Variations in Time to Recovery from Pediatric Concussion Based on Differing Outcomes of Interest

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S10.2-S11
Author(s):  
Christina Master ◽  
Kristi Metzger ◽  
Mr. Daniel Corwin ◽  
Catherine McDonald ◽  
Melissa Pfeiffer ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Clinical Care ◽  
Median Number ◽  
Self Report ◽  
Return To School ◽  
Self Assessment ◽  
Concussion Management ◽  
Pediatric Concussion ◽  
Concussion Recovery ◽  
Definition Of

ObjectiveTo quantify variability in pediatric concussion recovery across multiple outcomes of interest.BackgroundPediatric concussion studies are hindered by a common significant limitation: lack of agreement on a standard definition of “recovery.” A variety of clinical outcomes of interest utilized across studies, including symptom self-report, neurocognitive testing results, self-reported return to activity, and physician clearance for activity, leads to challenges for both research, as well as clinical concussion management.Design/MethodsWe enrolled concussed youth, ages 11–18 years, from a specialty sports medicine clinic = 28 days of injury. Patients were followed as part of clinical care for concussion for up to 13 weeks. At each visit, participants completed questionnaires and a battery of clinical measures. From these data, we constructed 10 potential definitions of recovery: 3 based on self-reported symptoms (change from pre-injury, no symptoms, below pre-determined thresholds), 2 based on visio-vestibular examination (VVE) deficits (none, = 1), 2 based on physician clearance (for return to school/sport), and 3 based on self-assessment (“back to normal”, return to school/exercise).ResultsOne hundred seventy-four concussed youth were enrolled (median age: 15 years, 54.6% female) with a median time from injury to initial visit of 12 days (IQR: 7, 20). Median number of visits was 2 (range: 1, 5). We observed a wide variation in the proportion of participants recovered across the 10 definitions. Depending on definition, between 4% and 45% were considered recovered within 4 weeks, and between 10% and 80% were considered recovered at the end of follow-up. The VVE-based definition (=1 deficit) consistently had the highest proportion recovered at all time points, while self-reported return to exercise had the lowest proportion.ConclusionsRecovery from concussion is not a single unitary point in time. These results will provide valuable guidance to clinicians in managing concussion and researchers in designing future observational and interventional trials of pediatric concussion.

scholarly journals Medical retirement from sport after concussions

2018 ◽  
Vol 8 (1) ◽  
pp. 40-47 ◽  
Author(s):  
Cecilia Davis-Hayes ◽  
David R. Baker ◽  
Thomas S. Bottiglieri ◽  
William N. Levine ◽  
Natasha Desai ◽  
...  
Keyword(s):  
Sports Medicine ◽  
Comprehensive Evaluation ◽  
Treatment Algorithm ◽  
Return To Sport ◽  
Real Patient ◽  
Patient Centered ◽  
Concussion Management ◽  
Injury Threshold ◽  
History Of ◽  
Concussion Recovery

Purpose of reviewIn patients with a considerable history of sports-related concussion, the decision of when to discontinue participation in sports due to medical concerns including neurologic disorders has potentially life-altering consequences, especially for young athletes, and merits a comprehensive evaluation involving nuanced discussion. Few resources exist to aid the sports medicine provider.Recent findingsIn this narrative review, we describe 10 prototypical vignettes based upon the authors' collective experience in concussion management and propose an algorithm to help clinicians navigate retirement discussions. Issues for consideration include absolute and relative contraindications to return to sport, ranging from clinical or radiographic evidence of lasting neurologic injury to prolonged concussion recovery periods or reduced injury threshold to patient-centered factors including personal identity through sport, financial motivations, and navigating uncertainty in the context of long-term risks.SummaryThe authors propose a novel treatment algorithm based on real patient cases to guide medical retirement decisions after concussion in sport.

