion (SRC), as these symptoms may contribute to overall symptoms and represent a modifiable risk factor of longer recovery. However, evidence of their effects on the entire return-to-play (RTP) trajectory, particularly among women and men, is limited. Purpose/Hypothesis: To examine the relationship between affective symptom reporting and RTP progression after SRC among a cohort of Division 1 student-athletes. We hypothesized that those endorsing affective symptoms, specifically nervous-anxious symptoms, spend more time in RTP progression and recovery. Study Design: Cohort study; Level of evidence, 3. Methods: Using SRC data from the Ivy League–Big Ten Epidemiology of Concussion Study among varsity athletes through February 2020, we identified the 4 affective symptoms from the Sport Concussion Assessment Tool symptom inventory. We modeled the relationship between a 4-category affective symptom variable and time to symptom resolution, RTP, and RTP progression, adjusting for nonaffective symptom prevalence and concussion history. Cox regressions were used to estimate hazard ratios for time to event outcomes, and linear regressions were used to evaluate mean differences for continuous outcomes. Results: Among 2077 student-athletes (men, 63.5%) with SRC symptoms, affective symptom prevalence was 47.6% and 44.3% in women and men, respectively, and nervous-anxious prevalence was 24.2% and 22.5%, respectively. When comparing women with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with affective symptoms, and women with nervous-anxious symptoms spent significantly longer in RTP progression. When comparing men with and without co-occurring affective symptoms, rates of symptom resolution and RTP were significantly lower in those with co-occurring affective symptoms, and affective symptoms were not associated with time in RTP progression. Conclusion: Student-athletes with affective symptoms and nervous-anxious symptoms exhibited delayed clinical recovery and RTP timelines, particularly for time in RTP. Symptom prevalence and concussion history contributed to this; however, unmeasured confounding remains, as indicated by the poor model fit. This study motivates future work to explore affective symptoms and RTP timelines, considering anxiety and risk/protective factors over time.

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“…According to their comprehensive research, individuals suffering from moderate-to-severe TBI carry an elevated risk of disordered behavior and cognition. These impairments hinder patients' physical and occupational rehabilitation and social reintegration, resulting in an overall poorer quality of life (QoL) [15]. The findings from Schoenhuber and Gentilini also highlighted the relationship between mild head trauma and the risk of later developing certain psychiatric ailments [12].…”

Section: Discussionmentioning

confidence: 99%

Depression and Anxiety in Patients With a History of Traumatic Brain Injury: A Case-Control Study

Al-Kader¹,

Onyechi²,

Ikedum³

et al. 2022

Cureus

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BackgroundThe burden of psychiatric illness following a head injury may have implications on the disease prognosis. The present study evaluated the association of depression and anxiety with traumatic brain injury (TBI). MethodsA case-control study was conducted in Karachi, Pakistan, from 2nd July 2021 and 30th January 2022, including individuals of age 18 and above of both genders, with or without a mild head trauma history, forming the case and control groups, respectively. Individuals with previous head trauma/congenital neurological dysfunction were excluded. A mental health assessment of the participants was carried out with two scales, the Generalized Anxiety Disorder-7 (GAD-7) scale and the Public Health Questionnaire-9 (PHQ-9) scale. Other parameters like age, gender, socioeconomic status, education status, and comorbidities were also documented. ResultsA total of 62 participants were enrolled with 31 cases and 31 controls. The majority were males aged between 18 and 39 years. About 29% of the patients with a history of mild TBI had moderate to severe depression while only 22.6% of them did not have depression or had minimal depression. We found that about 29.3% of patients with TBI had severe anxiety as compared to the only two healthy controls. The majority of the control group participants did not have anxiety. ConclusionTraumatic head injuries and their long-term side effects can predispose patients to a myriad of psychiatric comorbidities. In this study, we found definitive evidence that both anxiety and depression had a significantly higher incidence in cohorts that suffered from mild TBI. However, we recommend large-scale and multicenter studies in the future to explore these relationships more thoroughly and comprehensively.

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Characteristics of Pediatric Mild Traumatic Brain Injury and Recovery in a Concussion Clinic Population

Cited by 45 publications

References 42 publications

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

Evaluation of Posttraumatic Headache Phenotype and Recovery Time After Youth Concussion

The Role of Reported Affective Symptoms and Anxiety in Recovery Trajectories After Sport-Related Concussion

Depression and Anxiety in Patients With a History of Traumatic Brain Injury: A Case-Control Study

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