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1.
J Safety Res ; 76: 262-268, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653558

RESUMO

INTRODUCTION: Concussion is traumatic brain injury with associated tissue damage commonly produced by an indirect or direct head or facial trauma that can negatively impact an athletes' career and personal life. In this context, the importance on how to deal with a concussion has received attention from worldwide literature and has become a topic of enormous interest in the sports medicine arena. OBJECTIVE: This systematic review aimed to investigate how sports-related concussion is being managed regarding athletic injuries, athletes' age, clinical signs of concussion, adopted questionnaires, as well as decision making in sports medicine. METHODS: A systematic review of the literature was performed searching 10 electronic databases with no limitations for year of publication up to December 2019. The search terms used were: Brain Concussion, Athletes, Sports Medicine, Athletic Injuries, Clinical Decision-Making, and Decision Making. The articles were considered eligible when the studies related to populations of regular sports practitioners, professional or recreational, of any age; sports injury; articles reporting concussion evaluation in at least 30 athletes; and articles published in English, French, Portuguese, Italian. We excluded systematic review articles, reviews, editorials, sport-unrelated concussion, no questionnaire application, approaching retired athletes, consensus statement letters, author's reply to editorials, synopsis, and abstracts. RESULTS: The parameters adopted for decision-making and management were broadly variable and were based on a variety of clinical signs or scoring outcomes from a myriad of questionnaires with little consistency in protocol or management guidelines, which could guide the average clinician. CONCLUSION: This systematic review provides current evidence that post-concussion management in sports medicine has yet to accomplish a standardized protocol that clinicians could use to optimally care for athletes. The extensive number of manuscripts and studies addressing the topic confirms that sports-related concussion in the pediatric and adolescent population has come to the forefront in the sports medicine field.


Assuntos
Atletas/estatística & dados numéricos , Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Medicina Esportiva/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Criança , Feminino , Humanos , Masculino , Adulto Jovem
2.
Neurology ; 96(15): 705-715, 2021 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-33637627

RESUMO

OBJECTIVE: To evaluate whether participating in physical contact sports is associated with a release of neurofilaments and whether such release is related to future clinical neurologic and/or psychiatric impairment. METHODS: We performed a systematic review of the PubMed, MEDLINE, and Cochrane Library databases using a combination of the search terms neurofilament(s)/intermediate filament and sport(s)/athletes. Original studies, written in English, reporting on neurofilaments in CSF and/or serum/plasma of contact sport athletes were included. This review was conducted following the Preferred Reporting Items for Systematic Review and Analyses guidelines. RESULTS: Eighteen studies in 8 different contact sports (i.e., boxing, American football, ice hockey, soccer, mixed martial arts, lacrosse, rugby, and wrestling) matched our criteria. Elevated light chain neurofilament (NfL) levels were described in 13/18 cohorts. Most compelling evidence was present in boxing and American football, where exposure-related increases were appreciable at the intraindividual level (up to 4.1- and 2.0-fold, respectively) in well-defined groups. Differences in exposure severity (including previous cumulative effects), sampling/measurement time points (with regard to expected peak values), and definitions of the baseline setting are considered as main contributors to the variability in findings. No studies were encountered that have investigated the relationship with the targeted clinical end points; therefore no NfL cutoffs exist that are associated with a poor outcome. CONCLUSION: NfL release can be seen, as a potential marker of neuronal brain damage, in participants of physical contact sports, particularly boxing and American football. The exact significance regarding the risk for future clinical impairment remains to be elucidated.


Assuntos
Traumatismos em Atletas/diagnóstico , Biomarcadores/sangue , Biomarcadores/líquido cefalorraquidiano , Concussão Encefálica/etiologia , Filamentos Intermediários/metabolismo , Traumatismos em Atletas/sangue , Traumatismos em Atletas/líquido cefalorraquidiano , Boxe/lesões , Concussão Encefálica/diagnóstico , Futebol Americano/lesões , Hóquei/lesões , Humanos , Artes Marciais/lesões , Esportes com Raquete/lesões , Futebol/lesões , Luta Romana/lesões
3.
JAMA Netw Open ; 3(12): e2031509, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33372973

