Sport-Related Structural Brain Injury and Return to Play: Systematic Review and Expert Insight

Neurosurgery ◽  
2021 ◽  
Author(s):  
Scott L Zuckerman ◽  
Aaron M Yengo-Kahn ◽  
Alan R Tang ◽  
Julian E Bailes ◽  
Kathryn Beauchamp ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Injury ◽  
Case Reports ◽  
Operative Management ◽  
Return To Play ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Expert Opinions ◽  
Meta Analyses ◽  
Structural Brain

Abstract BACKGROUND Sport-related structural brain injury (SRSBI) is intracranial pathology incurred during sport. Management mirrors that of non-sport-related brain injury. An empirical vacuum exists regarding return to play (RTP) following SRSBI. OBJECTIVE To provide key insight for operative management and RTP following SRSBI using a (1) focused systematic review and (2) survey of expert opinions. METHODS A systematic literature review of SRSBI from 2012 to present in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a cross-sectional survey of RTP in SRSBI by 31 international neurosurgeons was conducted. RESULTS Of 27 included articles out of 241 systematically reviewed, 9 (33.0%) case reports provided RTP information for 12 athletes. To assess expert opinion, 31 of 32 neurosurgeons (96.9%) provided survey responses. For acute, asymptomatic SRSBI, 12 (38.7%) would not operate. Of the 19 (61.3%) who would operate, midline shift (63.2%) and hemorrhage size > 10 mm (52.6%) were the most common indications. Following SRSBI with resolved hemorrhage, with or without burr holes, the majority of experts (>75%) allowed RTP to high-contact/collision sports at 6 to 12 mo. Approximately 80% of experts did not endorse RTP to high-contact/collision sports for athletes with persistent hemorrhage. Following craniotomy for SRSBI, 40% to 50% of experts considered RTP at 6 to 12 mo. Linear regression revealed that experts allowed earlier RTP at higher levels of play (β = –0.58, 95% CI –0.111, –0.005, P = .033). CONCLUSION RTP decisions following structural brain injury in athletes are markedly heterogeneous. While individualized RTP decisions are critical, aggregated expert opinions from 31 international sports neurosurgeons provide key insight. Level of play was found to be an important consideration in RTP determinations.

scholarly journals Mortality of Diabetes-related Acute Metabolic Emergencies in COVID-19 patients: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Vasileios P. Papadopoulos ◽  
Peny Avramidou ◽  
Stefania-Aspasia Bakola ◽  
Dimitra-Geogia Zikoudi ◽  
Ntilara Touzlatzi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Diabetic Ketoacidosis ◽  
Critical Appraisal ◽  
Case Reports ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Meta Analyses

AbstractPurposeLittle is known on the mortality rate in COVID-19 related acute metabolic emergencies, namely diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS), combined DKA/HHS, and euglycaemic diabetic ketoacidosis (EDKA).MethodsA systematic literature review was conducted using EMBASE, PubMed/Medline, and Google Scholar from January 1, 2020 to January 9, 2021 to identify all case report series, cross-sectional studies, and meta-analyses of case reports describing mortality rate in DKA, HHS, and EDKA, in COVID-19 patients. The Joanna Briggs Institute critical appraisal checklist for case reports was used for quality assessment.ResultsFrom 313 identified publications, 4 fulfilled the inclusion criteria and analyzed qualitatively and quantitatively. A systematic review and meta-analysis with subgroup analyses examined mortality rate in a total of 152 COVID-19 patients who had developed DKA, HHS, combined DKA/HHS, or EDKA. Combined mortality rate and confidence intervals (CI) were estimated using random effects model. The study was registered to PROSPERO database (ID: 230737).ResultsCombined mortality rate was found to be 27.1% [95% CI: 11.2-46.9%]. Heterogeneity was considerable (I2=83%; 95% CI: 56-93%), corrected to 67% according to Von Hippel adjustment for small meta-analyses. Funnel plot presented no apparent asymmetry; Egger’s and Begg’s test yielded in P=0.44 and P=0.50, respectively. Sensitivity analysis failed to explain heterogeneity.ConclusionCOVID-19 related acute metabolic emergencies (DKA, HHS, and EDKA) are characterized by considerable mortality; thus, clinicians should be aware of timely detection and immediate treatment commencing.

scholarly journals Complications in adolescent pregnancy: systematic review of the literature

2015 ◽  
Vol 13 (4) ◽  
pp. 618-626 ◽  
Author(s):  
Walter Fernandes de Azevedo ◽  
Michele Baffi Diniz ◽  
Eduardo Sérgio Valério Borges da Fonseca ◽  
Lícia Maria Ricarte de Azevedo ◽  
Carla Braz Evangelista
Keyword(s):  
Systematic Review ◽  
Adolescent Pregnancy ◽  
Cesarean Delivery ◽  
Case Reports ◽  
Unwanted Pregnancy ◽  
Case Series ◽  
Medical Subject Headings ◽  
Maternal Complications ◽  
Cross Sectional ◽  
Meta Analyses

