INITIAL CLINICAL PRESENTATION OF PEDIATRIC PATIENTS WITH PSYCHOLOGICAL DISORDERS FOLLOWING CONCUSSION

Background: There is limited evidence regarding the impact of pre-existing psychological disorders on the initial clinical presentation in pediatric patients following concussion. Hypothesis/Purpose: To examine differences in clinical symptom measures between pediatric patients with a history of depression and/or anxiety and no history of psychological disorder (PD) following a concussion. Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015 and March 2020. Participants aged 5-18 years diagnosed with a concussion were included. Demographic variables and a range of clinical measures from initial presentation were reviewed, including SCAT-5 Symptom Log, Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7) scale, and Brief Resiliency Scale (BRS). Participants were separated into four groups based on self-reported prior diagnosis: depression, anxiety, depression+anxiety, and no PD. Results: A total of 1770 participants were included: 50 with depression, 82 with anxiety, 84 with both, and 1554 with no history of PD. There was no significant difference in age, sex, prior concussion history, or time to presentation between the depression and no PD group, or between the anxiety and no PD group. A significant difference was found between the depression+anxiety group and no PD group in the following variables: age (15.11±1.8 vs 13.68±2.61 years, p<0.001), prior concussion history (40.5% vs 23.9%, p=0.001), and time to presentation (31.47±25.82 vs 19.85±26.33 days, p=0.01). Additionally, there were more females in the depression+anxiety group than the no PD group (71.4% vs 47.8%, p<0.001). The depression, anxiety, and depression+anxiety groups had significantly higher rates of learning disorders than the no PD group (40%, 47.6%, 46.4% vs 16.4%, all p<0.001). A significant difference in SCAT-5 symptom severity scores between the depression, anxiety, and depression+anxiety groups compared to the no PD group was found. The PD groups all reported higher GAD-7 and PHQ-8 scores and lower BRS scores compared to the no PD group. The depression+anxiety group had the highest symptom severity, GAD-7, and PHQ-8 scores along with the lowest BRS score. Table 1.1 summarizes these significant findings. Conclusion: Differences were seen in participants with a history of depression and/or anxiety at initial clinical presentation, including history of learning disability, SCAT-5 symptom severity scores, and common screening tests for depression, anxiety, and resiliency compared to those without a history of PD. Understanding these differences at initial presentation may urge providers to engage multidisciplinary teams early in facilitating patient recovery. Tables/Figures: [Table: see text]

Download Full-text

Impact of Psychological Disorders on Clinical Presentation of Pediatric Patients Following a Concussion

Neurology ◽

10.1212/01.wnl.0000801932.81288.94 ◽

2021 ◽

Vol 98 (1 Supplement 1) ◽

pp. S21.1-S21

Author(s):

Hannah Worrall ◽

Shane Miller ◽

Munro Cullum ◽

Jane Chung

Keyword(s):