Concussion Management for Children Has Changed: New Pediatric Protocols Using the Latest Evidence

2019 ◽  
Vol 59 (1) ◽  
pp. 5-20 ◽  
Author(s):  
Carol DeMatteo ◽  
Sarah Randall ◽  
Katie Falla ◽  
Chia-Yu Lin ◽  
Lucy Giglia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Study ◽  
Empirical Data ◽  
Prospective Cohort ◽  
Specific Activity ◽  
Rest Period ◽  
Return To School ◽  
Concussion Management ◽  
Pediatric Concussion ◽  
Return To Activity

Return to activity (RTA) and return to school (RTS) are important issues in pediatric concussion management. This study aims to update CanChild’s 2015 RTA and RTS protocols, on the basis of empirical data and feedback collected from our recently completed prospective cohort study, focusing on concussed children and their caregivers; systematic review of evidence published since 2015; and consultation with concussion management experts. The new protocols highlight differences from the earlier versions, mainly, (1) symptom strata to allow quicker progression for those who recover most quickly; (2) a shortened rest period (24-48 hours) accompanied by symptom-guided activity; (3) the recommendation that children progress through the stages before they are symptom free, if symptoms have decreased and do not worsen with activity; (4) specific activity suggestions at each stage of the RTA protocol; (5) recommendations for the amount of time to spend per stage; and (6) integration of RTS and RTA.

scholarly journals Gender differences in outcome following pediatric concussion

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S23.1-S23
Author(s):  
Jacob James Michael Kay ◽  
Chandler Melton ◽  
Jeff Holloway ◽  
Davis Moore
Keyword(s):  
Mental Health ◽  
Gender Differences ◽  
Sports Medicine ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Pediatric Concussion ◽  
Symptom Questionnaire ◽  
Concussion Recovery ◽  
Gender Based ◽  
Time Since Injury

ContextConcussive injuries result in various somatic, cognitive, and mental health alterations which can negatively influence academic and vocational performance. Research demonstrates that gender may moderate concussion recovery, with females appearing to experience more severe and more protracted symptoms than males. However, we are just beginning to understand gender-based differences in concussion recovery, particularly during development. Accordingly, the purpose of our investigation was to advance the extant knowledge by examining the role of gender in concussion recovery in a pediatric population.MethodsData were collected from a local pediatric sports medicine clinic. Participants (8–18 years) who sustained concussions during the 2017–2018 school years were examined. Outcome measures of somatic (Rivermead Post-concussion Symptom Questionnaire), cognitive (CogState Brain Injury Battery), and mental health (Beck Depression Inventory-Youth) symptoms were analyzed. Key demographic variables (e.g., age, SES, medical history) and injury characteristics (e.g., time since injury, number of prior concussion) were controlled for in the statistical analyses.ResultsPreliminary findings indicated a significant gender difference in self-reported somatic symptoms (p < 0.05), with females (M = 5.3, SD = 3.8) reporting greater symptom scores on the Rivermead Post-concussion Symptom Questionnaire than males (M = 2.8, SD = 2.5). In contrast, no significant differences were observed for any metric of cognition or mental health (ps ≥ 0.15).ConclusionsOur findings corroborate evidence that concussed females report greater clinical symptoms than do concussed males. Importantly, no gender differences were observed in terms of cognition or mental health. Thus, differences in concussion symptom scales may not be useful proxies of cognitive or mental health. Future researchers and clinicians should go beyond concussion symptom scales to gain a more accurate understanding of gender differences, if any, following concussion.Disclosures: Dr. Kay has nothing to disclose. Dr. Melton has nothing to disclose. Dr. Holloway has nothing to disclose. Dr. Moore has nothing to disclose.