Sexual activity during adolescence can lead to unwanted pregnancy, which in turn can result in serious maternal and fetal complications. The present study aimed to evaluate the complications related to adolescent pregnancy, through a systematic review using the Medical Subject Headings: “pregnancy complication” AND “adolescent” OR “pregnancy in adolescence”. Only full original articles in English or Portuguese with a clearly described methodology, were included. No qualitative studies, reviews or meta-analyses, editorials, case series, or case reports were included. The sample consisted of 15 articles; in that 10 were cross-sectional and 5 were cohort studies. The overall prevalence of adolescent pregnancy was 10%, and among the Brazilian studies, the adolescent pregnancy rate was 26%. The cesarean delivery rate was lower than that reported in the general population. The main maternal and neonatal complications were hypertensive disorders of pregnancy, prematurity and low birth weight, respectively. Adolescent pregnancy is related to increased frequency of neonatal and maternal complications and lower prevalence of cesarean delivery.

scholarly journals Sport-related structural brain injury associated with arachnoid cysts: a systematic review and quantitative analysis

2016 ◽  
Vol 40 (4) ◽  
pp. E9 ◽  
Author(s):  
Scott L. Zuckerman ◽  
Colin T. Prather ◽  
Aaron M. Yengo-Kahn ◽  
Gary S. Solomon ◽  
Allen K. Sills ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quantitative Analysis ◽  
Brain Injury ◽  
Neurological Deficit ◽  
Motor Vehicle ◽  
Case Reports ◽  
Case Series ◽  
Arachnoid Cysts ◽  
Cystoperitoneal Shunt ◽  
Structural Brain

OBJECTIVE Arachnoid cysts (ACs) are congenital lesions bordered by an arachnoid membrane. Researchers have postulated that individuals with an AC demonstrate a higher rate of structural brain injury after trauma. Given the potential neurological consequences of a structural brain injury requiring neurosurgical intervention, the authors sought to perform a systematic review of sport-related structural-brain injury associated with ACs with a corresponding quantitative analysis. METHODS Titles and abstracts were searched systematically across the following databases: PubMed, Embase, CINAHL, and PsycINFO. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed case reports, case series, or observational studies that reported a structural brain injury due to a sport or recreational activity (hereafter referred to as sport-related) with an associated AC were included. Patients were excluded if they did not have an AC, suffered a concussion without structural brain injury, or sustained the injury during a non–sport-related activity (e.g., fall, motor vehicle collision). Descriptive statistical analysis and time to presentation data were summarized. Univariate logistic regression models to assess predictors of neurological deficit, open craniotomy, and cystoperitoneal shunt were completed. RESULTS After an initial search of 994 original articles, 52 studies were found that reported 65 cases of sport-related structural brain injury associated with an AC. The median age at presentation was 16 years (range 4–75 years). Headache was the most common presenting symptom (98%), followed by nausea and vomiting in 49%. Thirteen patients (21%) presented with a neurological deficit, most commonly hemiparesis. Open craniotomy was the most common form of treatment (49%). Bur holes and cyst fenestration were performed in 29 (45%) and 31 (48%) patients, respectively. Seven patients (11%) received a cystoperitoneal shunt. Four cases reported medical management only without any surgical intervention. No significant predictors were found for neurological deficit or open craniotomy. In the univariate model predicting the need for a cystoperitoneal shunt, the odds of receiving a shunt decreased as age increased (p = 0.004, OR 0.62 [95% CI 0.45–0.86]) and with male sex (p = 0.036, OR 0.15 [95% CI 0.03–0.88]). CONCLUSIONS This systematic review yielded 65 cases of sport-related structural brain injury associated with ACs. The majority of patients presented with chronic symptoms, and recovery was reported generally to be good. Although the review is subject to publication bias, the authors do not find at present that there is contraindication for patients with an AC to participate in sports, although parents and children should be counseled appropriately. Further studies are necessary to better evaluate AC characteristics that could pose a higher risk of adverse events after trauma.

scholarly journals Structural brain injury in sports-related concussion

2012 ◽  
Vol 33 (6) ◽  
pp. E6 ◽  
Author(s):  
Scott L. Zuckerman ◽  
Andrew Kuhn ◽  
Michael C. Dewan ◽  
Peter J. Morone ◽  
Jonathan A. Forbes ◽  
...  
Keyword(s):  
Brain Injury ◽  
Literature Review ◽  
Brain Injuries ◽  
Case Reports ◽  
Head Injuries ◽  
Health Concern ◽  
Prevalence Data ◽  
Small Series ◽  
Structural Brain

