Amygdala response to emotional faces in adolescents with persistent post-concussion symptoms.

Approximately 30% of adolescents with concussion develop persistent post-concussion symptoms (PPCS) that include emotional symptoms. Elevated amygdalae reactivity to emotional faces has been reported in a variety of psychopathologies characterized by emotional symptoms overlapping with those in PPCS. We tested the hypothesis that amygdalae reactivity to emotional faces in adolescents with PPCS+ is elevated compared to concussed adolescents without PPCS and healthy controls. Concussed adolescents (ages 14-18) with (PPCS+; n = 23) and without PPCS (PPCS-; n = 13) participated in visits at least 4 weeks post-injury. Adolescents without prior concussion served as controls (HC; n = 15). All participants completed a detailed clinical battery and a common emotional face processing task that involved matching of emotional faces or shapes. Compared to HC and PPCS-, adolescents with PPCS+ had elevated depression symptoms, anhedonia, general psychological symptoms, and anxiety symptoms. Contrary to our hypothesis, PPCS+ had lower amygdalae activity to the emotional faces versus shapes condition relative to HC and a trend for lower activity relative to PPCS-. There was a non-significant inverse association between anhedonia amygdalae activity in adolescents with PPCS. Results suggest that adolescents with PPCS have altered amygdalae activity during the processing of emotional face stimuli.

Acute Clinical Predictors of Symptom Recovery in Emergency Department Patients with Uncomplicated Mild Traumatic Brain Injury or Non-Traumatic Brain Injuries.

There is a subset of patients with mild traumatic brain injury (mTBI) who report persistent symptoms that impair their functioning and quality of life. Being able to predict which patients will experience prolonged symptom recovery would help clinicians target resources for clinical follow-up to those most in need, and would facilitate research to develop precision medicine treatments for mTBI. The purpose of this study was to investigate the predictors of symptom recovery in a prospective sample of emergency department trauma patients with either mTBI or non-mTBI injuries. Subjects were examined at several time points from within 72 h to 45 days post-injury. We quantified and compared the value of a variety of demographic, injury, and clinical assessment (symptom, neurocognitive) variables for predicting self-reported symptom duration in both mTBI (n = 89) and trauma control (n = 73) patients. Several injury-related and neuropsychological variables assessed acutely (< 72 h) post-injury predicted symptom duration, particularly loss of consciousness (mTBI group), acute somatic symptom burden (both groups), and acute reaction time (both groups), with reasonably good model fit when including all of these variables (area under the receiver operating characteristic curve [AUC] = 0.76). Incorporating self-reported litigation involvement modestly increased prediction further (AUC = 0.80). The results highlight the multifactorial nature of mTBI recovery, and injury recovery more generally, and the need to incorporate a variety of variables to achieve adequate prediction. Further research to improve this model and validate it in new and more diverse trauma samples will be useful to build a neurobiopsychosocial model of recovery that informs treatment development.

Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools Part 2: Utility for Assessment of Mild Traumatic Brain Injury in Emergency Department Patients.

OBJECTIVES: The aim of this study was to evaluate the reliability and validity of three computerized neurocognitive assessment tools (CNTs; i.e., ANAM, DANA, and ImPACT) for assessing mild traumatic brain injury (mTBI) in patients recruited through a level I trauma center emergency department (ED). METHODS: mTBI (n=94) and matched trauma control (n=80) subjects recruited from a level I trauma center emergency department completed symptom and neurocognitive assessments within 72 hr of injury and at 15 and 45 days post-injury. Concussion symptoms were also assessed via phone at 8 days post-injury. RESULTS: CNTs did not differentiate between groups at any time point (e.g., M 72-hr Cohen's d=-.16, .02, and .00 for ANAM, DANA, and ImPACT, respectively; negative values reflect greater impairment in the mTBI group). Roughly a quarter of stability coefficients were over .70 across measures and test-retest intervals in controls. In contrast, concussion symptom score differentiated mTBI vs. control groups acutely), with this effect size diminished over time (72-hr and day 8, 15, and 45 Cohen's d=-.78, -.60, -.49, and -.35, respectively). CONCLUSIONS: The CNTs evaluated, developed and widely used to assess sport-related concussion, did not yield significant differences between patients with mTBI versus other injuries. Symptom scores better differentiated groups than CNTs, with effect sizes weaker than those reported in sport-related concussion studies. Nonspecific injury factors, and other characteristics common in ED settings, likely affect CNT performance across trauma patients as a whole and thereby diminish the validity of CNTs for assessing mTBI in this patient population. (JINS, 2017, 23, 293-303).

Baseline Performance and Psychometric Properties of the Child Sport Concussion Assessment Tool 3 (Child-SCAT3) in 5- to 13-year-old Athletes.

OBJECTIVE: To determine the normative, baseline performance and psychometric properties of the Child Sport Concussion Assessment Tool 3 (Child-SCAT3) in 5- to 13-year-old athletes. DESIGN: Cross-sectional study. SETTING: Practice fields. PARTICIPANTS: Contact sport athletes (N = 155) 5 to 13 years old. INDEPENDENT VARIABLES: Age, gender, verbal intellectual functioning (receptive vocabulary). MAIN OUTCOME MEASURES: Child-SCAT3: self-reported and parent-reported symptoms, cognitive performance (child form of the Standardized Assessment of Concussion; SAC-C), and balance (modified Balance Error Scoring System, mBESS-C; tandem gait). A subset of the sample repeated the Child-SCAT3 at another date. Some subjects also completed the Adult-SCAT3 version of the symptom checklist and mBESS. RESULTS: Small-to-medium-sized effects of age were observed on all Child-SCAT3 components. Effects of gender and receptive vocabulary were observed on select components of the SCAT3. Younger age and lower receptive vocabulary were independently associated with greater symptom endorsement, yet parents rated higher symptom burden for older children. Internal consistency reliability and stability of symptom ratings was good to excellent. Stability was more modest for SAC-C and tandem gait scores and very poor for mBESS-C scores, perhaps due to restricted variance. Inter-rater reliability (self-rated vs parent-rated symptoms) was fair. CONCLUSIONS: The Child-SCAT3 self-report symptom checklist may be inappropriate to administer to younger school-aged children. Some of the age effects observed warrant use of demographically appropriate norms in Child-SCAT3 interpretation. The findings can provide guidance for clinicians assessing children of varying ages and point to directions for further development of refined approaches for pediatric concussion assessment.

Frequency of Factors that Complicate the Identification of Mild Traumatic Brain Injury in Level I Trauma Center Patients.

AIM: Determine the frequency of factors that complicate identification of mild traumatic brain injury (mTBI) in emergency department (ED) patients. SETTING: Chart review. MATERIALS & METHODS: Records of 3,042 patients (age 18-45) exposed to a potential mechanism of mTBI were reviewed for five common complicating factors and signs of mTBI. RESULTS: Most patients (65.1%) had at least one complicating factor: given narcotics in the ED (43.7%), on psychotropic medication (18.4%), psychiatric diagnosis (15.3%), alcohol consumption near time of admission (14.2%), and pre-admission narcotic prescription (8.9%). CONCLUSION: Our findings highlight the frequency of these confounding factors in this population. Future research should identify how these factors interact with performance on assessment measures to improve evidence-based mTBI assessment in this population.