Symptom Severity ◽

Pediatric Patients ◽

Clinical Presentation ◽

Psychological Disorders ◽

Initial Presentation ◽

Multidisciplinary Teams ◽

Severity Scores ◽

Significant Difference ◽

History Of ◽

History Of Depression

ObjectiveTo examine differences in clinical symptom measures between pediatric patients with a history of depression and/or anxiety and no history of psychological disorders (PD) following a concussion.BackgroundLimited information exists regarding impact of pre-existing psychological disorders on initial clinical presentation in pediatric patients following concussion.Design/MethodsData were prospectively collected from participants aged 5–18 diagnosed with a concussion between August 2015 and March 2020. Demographics and clinical measures from initial presentation were reviewed, including SCAT-5 Symptom, Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7) scale, and Brief Resiliency Scale (BRS). Participants were separated into 4 groups based on self-reported prior diagnosis: depression, anxiety, both, and no PD.ResultsOne thousand seven hundred seventy participants included: 50 depression, 82 anxiety, 84 both, and 1,554 no PD history. There was no significant difference in age, sex, prior concussion history, or time to presentation between the depression and no PD group, or the anxiety and no PD group. The both group was older, had more females and prior concussions, and presented later than the no PD group. The depression, anxiety, and both groups had higher rates of learning disorders than the no PD group (40%, 47.6%, 46.4% vs 16.4%, all p < 0.001). Each PD group had higher symptom severity scores than the no PD group. The PD groups all reported higher GAD-7 and PHQ-8 scores and lower BRS scores compared to the no PD group. The both group had the highest symptom severity, GAD-7, and PHQ-8 scores along with the lowest BRS score. All findings p = 0.001.ConclusionsDifferences were seen in participants with a history of depression and/or anxiety at initial clinical presentation, including history of learning disability, symptom severity scores, and screening tests for depression, anxiety, and resiliency compared to those without a history of PD. Understanding differences at initial presentation may urge providers to engage multidisciplinary teams in facilitating patient recovery.

Download Full-text

A-32 Acute Concussive Symptom Profiles in Adolescents and Young Adults with History of Depression and Anxiety

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa036.32 ◽

2020 ◽

Vol 35 (5) ◽

pp. 628-628

Author(s):

C Presley ◽

T Meredith-Duliba ◽

T Tarkenton ◽

M Stokes ◽

S Miller ◽

...

Keyword(s):

Young Adults ◽

Symptom Severity ◽

Adolescents And Young Adults ◽

Depression And Anxiety ◽

Cognitive Fatigue ◽

Anxiety Group ◽

Symptom Profiles ◽

Symptom Profile ◽

History Of ◽

History Of Depression

Abstract Objective The aims of this study are (1) to examine the clinical symptom profiles of individuals with depression and/or anxiety history following a concussion and (2) to compare profile differences across groups. Method Participants aged 12-25 (n=129, mean=15.6) with premorbid diagnoses of depression (n=24), anxiety (n=50), or depression+anxiety (n=55) were evaluated within 21 days after sustaining a concussion as part of the North Texas Concussion Registry (ConTex) using the Post-Concussion Symptom Scale (PCSS). Following the model described by Kontos and Collins (2014), symptom clusters were derived from the PCSS to create six domains (cognitive/fatigue, vestibular, ocular, posttraumatic migraine, anxiety/mood, cervical). ANOVAs with Tukey’s post-hoc tests were conducted to compare domain symptom severity and total symptom severity across groups. Results There were no demographic differences between groups. A single symptom profile was prominent across each group, with the primary, secondary, and tertiary symptomatic domains being posttraumatic migraine, ocular, and cognitive/fatigue, respectively. Across each domain the depression+anxiety group was most symptomatic, followed in order by the depression and anxiety groups. The depression+anxiety group reported significantly higher anxiety/mood (M=2.0 vs. M=1.3) and cognitive/fatigue (M=2.9 vs M=2.1) symptom severity compared to the anxiety group. Group differences on total symptom severity approached significance (F=2.83, p=.06). Conclusions The observed symptom profiles suggest that the acute-concussive response is similar in adolescents and young adults with history of depression and/or anxiety. Multiple premorbid conditions, such as depression and anxiety, appear to magnify overall symptom severity. Further research is warranted to understand the relationship between symptom burden and premorbid mental health factors.

Download Full-text

Effect of concussion history on symptom burden and recovery following pediatric sports-related concussion

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.9.peds17392 ◽

2018 ◽

Vol 21 (4) ◽

pp. 401-408 ◽

Cited By ~ 8

Author(s):

Michael Ellis ◽

Cameron Krisko ◽

Erin Selci ◽

Kelly Russell

Keyword(s):