Object Sports-related concussions (SRCs) represent a significant and growing public health concern. The vast majority of SRCs produce mild symptoms that resolve within 1–2 weeks and are not associated with imaging-documented changes. On occasion, however, structural brain injury occurs, and neurosurgical management and intervention is appropriate. Methods A literature review was performed to address the epidemiology of SRC with a targeted focus on structural brain injury in the last half decade. MEDLINE and PubMed databases were searched to identify all studies pertaining to structural head injury in sports-related head injuries. Results The literature review yielded a variety of case reports, several small series, and no prospective cohort studies. Conclusions The authors conclude that reliable incidence and prevalence data related to structural brain injuries in SRC cannot be offered at present. A prospective registry collecting incidence, management, and follow-up data after structural brain injuries in the setting of SRC would be of great benefit to the neurosurgical community.

scholarly journals Occupational Asthma in Antibiotic Manufacturing Workers: Case Reports and Systematic Review

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Sara Díaz Angulo ◽  
Joanna Szram ◽  
Jenny Welch ◽  
Julie Cannon ◽  
Paul Cullinan
Keyword(s):  
Systematic Review ◽  
Occupational Asthma ◽  
Case Reports ◽  
Bronchial Hyperresponsiveness ◽  
Specific Ige ◽  
Review Of The Literature ◽  
Cross Sectional ◽  
Immunological Tests ◽  
Asthmatic Reaction ◽  
Provocation Testing

Background. The risks of occupational asthma (OA) from antibiotics are uncertain. We report 4 new cases and a systematic review of the literature. Methods. Cases were identified through a specialist clinic, each underwent specific provocation testing (SPT). We subsequently reviewed the published literature. Results. The patients were employed in the manufacture of antibiotics; penicillins were implicated in three cases, in the fourth erythromycin, not previously reported to cause OA. In two, there was evidence of specific IgE sensitisation. At SPT each developed a late asthmatic reaction and increased bronchial hyperresponsiveness. 36 case reports have been previously published, 26 (citing penicillins or cephalosporins). Seven cross-sectional workplace-based surveys found prevalences of 5–8%. Conclusions. OA in antibiotic manufacturers may be more common than is generally recognised. Its pathogenesis remains unclear; immunological tests are of uncertain value and potential cases require confirmation with SPT. Further study of its frequency, mechanisms, and diagnosis is required.

Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review

2021 ◽  
pp. 036354652110389
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Matthew G. Davey ◽  
Jordan W. Fried ◽  
Andrew J. Hughes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Operative Management ◽  
Return To Play ◽  
Return To Sports ◽  
Level Of Evidence ◽  
The Mean

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.

Rehabilitation outcomes of persons with severe traumatic brain injury: A cross-sectional survey

2021 ◽  
Vol 53 (1) ◽  
pp. 31
Author(s):  
Selvaraj Samuelkamaleshkumar ◽  
CatherineJudithHossanna ◽  
Ranjan Aruna ◽  
Suresh Annpatriciacatherine ◽  
Stephen Reethajanetsurekha ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Rehabilitation Outcomes

scholarly journals Parkinson’s Disease and Metal Storage Disorders: A Systematic Review

2018 ◽  
Vol 8 (11) ◽  
pp. 194 ◽  
Author(s):  
Edward Botsford ◽  
Jayan George ◽  
Ellen Buckley
Keyword(s):  
Systematic Review ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Wilson’S Disease ◽  
Case Reports ◽  
Hereditary Hemochromatosis ◽  
Wilson's Disease ◽  
Neurological Dysfunction ◽  
Cross Sectional ◽  
Storage Disorders

Metal storage disorders (MSDs) are a set of rare inherited conditions with variable clinical pictures including neurological dysfunction. The objective of this study was, through a systematic review, to identify the prevalence of Parkinsonism in patients with MSDs in order to uncover novel pathways implemented in Parkinson’s disease. Human studies describing patients of any age with an MSD diagnosis were analysed. Foreign language publications as well as animal and cellular studies were excluded. Searches were conducted through PubMed and Ovid between April and September 2018. A total of 53 publications were identified including 43 case reports, nine cross-sectional studies, and one cohort study. The publication year ranged from 1981 to 2018. The most frequently identified MSDs were Pantothenate kinase-associated neurodegeneration (PKAN) with 11 papers describing Parkinsonism, Hereditary hemochromatosis (HH) (7 papers), and Wilson’s disease (6 papers). The mean ages of onset of Parkinsonism for these MSDs were 33, 53, and 48 years old, respectively. The Parkinsonian features described in the PKAN and HH patients were invariably atypical while the majority (4/6) of the Wilson’s disease papers had a typical picture. This paper has highlighted a relationship between MSDs and Parkinsonism. However, due to the low-level evidence identified, further research is required to better define what the relationship is.

The methodological quality of dose-response meta-analyses needed substantial improvement: a cross-sectional survey and proposed recommendations

2019 ◽  
Vol 107 ◽  
pp. 1-11 ◽  
Author(s):  
Chang Xu ◽  
Yu Liu ◽  
Peng-Li Jia ◽  
Ling Li ◽  
Tong-Zu Liu ◽  
...  
Keyword(s):  
Dose Response ◽  
Methodological Quality ◽  
Substantial Improvement ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Meta Analyses
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