RESUMO

Importance: Despite increased concern about the health consequences of contact sports, little is known about athletes' understanding of their own risk of sports-related injury. Objective: To assess whether college football players accurately estimate their risk of concussion and nonconcussion injury and to identify characteristics of athletes who misestimate their injury risk. Design, Setting, and Participants: In this survey study, questionnaires were given to 296 current college football players on 4 teams from the 3 of the 5 most competitive conferences of the US National Collegiate Athletic Association. Surveys were conducted between February and May 2017. Data were analyzed from June 2017 through July 2020. Main Outcomes and Measures: Multiple approaches were taken to compare athlete perceptions of their risks of concussion and nonconcussion injury with individual probabilities of these risks, which were modeled using logistic regression. Results: Of 296 male college-aged athletes from 4 football teams who participated in the survey, 265 (89%) answered all questions relevant for this study. Participating teams were similar to nonparticipating teams across nearly all measured characteristics. One hundred athletes (34%) had sustained 1 or more concussions, and 197 (68% of the 289 who responded to the question) had sustained 1 or more injuries in the previous football season. Logistic regression models of single-season injury and concussion had reasonably good fit (area under the curve, 0.75 and 0.73, respectively). Of the 265 participants for whom all relevant data were available, 111 (42%) underestimated their risk of concussion (χ2 = 98.6; P = .003). A similar proportion of athletes (113 [43%]) underestimated their risk of injury, although this was not statistically significant (χ2 = 34.0; P = .09). An alternative analytic strategy suggested that 241 athletes (91%) underestimated their risk of injury (Wilcoxon statistic, 7865; P < .001) and 167 (63%) underestimated their risk of concussion (Wilcoxon statistic, 26 768; P < .001). Conclusions and Relevance: The findings of this survey study suggest that college football players may underestimate their risk of injury and concussion. The implications for informed participation in sport are unclear given that people generally underestimate health risks. It is necessary to consider whether athletes are sufficiently informed and how much risk is acceptable for an athlete to participate in a sport.


Assuntos
Atletas/estatística & dados numéricos , Concussão Encefálica/epidemiologia , Autoavaliação Diagnóstica , Futebol Americano/lesões , Estudantes/estatística & dados numéricos , Adolescente , Atletas/psicologia , Concussão Encefálica/etiologia , Futebol Americano/psicologia , Humanos , Modelos Logísticos , Masculino , Medição de Risco/métodos , Estudantes/psicologia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Universidades , Adulto Jovem
4.
PLoS One ; 15(8): e0235609, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776940

RESUMO

Soccer is the most popular sport in the world and, since it is a contact sport, players are at risk for head injury, including concussion. Here, we proposed to investigate the association of heading and concussion with macroscopic brain structure among adult amateur soccer players. For this study, 375 amateur soccer players (median age 23 years) completed HeadCount-12m to estimate heading over the 12 months prior to MRI and lifetime concussion. T1-weighted 3D magnetization prepared rapid acquisition gradient echo (MP-RAGE) MRI was performed at 3 Tesla. Parcellation was performed using Freesurfer to extract regional gray and white matter volumes as well as regional cortical thickness and total intracranial volume. Regional cortical brain volumes were normalized by total intracranial volume. We categorized heading into quartiles and concussion as 0, 1 or 2 or more. Generalized linear regressions were used to test the association of heading or concussion with each brain morphometry metric, including age and sex, as covariates. Neither heading nor concussion were associated with reduced brain volume or cortical thickness. We observed that greater heading was associated with greater gray matter volume in the left inferior parietal area, which may reflect effects related to training.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Concussão Encefálica/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Futebol , Adulto , Encéfalo/anatomia & histologia , Concussão Encefálica/etiologia , Córtex Cerebral/anatomia & histologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Tamanho do Órgão
5.
PLoS One ; 15(8): e0237800, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797073

RESUMO

USA Football established five levels-of-contact to guide the intensity of high school football practices. The objective of this study was to examine head impact frequency and magnitude by levels-of-contact to determine which drills had the greatest head impact exposure. Our primary hypothesis was that there would be an incremental increase in season-long head impact exposure between levels-of-contact: air100g) head impacts were more frequently observed during live and thud drills. Level-of-contact influences cumulative head impact frequency and magnitude in high-school football, with players incurring frequent, high magnitude head impacts during live, thud, and control. It is important to consider level-of-contact to refine clinical exposure guidelines to minimize head impact burden in high-school football.


