Showing posts with label concussion. Show all posts
Showing posts with label concussion. Show all posts

Friday, May 15, 2015

Heads Up: A New Study on Concussion and Its Adverse Effects on Academics

By: Lewis First, MD, MS; Editor-in-Chief      

          It is rare not to have a study in our journal on some new aspect of concussion usually focused on the diagnosis and treatment of this serious head injury.  The after-effects of concussion in children seem not to get as much attention as the acute presentation, but this week Ransom et al. (doi: 10.1542/peds.2014-3434) report on their study of almost 350 children and teens for whom parents reported academic concerns in the aftermath of the injury as documented on a structured questionnaire completed by parents within four weeks of the event.   
     The authors also measured the presence or absence of post-concussive symptoms as well as recovery status and level of schooling.  The results suggest that the more severe the symptoms are upon return to school or the higher the academic grade level, the more parents raised concern about academic learning and performance in their child.  Can a school-based plan  based on severity of symptoms for returning to the classroom as well as the level of activity recommended reduce the impact of injury on school performance as well as improve time to recovery?  
      Reading this study suggests that would be the next step in your local school district—so hopefully with guidance from the AAP’s 2013 clinical report on “Returning to Learning Following a Concussion” (REF) and sharing of this study with your local school district, a more unified evidence-based approach to reducing academic difficulties post-concussion can be achieved.

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Friday, February 6, 2015

Headaches after Minor Blunt Head Trauma: Cause for Alarm or a Reassuring Symptom?

     Recognizing the earliest signs of a traumatic brain injury can be life-saving but what if that sign is a headache and the injury to the head is a mild one? Should these children get further investigated with neuroimaging or can we be reassured if headache is the only symptom present?
     Dayan et al. ( (doi:10.1542/peds.2014-2695)) investigated this concern by looking prospectively at a cohort of more than 12,000 children between the ages of 2 to 18 years who experienced minor blunt head trauma as characterized by a Glasgow Coma Score of 14 or 15.  The investigators then recorded whether headache was present and whether injury was noted on CT scan as well as whether it was a clinically-important traumatic brain injury.       
     Almost 20% of this cohort had isolated headaches with less than 1% showing a CT finding and none having a clinically significant traumatic brain injury.  Is this study enough to convince you to not image a child who has had a mild injury and headache only—or will you still want to get that head scan?  We think this study may result in less scans ordered—but would love to hear your take as well.  Share your comments via a response to this blog or via an e-letter or post on our Facebook and Twitter sites. 
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Wednesday, January 7, 2015

Strict Rest Following a Concussion. Heads Up on An Interesting Study!

By: Lewis First, MD, MS; Editor-in-Chief
Bethesda Naval Medical Center
     We certainly have become familiar with the recommendations for strict rest following a concussion. Often we council families to rest for 5 days before considering return to school or return to play activity—but how much better is 5 days versus fewer days before a step-wise return to activity?
     Thomas et al. (doi:10.1542/peds.2014-0966) sought to answer that question through a methodologically sound randomized controlled trial involving 45 intervention subjects 11-22 years of age who received recommendations for 5 days of strict bed rest  and 43 control subjects told to return to normal activity following 1-2 days of rest. 
      The result will surprise you. The group that got the prolonged rest had more post-concussive symptoms and slower symptom recovery. Just why did this study showed findings that differ from others?  That is the subject of discussion by the authors as well as by Doctors William Meehan and Richard Bachur (doi:10.1542/peds.2014-3665in an accompanying commentary to this study.   
      Do you agree with the findings in this study or feel 5 days of bed rest is still the way to head off complications of a serious concussion? Share your thoughts on this article and commentary by responding to this blog, or via an e-letter, or by commenting on our Facebook or Twitter sites.

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Friday, August 15, 2014

Heads Up: Impact Location & Concussion Outcomes in High School Football Collisions

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Erik Drost via Flickr
It seems that concussion studies are appearing more and more frequently in pediatric peer review journals given the seriousness of these head injuries. Yet few, if any, have looked at the importance of impact location until Kerr et al. (doi: 10.1542/peds.2014-0770) examined rates and outcomes of football concussions by location (front, back, side, and top of head).