Consideration of the Federal Guidelines for Academic Services for Student-Athletes with Sports-Related Concussion

2012 ◽  
Vol 13 (3) ◽  
pp. 70-78 ◽  
Author(s):  
Bess Sirmon-Taylor ◽  
Anthony P. Salvatore
Keyword(s):  
Student Athletes ◽  
Section 504 ◽  
Return To Play ◽  
Behavioral Deficits ◽  
Prevention Education ◽  
Concussion Management ◽  
School Settings ◽  
Definition Of ◽  
Federal Guidelines ◽  
Academic Services

Abstract Purpose: Federal regulations should be implemented to provide appropriate services for student-athletes who have sustained a concussion, which can result in impaired function in the academic setting. Eligibility guidelines for special education services do not specifically address the significant, but sometimes transient, impairments that can manifest after concussion, which occur in up to 10% of student-athletes. Method: We provide a definition of the word concussion and discuss the eligibility guidelines for traumatic brain injury and other health-impaired under IDEA, as is the use of Section 504. Results: The cognitive-linguistic and behavioral deficits that can occur after concussion can have a significant impact on academic function. We draw comparisons between the clinical presentation of concussion and the eligibility indicators in IDEA and Section 504. Conclusion: Speech-language pathologists are well-positioned to serve on concussion management teams in school settings, providing services including collection of baseline data, intervention and reassessment after a concussion has occurred, prevention education, and legislative advocacy. Until the cultural perception of concussion changes, with increased recognition of the potential consequences, student-athletes are at risk and appropriate implementation of the existing guidelines can assist in preservation of brain function, return to the classroom, and safe return to play.

SELF ASSESSMENT TO KNOW UNDERSTANDING MATHEMATIC CONCEPT

2018 ◽  
Vol 3 (1) ◽  
pp. 14-21
Author(s):  
Deni Iriyadi
Keyword(s):  
Qualitative Study ◽  
Qualitative Analysis ◽  
Resolution Limit ◽  
Self Assessment ◽  
Limit Concept ◽  
Research Instrument ◽  
Definition Of ◽  
The Right

This research is a qualitative study aimed to determine the students' understanding of the concept of matter limit. The subjects were students of class XI IPA 1 SMA Negeri 1 Watampone. The concept includes the definition of the limit. Data obtained using a research instrument in the form of self-assessment and then proceed with the interview subjects were selected based on the results of self-assessment has been done before. Analysis using qualitative analysis of students' understanding of the concept of the limit concept. The results of this study indicate that students' understanding of concepts some of which are not / do not understand especially regarding definitions limit. In addition students are also wrong about the resolution limit. Students who understand the concept of limit dinyakatakan them restate concepts, including examples and classify the sample to non-completion of function and limit the right results.

Biomarkers of Acromegaly and Growth Hormone Action

2020 ◽  
Vol 27 (12) ◽  
pp. 1231-1245
Author(s):  
Filippo Maffezzoni ◽  
Teresa Porcelli ◽  
Andrea Delbarba ◽  
Letizia Pezzaioli ◽  
Carlo Cappelli ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Biological Markers ◽  
Clinical Care ◽  
Hormone Deficiency ◽  
Surrogate Outcomes ◽  
Current State ◽  
Growth Hormone Action ◽  
Igf I ◽  
Definition Of

: Biological markers (biomarkers) play a key role in drug development, regulatory approval and clinical care of patients and are linked to clinical and surrogate outcomes. : Both acromegaly and Growth Hormone Deficiency (GHD) are pathological conditions related to important comorbidities that, in addition to having stringent diagnostic criteria, require valid markers for the definition of treatment, treatment monitoring and follow-up. GH and insulin-like growth factor-I (IGF-I) are the main biomarkers of GH action in children and adults while, in acromegaly, both GH and IGF-I are established biomarkers of disease activity. : However, although GH and IGF-I are widely validated biomarkers of GHD and acromegaly, their role is not completely exhaustive or suitable for clinical classification and follow-up. Therefore, new biological markers for acromegaly and GH replacement therapy are strongly needed. : The aim of this paper is to review and summarize the current state in the field pointing out new potential biomarkers for acromegaly and GH use/abuse.