Assuntos
Concussão Encefálica/etiologia , Traumatismos Craniocerebrais/etiologia , Futebol Americano , Cabeça/patologia , Adolescente , Concussão Encefálica/patologia , Traumatismos Craniocerebrais/patologia , Dispositivos de Proteção da Cabeça , Humanos , Masculino , Instituições Acadêmicas
6.
Leg Med (Tokyo) ; 46: 101728, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32531668

RESUMO

A search was undertaken of the Forensic Science South Australia, Australia, autopsy database over a 25-year period from 1995 to 2019 with the aim of understanding more about the role that recreational horse use not involving racing may have in mortality. Eight cases were found with an age range of 8-73 years (mean 47 years) and a male:female ratio of 5:3. The major category was a fall while riding (N = 7) with the remaining case (N = 1) sustaining a lethal kicking. Blunt craniocerebral trauma was responsible for death in 4 cases with injuries following falls including acute subdural and subarachnoid haemorrhage, cerebral contusions and lacerations with associated significant cerebral edema. Skeletal injuries occurred in 2 cases with falls that had caused fractures of cervical vertebrae 2 and 4, with contusion of the underlying spinal cord (N = 1), and fracture of the pelvis with significant retroperitoneal hemorrhage from associated vascular injuries (N = 1). Lethal abdominal and chest injuries occurred in 2 cases, both with lacerated livers and multiple rib fractures. In the final case of an 8-year-old girl who was kicked by a horse there was a lacerated liver with a hematoperitoneum, and fractures of the ribs on the right side with contusion of the underlying lung. The size, strength and temperament of horses make them potentially dangerous during leisure time activities such as grooming and riding. Lethal head injuries often follow falls and kicks. Traumatic lesions identified at autopsy include fractures and blunt craniocerebral, thoracic and abdominal trauma.


Assuntos
Medicina Legal , Traumatismos Cranianos Fechados/etiologia , Cavalos , Recreação , Adolescente , Adulto , Idoso , Animais , Concussão Encefálica/epidemiologia , Concussão Encefálica/etiologia , Criança , Feminino , Traumatismos Cranianos Fechados/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
J Athl Train ; 55(6): 587-593, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32383984

RESUMO

CONTEXT: The relative availability of clinicians as well as the types and training of health care providers have been associated with morbidity and mortality in non-athletic health care settings. Whether staffing variations are associated with injury incidence in collegiate athletes is unknown. OBJECTIVE: To evaluate whether the institutional ratio of athletes to athletic trainers (patient load) or the ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers or both is associated with the incidence of injuries sustained by male ice hockey athletes at the school. DESIGN: Descriptive epidemiology study. SETTING: National Collegiate Athletic Association (NCAA) men's ice hockey teams. PATIENTS OR OTHER PARTICIPANTS: Collegiate men's ice hockey athletes. MAIN OUTCOME MEASURE(S): The NCAA Injury Surveillance Program collected data from collegiate men's ice hockey athletes. Staffing patterns were obtained through telephone interviews. Injury counts, injury rates per 1000 athlete-exposures, and injury rate ratios with 95% confidence intervals were calculated and compared between the following groups: (1) schools with high (versus low) patient load and (2) schools with high (versus low) ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers. RESULTS: Both the patient load and relative number of staff athletic trainers were associated with variations in the incidences and types of diagnosed injuries in male ice hockey players. Specifically, fewer injuries were diagnosed by clinicians at institutions with high patient loads. The rates of injury overall and non-time-loss injuries were lower in the high patient-load group. Time-loss injury rates, severe injury rates, concussion rates, and overall rates of injury during competition were greater in the group with a higher proportion of staff athletic trainers, whereas non-time-loss injury rates were lower. CONCLUSIONS: In this study of collegiate men's ice hockey players, athlete health outcomes were directly related to the number and types of clinicians available. Future researchers should evaluate whether this finding extends beyond men's ice hockey.


Assuntos
Traumatismos em Atletas , Concussão Encefálica , Hóquei/lesões , Gestão de Riscos , Medicina Esportiva , Recursos Humanos , Adulto , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/prevenção & controle , Concussão Encefálica/epidemiologia , Concussão Encefálica/etiologia , Humanos , Incidência , Masculino , Avaliação de Resultados em Cuidados de Saúde , Administração de Recursos Humanos , Gestão de Riscos/economia , Gestão de Riscos/normas , Medicina Esportiva/métodos , Medicina Esportiva/organização & administração , Estados Unidos , Universidades/estatística & dados numéricos
8.
Mil Med ; 185(Suppl 1): 243-247, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074348

RESUMO

INTRODUCTION: Blast-induced mild traumatic brain injury was generated in a mouse model using a shock tube to investigate recovery and axonal injury from single blast. METHODS: A supersonic helium wave hit the head of anesthetized male young adult mice with a reflected pressure of 69 psi for 0.2 ms on Day 1. Subsequently, the mice were cardioperfused on Days 2, 5, or 12. The isolated brains were subjected to diffusion tensor imaging. Reduced fractional anisotropy (FA) indicated axonal injury. RESULTS: After single blast, FA showed a biphasic response in the corpus callosum with decrease on Days 2 and 12 and increase on Day 5. CONCLUSIONS: Blast-induced mild traumatic brain injury in a mouse model follows a biphasic FA response within 12 days after a single blast similar to that reported for human subjects.