Pediatric Patients ◽

Symptom Burden ◽

Retrospective Chart Review ◽

Initial Assessment ◽

Long Term Effects ◽

Symptom Scale ◽

Clinical Recovery ◽

Significant Difference ◽

History Of ◽

Concussion History

OBJECTIVEThe aim of this study was to examine differences in symptom burden and duration until physician-documented clinical recovery among pediatric patients with sports-related concussion (SRC) with and without a history of concussion.METHODSA retrospective chart review was performed for all pediatric patients (7–19 years old) referred to the Pan Am Concussion Program in Winnipeg, Canada, with an SRC and evaluated < 30 days postinjury between September 1, 2013, and August 1, 2015.RESULTSA total of 322 patients with SRC (64.91% male, mean age 13.96 years) who were evaluated a median of 7 days (interquartile range [IQR] 5–11 days) postinjury were included. Patients without a history of concussion endorsed significantly fewer concussion symptoms at initial assessment (median 5.5 symptoms, IQR 1–10 symptoms) than those with a previous concussion (median 7 symptoms, IQR 2–13.25 symptoms; p = 0.036). The median Post-Concussion Symptom Scale scores were 9 (IQR 1–23) for patients with no concussion history and 13 (IQR 3–33) for those with a history of concussion (p = 0.032). For patients with no previous concussion, the median number of days until physician-documented clinical recovery was 23 (IQR 15–44 days) compared with 25 days (IQR 18–43 days) for those with a history of concussion (p = 0.281). There was no significant difference in the proportion of patients who experienced delayed time until physician-documented clinical recovery (> 1 month postinjury) between the groups (p = 0.584).CONCLUSIONSAlthough a history of concussion may be associated with increased symptom burden following pediatric SRC, there was no difference in the time until physician-documented clinical recovery. Pediatric patients with SRC who have a history of concussion should be managed on an individualized basis. Future work is needed to examine the short- and long-term effects of multiple concussions in children and adolescents.

Download Full-text

A - 03 Concussion Symptom Reporting in Sport-Related Concussions During The COVID-19 Pandemic

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acab035.03 ◽

2021 ◽

Vol 36 (4) ◽

pp. 643-643

Author(s):

Bunt SC ◽

Presley C ◽

Tarkenton T ◽

Wilmoth K ◽

Didehbani N ◽

...

Keyword(s):

Symptom Severity ◽

Assessment Tool ◽

Symptom Reporting ◽

Anxiety And Depression ◽

Young Athletes ◽

North Texas ◽

Symptom Evaluation ◽

Significant Difference ◽

Sport Concussion ◽

History Of

Abstract Objective Evaluation of concussion symptoms is a key element in management of sport-related concussions (SRC). The COVID-19 pandemic has been linked to increased reports of anxiety and depression in the general population, though it is unknown if this increase has also affected reporting of concussion symptoms. The purpose of this study was to determine whether there were differences in reporting of concussion symptoms in adolescents who sustained an SRC before versus during the COVID-19 pandemic. Methods Subjects (n = 707) aged 12–18 with SRC were evaluated within 14 days of injury (M = 5.64 days, SD = 3.68) at a North Texas Concussion Registry (ConTex) clinic and completed the Sport Concussion Assessment Tool-5 (SCAT-5) Symptom Evaluation. Subjects were grouped by those evaluated before (n = 625) or after (n = 82) March 23, 2020 and were similar in age, sex, and history of treatment for anxiety or depression. T-tests were used to compare the number of endorsed concussion symptoms and symptom severity between groups. Results There was no significant difference in number of concussion symptoms endorsed (M = 10.81, SD = 6.53 vs M = 11.35, SD = 6.25, p = 0.463) or symptom severity (M = 28.33, SD = 24.14, M = 26.79, SD = 20.91, p = 0.540) between before vs during COVID-19 SRC groups. Conclusions In this cohort of young athletes, results suggest that despite effects of the COVID-19 epidemic on community mental health, we did not see evidence of a systematic influence on SRC symptom reporting during the pandemic.