So does location matter when it comes to where the head is hit? The authors tackled this question using five years’ worth of national sports-related injury surveillance data to determine that although player-to-player collisions were mostly likely to result in front-of-the head concussions, top-of-the-head concussions most frequently caused a lack of consciousness.

The researchers go for the extra point by exploring the importance of proper tackling technique to reduce concussion rates. So read this study and huddle with your football-playing patients to make sure they are doing all they can to reduce their risk of concussion.

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Thursday, June 26, 2014

Acute Concussion Symptom Severity and Delayed Symptom Resolution

Pediatrics Editorial Board Member, Stephen Harris MD, MS, shares his expert perspective on a new article from our July issue. To learn more about Dr. Harris and his work in pediatric medicine, check out our Contributors page.

By: Stephen Harris, MD, MS

child wearing helmet
Photo by Abhisek Sarda via Flickr
During pediatric residency, I used to wear a button that said “I could’a been a brain surgeon,” just to tick off the neurosurgeons. Had I only rested my brain after getting my “bell rung” during my high school hockey days, who knows? Emergency department physicians and those who provide medical care for children now have a variety of practice guidelines, management tools and questionnaires readily available to determine the severity of a concussion, track a patient’s recovery and titrate a slow and safe return to physical and cognitive activities.

Grubenhoff and colleagues, writing in the July issue of Pediatrics (doi: 10.1542/peds.2013-2988), note that 630,000 children 0 to 19 years old visit US emergency departments (ED) for concussion. Citing the evidence that the risk of persistent symptoms may be modifiable, they hypothesized that an elevated symptom score on standardized evaluation at presentation would predict an increased risk of delayed symptom resolution.

Despite careful analysis of a well conducted study, Grubenhoff’s group did not find a target score that was statistically significantly associated with delayed symptom resolution. The authors explain that other studies have shown initial acuity predicts early symptoms, but complex, pre-existing psychological factors come into play to help explain who suffers from prolonged symptoms.

In a secondary analysis, Grubenhoff’s group did find a target score that predicted a higher risk of post-concussive syndrome as defined in the new ICD-10 system. They highlight some similarities between ICD-10 and the clinical criteria they used for delayed symptom resolution, but point out that the diagnostic accuracy of the ICD-10 criteria “is a topic of scientific debate as it is both subjective and imprecise.”

The authors’ call for those working in this research area to refine the definition of post-concussive syndrome should be heeded.

Grubenhoff and colleague’s work supports a continued conservative trajectory in the management of concussion. We now have a more full awareness of the increased risk of cerebral hemorrhage following a “second hit” to the head before one has completely recovered from a concussion—for children or adolescents. We also have an enormous and growing literature on the long-term neurologic and psychiatric consequences that may face those who participate in professional sports where one objective is to savage your opponent.

At the end of the day, any patient suffering a concussion should have close outpatient follow-up and serial symptom assessment following ED discharge.

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Tuesday, May 13, 2014

Heads Up on the Type and Duration of Post-Concussive Symptoms

By: Lewis First, MD, MS

Concurrent with the prominence of concussion as a topic that seems to be garnering more and more attention in the public media have been an array of studies attempting to help us better correctly diagnose and treat this traumatic brain injury. Our journal is no exception to the flurry of solid studies we have recently published on concussion.

Photo by Lindsay Shaver via Flickr
This week, we share a prospective cohort study by Eisenberg et al. (doi: 10.1542/peds. 2014-0158) that uses this longitudinal methodology to track children, teens, and young adults (ages 11-22) seen in an emergency department with acute concussion and then follows them for three months or until symptoms resolved.

The authors track the type of symptom encountered at the time of concussion as well as new symptoms, largely emotional, that develop during the follow-up period. They also chart the time course of symptoms to resolution providing new insight into the natural history and what to expect in the post-concussive time period.

If you want to stay ahead when it comes to knowing about concussion, this study gives you, and in turn the families of your patients, post-concussion information that will allow all of us to better monitor their recovery progress as well as what to expect in the days following the injury. Check out this article and learn more.

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