Validation of a Concussion Screening Battery for Use in Medical Settings: Predicting Centers for Disease Control Concussion Symptoms in Children and Adolescents.

OBJECTIVE: Effective screening for concussion is increasingly important, and medical professionals play a critical role in diagnostic and return-to-play decisions. However, few well-validated measures are available to assist in those decisions. This study aims to determine whether previously validated measures assessing neurocognitive and neurobehavioral abilities can predict Centers for Disease Control (CDC) concussion symptom endorsement in a sample of child or youth athletes. METHOD: Participants were 113 individuals, aged 6-17, representing 29 consecutive cases undergoing a post-concussion evaluation by a pediatric neurologist and 84 consecutive cases completing standardized baseline assessments (i.e., not being evaluated as a follow-up to a concussion). All participants completed the same standardized battery of tests comprised of the Connors' Continuous Performance Test (CPT 3), the Balance Error Scoring System (BESS), and the NIH 4-Meter Gait Test as well as completing a checklist of CDC concussion symptoms. RESULTS: Regression analyses indicate that the screening battery explained 33% of the variance (d = 1.4) in concussion symptom endorsement, after controlling for age. The neurocognitive test alone (CPT 3) accounts for 21.5% of the variance (d = 1.05) in symptoms after controlling for age, and the neurobehavioral measures (BESS and NIH 4-Meter Gait) then account for an additional 11.5% variance (accounting for 18.6% variance, d = .96, when entered first). These effect sizes are considered large to very large and reflect a marked increase in predictive validity relative to existing measures commonly used in concussion assessments. CONCLUSIONS: A relatively brief screening battery can function in medical settings to predict significant and substantial variability in CDC concussion symptoms in a pediatric sample.

Can epidural anesthesia and warfarin be coadministered?

Epidural hypotensive anesthesia can, in addition to imparting numerous intraoperative benefits, provide excellent postoperative pain control for patients having joint arthroplasties. However, because of the risk of epidural hematoma, epidural anesthesia is not coadministered with anticoagulation in some centers. We retrospectively ascertained, by chart review, the incidence of epidural hematoma in 11,235 patients having 12,991 knee arthroplasties at our institution who received oral anticoagulation and epidural anesthesia for their surgery. Warfarin was administered on the day of surgery. With the exception of 212 patients, the epidural catheter was removed within 48 hours of surgery. Based on clinical examinations, we detected no epidural hematomas. For 1030 patients (1038 knees) whose charts were reviewed in detail, the mean international normalized ratio at the time of removal of the epidural catheter was 1.54 (range, 0.93-4.25). We identified no other complications related to the coadministration of epidural anesthesia and warfarin. Although administration of epidural anesthesia in patients with coagulopathy can be detrimental, we recognized no cases of epidural hematoma causing neurologic symptoms in patients receiving controlled oral anticoagulation after total knee arthroplasty.

Simultaneous primary total hip arthroplasty and contralateral revision hip arthroplasty: role for use of femoral head autograft.

We report the outcome of revision hip arthroplasty for patients with acetabular bone loss in whom the femoral head retrieved from arthritic contralateral hip during the same anesthesia was used as autograft for acetabular reconstruction. Thirty-two hips in 16 patients with a mean age of 63.8 years (range, 43-79 years) were followed for an average of 3.5 years. All primary arthroplasties were successful. Evidence of autograft incorporation was found in all except 2 patients. The acetabular component failed and required revision in the latter 2 patients. The use of femoral head autograft in a select group of patients with symptomatic arthritis of hip and a failed prosthetic hip with severe bone loss in the contralateral side is a viable option. However, this technique should not be applied to acetabular reconstructions in which protected weight-bearing in the postoperative period may be necessary.