Download Full-text

651. Comparative Analysis Between Bacterial And Fungal Malignant Otitis Externa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.845 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S383-S384

Author(s):

Fatma Hammami ◽

Makram Koubaa ◽

Amal Chakroun ◽

Fatma Smaoui ◽

Khaoula Rekik ◽

...

Keyword(s):

Otitis Externa ◽

Clinical Presentation ◽

The Elderly ◽

Causative Organism ◽

Diabetic Patients ◽

Duration Of Treatment ◽

Evolutionary Features ◽

Significant Difference ◽

Malignant Otitis Externa ◽

History Of

Abstract Background Malignant otitis externa is a fatal infection of the external ear and temporal bone. Pseudomonas aeruginosa is the most common causative organism, while fungi are a rare cause of malignant otitis externa. We aimed to compare the clinical, therapeutic and evolutionary features between bacterial and fungal malignant otitis externa. Methods We conducted a retrospective study including all patients hospitalized for malignant otitis externa in the infectious diseases department between 2000 and 2018. Results Overall, we encountered 82 cases of malignant otitis externa, among which there were 54 cases (65.9%) of bacterial malignant otitis externa (BMO) and 28 cases (34.1%) of fungal malignant otitis externa (FMO). The males were predominant among BMO cases (57.4% vs 50%; p=0.5). Patients with FMO were significantly older (70±9 years vs 61±10 years; p< 0.001) and had medical history of diabetes mellitus more frequently (96.4% vs 77.8%; p=0.03). The use of topical corticosteroids was significantly more reported among FMO cases (28.6% vs 5.6%; p=0.006). Otalgia (96.4% vs 81.5%), otorrhea (75% vs 66.7%) and cephalalgia (46.4% vs 42.6%) were the revealing symptoms among FMO and BMO, respectively, with no significant difference. Tenderness to palpation of the mastoid bone (64.3% vs 38.9%; p=0.02) and stenosis of the external auditory canal (92.9% vs 72.2%; p=0.02) were significantly more frequent among FMO cases. Complications were significantly more frequent among FMO cases (42.9% vs 9.3%; p< 0.001). Treatment duration was significantly longer among FMO cases (70[40-90] days vs 45[34-75] days; p=0.03). Conclusion Our study showed that FMO affected more frequently the elderly and diabetic patients, when compared with BMO. Regardless of the causative agent, the clinical presentation was similar. However, the outcome was poor among FMO cases with the occurrence of complications, requiring a longer duration of treatment. Disclosures All Authors: No reported disclosures

Download Full-text

Resting State Functional Connectivity is Directly Related to Clinical Presentation of Mild Traumatic Brain Injury

Neurology ◽

10.1212/01.wnl.0000581088.06830.74 ◽

2019 ◽

Vol 93 (14 Supplement 1) ◽

pp. S26.2-S27

Author(s):