Ambiguous terminology in animal personality research: a self-report questionnaire and a systematic review

2021 ◽  
Author(s):  
Alfredo Sánchez-Tójar ◽  
Maria Moiron ◽  
Petri Toivo Niemelä
Keyword(s):  
Literature Review ◽  
Animal Personality ◽  
Self Report ◽  
Behavioural Ecology ◽  
Biological Organization ◽  
Personality Research ◽  
Conceptual Definition ◽  
Multiple Levels ◽  
Definition Of ◽  
Key Questions

Whether animal personality studies provide insights of broader evolutionary and ecological relevance to behavioural ecology is frequently questioned. One source of controversy is the vast, but often vague conceptual terminology used. From a statistical perspective, animal personality is defined as repeatable among-individual variance in behaviour; however, numerous conceptual definitions of animal personality exist. Here, we performed a 1) self-report questionnaire and 2) systematic literature review to quantify how researchers interpret conceptual and statistical definitions commonly used in animal personality research. We also investigated whether results from the questionnaire agree with those of the literature review. Among the 430 self-reported researchers that participated in our questionnaire, we observed discrepancies in key questions such as the conceptual definition of animal personality or the interpretation of repeatability. Our literature review generally confirmed the global patterns revealed by the questionnaire. Overall, we identified common disagreements in animal personality research and discussed potential solutions. We advocate for the usage of statistically-oriented terminology because conceptual definitions can seemingly be interpreted at multiple levels of biological organization. We expect that adopting such statistically-oriented terminology will, at least partly, avoid the confusion generated by the label “animal personality”, and ultimately help to clarify and move the field forward.

Patient self-reporting of tolerability using PRO-CTCAE: A randomized double-blind placebo controlled phase II trial comparing gemcitabine in combination with adavosertib or placebo in women with platinum resistant epithelial ovarian cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 5541-5541
Author(s):  
Ainhoa Madariaga ◽  
Sandra A. Mitchell ◽  
Tyler Pittman ◽  
Lisa Wang ◽  
Valerie Bowering ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Abdominal Pain ◽  
Objective Assessment ◽  
Area Under The Curve ◽  
Recurrent Ovarian Cancer ◽  
Median Number ◽  
Self Report ◽  
Double Blind ◽  
Patient Reported ◽  
Fatigue Severity

5541 Background: A 4 month improvement in OS was demonstrated when Wee1 inhibitor adavosertib (Ad) and gemcitabine (G; arm A) was compared to G and placebo (P; arm B) in a phase 2 trial in recurrent ovarian cancer (NCT02151292). The patient reported outcome version of the CTCAE (PRO-CTCAE) was used to capture self-report of the frequency, severity and/or interference (scored 0-4; higher scores indicating worse symptomatic adverse events [syAEs]). Methods: Ad/P was given orally on D1-2, D8-9, D15-16 with G D1, D8, D15 in a 28-day cycle. English speaking pts in 2 centres completed PRO-CTCAE items electronically in clinic at baseline, D1 and D15 of each cycle and off treatment. An exploratory objective was to characterize syAEs in the first 3 months of therapy. We calculated 12-week area under the curve (AUC12w) as a measure of syAE over time and incremental AUC12w (iAUC12w) for adjustment to baseline syAEs and compared arms A and B using an independent samples t-test. We assessed proportion of scores 3-4 at 6 time-points and compared them using Fisher’s Exact Test at each survey. Results: 51 pts were enrolled and completed ≥1 survey, 47 were evaluable for primary outcome (arm A: 28, B: 19). ECOG status was ≤1 in 44/47 pts. Median number of cycles of therapy were 5 (1-16) in arm A, and 2 (1-16) in B. Survey completion rates were high (arm A 93%, B 95%). Mean AUC12w fatigue severity (A 152 [standard error 9] vs B 112 [10]; p = 0.005) and interference (A 144 [11] vs 98 [15]; p = 0.018), diarrhea frequency (A 70 [12] vs B 33 [9]; p = 0.014), mucositis (A 23 [6] vs B 6 [3]; p = 0.012) and difficulty swallowing severity (A 10 [3] vs B 2 [2]; p = 0.023) were higher in arm A (any grade). There were no statistically significant between-arm differences in abdominal pain, bloating, nausea, vomiting and anxiety. The iAUC12w was significantly higher in arm A vs B for difficulty swallowing severity (A 10.1 [3] vs B -2.7 [4.7]; p = 0.02), mucositis severity (A 19.9 [6.6] vs B -3.1 [6.9]; p = 0.02) and fatigue severity (A 35.2 [8.2] vs B -3.1 [9.8]; p = 0.005). Proportions with high scores (3-4) were only significantly higher at C1D15 for fatigue severity in arm A (A 55% vs B 19%, p = 0.044). No significant differences were seen in other 3-4 scores per survey time. Conclusions: This is the first study evaluating pts self-reported toxicity with adavosertib in a randomized setting, allowing pts self-evaluation of toxicity in the context of improved PFS and OS. Greater fatigue, diarrhea, mucositis and difficulty swallowing were experienced by pts receiving adavosertib and gemcitabine, but score 3-4 reached significance on C1D15 fatigue only. No significant differences were detected in syAE profile for nausea, vomiting, abdominal pain, bloating and anxiety. This approach allows objective assessment of pts perception of toxicity with complex therapy. Clinical trial information: NCT02151292.