Teena Shetty ◽

Joseph Nguyen ◽

Esther Kim ◽

George Skulikidis ◽

Matthew Garvey ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

White Matter ◽

Functional Connectivity ◽

Mild Traumatic Brain Injury ◽

Resting State ◽

Symptom Severity ◽

Grey Matter ◽

Clinical Presentation ◽

Severity Scores

ObjectiveTo determine the utility of fractional amplitude of low frequency fluctuations (fALFF) during resting state fMRI (rs-fMRI) as an advanced neuroimaging biomarker for Mild Traumatic Brain Injury (mTBI).BackgroundmTBI is defined by a constellation of functional rather than structural deficits. As a measure of functional connectivity, fALFF has been implicated in long-term outcomes post-mTBI. It is unclear however, how longitudinal changes in fALFF may relate to the clinical presentation of mTBI.Design/Methods111 patients and 32 controls (15–50 years old) were enrolled acutely after mTBI and followed with up to 4 standardized serial assessments. Patients were enrolled at either Encounter 1 (E1), within 72 hours, or Encounter 2 (E2), 5–10 days post-injury, and returned for Encounter 3 (E3) at 15–29 days and Encounter 4 (E4) at 83–97 days. Each encounter included a clinical exam, neuropsychological assessment, as well as rs-fMRI imaging. fALFF was analyzed independently in 14 functional networks and, in grey and white matter as a function of symptom severity. Symptom severity scores (SSS) ranged from 0–132 as defined by the SCAT2 symptom evaluation.ResultsIn mTBI patients, fALFF scores across 5 functional brain networks (language, sensorimotor, visuospatial, higher-order visual, and posterior salience) differed between mTBI patients with low versus high SSS (SSS <5 and >30, respectively). Overall, greater SSS were indexed by reduced connectivity (p < 0.03, Bonferroni corrected). Further analysis also identified corresponding network pairs which were most predictive of increased SSS. White matter fALFF was not correlated with symptom severity, however, decreased grey matter fALFF was significantly correlated with greater SSS (r = −0.25, p = 0.002).ConclusionsGrey matter fALFF was correlated with mTBI symptom burden suggesting that patterns of neural connectivity relate directly to the clinical presentation of mTBI. Furthermore, differences in functional network connectivity as a function of SSS may reflect which networks are implicated in recovery of mTBI.

Download Full-text

Vaping in today’s pandemic: E-cigarette, or vaping, product use–associated lung injury mimicking COVID-19 in teenagers presenting with respiratory distress

SAGE Open Medical Case Reports ◽

10.1177/2050313x20969590 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2096959

Author(s):

Daphne O Darmawan ◽

Kriti Gwal ◽

Brian D Goudy ◽

Sanjay Jhawar ◽

Kiran Nandalike

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Lung Injury ◽

Respiratory Distress ◽

Pediatric Patients ◽

Clinical Presentation ◽

Case Series ◽

Product Use ◽

Abdominal Symptoms ◽

History Of ◽

High Index Of Suspicion

The clinical presentation of children and adolescents infected with severe acute respiratory syndrome coronavirus 2 can range from asymptomatic to mild or moderate manifestations. We present a case series of three adolescents who presented during the coronavirus disease 2019 (COVID-19) pandemic with symptoms concerning for COVID-19, including fever, abdominal symptoms, cough, respiratory distress, and hypoxemia. Their laboratory results showed elevated inflammatory markers that are also commonly seen in COVID-19. The chest imaging studies mimicked COVID-19 with non-specific ground glass opacities and interstitial prominence patterns. However, severe acute respiratory syndrome coronavirus 2 testing was negative and further questioning of these adolescents and their parents revealed a history of vaping marijuana-related products leading to the eventual diagnosis of e-cigarette, or vaping, product use–associated lung injury. Our patients were successfully treated with corticosteroids. The providers caring for pediatric patients, especially adolescents, should continue to have a high index of suspicion for e-cigarette, or vaping, product use–associated lung injury in patients presenting with unexplained respiratory failure, while ruling out COVID-19.

Download Full-text

Readmissions for Depression and Suicide Attempt following Stroke and Myocardial Infarction

Cerebrovascular Diseases Extra ◽

10.1159/000509454 ◽

2020 ◽

Vol 10 (2) ◽

pp. 94-104

Author(s):

Laura K. Stein ◽

Alana Kornspun ◽

John Erdman ◽

Mandip S. Dhamoon

Keyword(s):

Myocardial Infarction ◽

Suicide Attempt ◽

Cox Regression ◽

Vascular Events ◽

Discharge Home ◽

Increased Risk ◽

Significant Difference ◽

History Of ◽

Nationally Representative ◽

History Of Depression

Background and Purpose: Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events. Methods: The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere. Results: Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25–1.79, p < 0.0001). History of depression (HR 3.70 [3.07–4.46]), alcoholism (2.04 [1.34–3.09]), and smoking (1.38 [1.15–1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37–0.56]) and discharge home (0.69 [0.57–0.83]) were associated with reduced hazards of readmission due to depression. Conclusions: IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.