scholarly journals A history of health-related quality of life outcomes in psychiatry

2014 ◽  
Vol 16 (2) ◽  
pp. 127-135 ◽  
Keyword(s):  
Quality Of Life ◽  
Psychiatric Patients ◽  
Clinical Care ◽  
Self Report ◽  
Psychiatric Research ◽  
Health Related Quality ◽  
Patient Centered ◽  
Related Quality ◽  
Health Related

Health-related quality of life (HRQoL) is a multidimensional concept that includes subjective reports of symptoms, side effects, functioning in multiple life domains, and general perceptions of life satisfaction and quality. Rather than estimating it from external observations, interview, or clinical assessment, it is best measured by direct query. Due to a perception that respondents may not be reliable or credible, there has been some reluctance to use self-report outcomes in psychiatry. More recently, and increasingly, HRQoL assessment through direct patient query has become common when evaluating a range of psychiatric, psychological, and social therapies. With few exceptions, psychiatric patients are credible and reliable reporters of this information. This article summarizes studies that highlight the development, validation, and application of HRQoL measures in psychiatry. Thoughtful application of these tools in psychiatric research can provide a much-needed patient perspective in the future of comparative effectiveness research, patient-centered outcomes research, and clinical care.

scholarly journals Stillbirth in Canada: anachronistic definition and registration processes impede public health surveillance and clinical care

2021 ◽  
Author(s):  
K.S. Joseph ◽  
Lily Lee ◽  
Laura Arbour ◽  
Nathalie Auger ◽  
Elizabeth K. Darling ◽  
...  
Keyword(s):  
Public Health ◽  
Public Health Surveillance ◽  
Fetal Death ◽  
Clinical Care ◽  
Induced Abortion ◽  
Death Registration ◽  
Starting Point ◽  
Induced Abortions ◽  
History Of ◽  
Definition Of

AbstractThe archaic definition and registration processes for stillbirth currently prevalent in Canada impede both clinical care and public health. The situation is fraught because of definitional problems related to the inclusion of induced abortions at ≥20 weeks’ gestation as stillbirths: widespread uptake of prenatal diagnosis and induced abortion for serious congenital anomalies has resulted in an artefactual temporal increase in stillbirth rates in Canada and placed the country in an unfavourable position in international (stillbirth) rankings. Other problems with the Canadian stillbirth definition and registration processes extend to the inclusion of fetal reductions (for multi-fetal pregnancy) as stillbirths, and the use of inconsistent viability criteria for reporting stillbirth. This paper reviews the history of stillbirth registration in Canada, provides a rationale for updating the definition of fetal death and recommends a new definition and improved processes for fetal death registration. The recommendations proposed are intended to serve as a starting point for reformulating issues related to stillbirth, with the hope that building a consensus regarding a definition and registration procedures will facilitate clinical care and public health.

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