Download Full-text

Clinical features and sex differences in pediatric post-traumatic headache: A retrospective chart review at a Boston area concussion clinic

Cephalalgia ◽

10.1177/0333102419896754 ◽

2019 ◽

Vol 40 (7) ◽

pp. 701-711 ◽

Cited By ~ 2

Author(s):

Haley McEvoy ◽

David Borsook ◽

Scott A Holmes

Keyword(s):

Clinical Features ◽

Chart Review ◽

Pediatric Patients ◽

Clinical Presentation ◽

Retrospective Chart Review ◽

Post Injury ◽

Equivalent Representation ◽

Childhood Education ◽

History Of ◽

Post Traumatic

Background Often concussion/mTBI triggers a chronic headache syndrome called persistent post-traumatic headache (P-PTH) that can last from months to years post-injury, and produce significant disruption of childhood education, social interaction and development. Although prevalent and highly disabling, P-PTH is underrepresented in headache and pain research and lacks clear definition and pathophysiology. Clinical presentation of P-PTH frequently resembles that of other headache disorders, like migraine, yet the pathophysiological mechanisms are distinct and not fully understood, making the disorder difficult to treat in the clinical setting. Methods In a retrospective analysis of 1506 pediatric patients attending Boston Children’s Hospital clinics, demographic trends, symptom features, and the influence of sex on clinical presentation of PTH are presented. We compare clinical characteristics of P-PTH with a published cohort of migraine patients to evaluate the clinical features that are unique to P-PTH. Results Findings show that despite equivalent representation of sex in the clinic, P-PTH is expressed more in females than males and is weighted towards somatic symptoms. Relative to migraine, PTH is less associated with a family history of headache. Conclusions The ability to identify persons with PTH can help manage risk factors and identify persons likely to develop persistent post-concussion symptoms.

Download Full-text

Anxiety and Depression in Patients Who Undergo a Cerebrovascular Procedure

10.21203/rs.2.20492/v2 ◽

2020 ◽

Author(s):

Lauren Lombardo ◽

Richard Shaw ◽

Kathleen Sayles ◽

Dorothea Altschul

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Physical Health ◽

Global Mental Health ◽

Anxiety And Depression ◽

Life Outcomes ◽

Quality Of Life Outcomes ◽

Significant Difference ◽

History Of

Abstract Background: Observe the relationship of anxiety and depression on quality of life outcomes after open and endovascular cerebrovascular procedures. Methods: We retrospectively analyzed 349 patients who underwent a procedure for aneurysm, arteriovenous malformation, intraparenchymal hemorrhage, carotid stenosis, acute stroke, and conventional catheter angiogram over three years at a community hospital. We correlated pre-procedural anxiety and depression with Global Physical Health, Global Mental Health, and Modified Rankin Scale scores. We performed univariate and multivariate linear and logistic regression analyses adjusting for past medical history and sociodemographic factors. Results: Anxiety or depression occurred in eighteen percent of patients. Patients with anxiety or depression were more likely to be female (81% vs 60.8%; p=0.002) and younger (54 vs. 59 years old; p=0.025). The groups did not differ in type or urgency of procedure, smoking or history of diabetes, or cardiovascular disease. Patients with anxiety or depression reported lower mental health scores at 30 days (45.1 vs 48.2; p=0.002) post-procedure. In multivariate analyses, anxious or depressed patients had worse mental health scores at 30 days (t=-2.893; p=0.008) than those who did not have a history of anxiety or depression. There was no difference between groups in length of stay, mortality, physical health t-scores, functionality scores, or six month quality of life outcomes. Conclusions: Patients undergoing cerebrovascular procedures who self-reported anxiety or depression showed a significant difference in mental health outcomes at 30 days, but six month mental health and other medical and functional outcomes measures were similar to patients without these diagnoses.

Download Full-text