Assuntos
Anisotropia , Traumatismos por Explosões/complicações , Concussão Encefálica/etiologia , Animais , Traumatismos por Explosões/fisiopatologia , Concussão Encefálica/fisiopatologia , Imagem de Tensor de Difusão/métodos , Modelos Animais de Doenças , Explosões/estatística & dados numéricos , Camundongos
9.
Mil Med ; 185(Suppl 1): 248-255, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074377

RESUMO

INTRODUCTION: The peripheral auditory system and various structures within the central auditory system are vulnerable to blast injuries, and even blast overpressure is at relatively mild traumatic brain injury (TBI) level. However, the extent of hearing loss in relation to blast number and time course of post-blast is not well understood. This study reports the progressive hearing damage measured in chinchillas after multiple blast exposures at mild TBI levels (103-138 kPa or 15-20 psi). MATERIALS AND METHODS: Sixteen animals (two controls) were exposed to two blasts and three blasts, respectively, in two groups with both ears plugged with foam earplugs to prevent the eardrum from rupturing. Auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE) were measured in pre- and post-blasts. Immunohistochemical study of chinchilla brains were performed at the end of experiment. RESULTS: Results show that the ABR threshold and DPOAE level shifts in 2-blast animals were recovered after 7 days. In 3-blast animals, the ABR and DPOAE shifts remained at 26 and 23 dB, respectively after 14 days. Variation of auditory cortex damage between 2-blast and 3-blast was also observed in immunofluorescence images. CONCLUSIONS: This study demonstrates that the number of blasts causing mild TBI critically affects hearing damage.


Assuntos
Traumatismos por Explosões/complicações , Perda Auditiva Provocada por Ruído/etiologia , Perda Auditiva/etiologia , Animais , Traumatismos por Explosões/fisiopatologia , Concussão Encefálica/etiologia , Concussão Encefálica/fisiopatologia , Chinchila/lesões , Chinchila/fisiologia , Modelos Animais de Doenças , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Perda Auditiva/fisiopatologia , Perda Auditiva Provocada por Ruído/fisiopatologia , Emissões Otoacústicas Espontâneas/fisiologia , Pressão/efeitos adversos , Membrana Timpânica/lesões , Membrana Timpânica/fisiopatologia
10.
JAMA Ophthalmol ; 138(4): 350-357, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32053162

RESUMO

Importance: Subconcussive head impacts have emerged as a complex public health concern. The oculomotor system is sensitive to brain trauma; however, neuro-ophthalmologic response to subconcussive head impacts remains unclear. Objective: To examine whether subconcussive head impacts cause impairments in neuro-ophthalmologic function as measured by the King-Devick test (KDT) and oculomotor function as measured by the near point of convergence. Design, Setting, and Participants: In this randomized clinical trial, adult soccer players were randomized into either a heading group or kicking (control) group. The heading group executed 10 headers with soccer balls projected at a speed of 25 mph. The kicking-control group followed the same protocol but with 10 kicks. Peak linear and rotational head accelerations were assessed with a triaxial accelerometer. The KDT speed and error and near point of convergence were assessed at baseline (preheading or prekicking) and at 0, 2, and 24 hours after heading or kicking. Exposures: Ten soccer-ball headings or kicks. Main Outcomes and Measures: The primary outcome was the group-by-time interaction of KDT speed at 0 hours after heading or kicking. The secondary outcomes included KDT speed at 2 hours and 24 hours after heading or kicking, KDT error, and near point of convergence. Results: A total of 78 individuals enrolled (heading group, n = 40; kicking-control group, n = 38). Eleven individuals (heading group: 4 women; mean [SD] age, 22.5 [1.0] years; kicking-control group, 3 women and 4 men; mean [SD] age, 20.9 [1.1] years) voluntarily withdrew from the study. Data from 67 participants with a mean (SD) age of 20.6 (1.7) years were eligible for analysis (heading, n = 36; kicking-control, n = 31). Mean (SD) peak linear accelerations and peak rotational accelerations per impact for the heading group were 33.2 (6.8) g and 3.6 (1.4) krad/s2, respectively. Conversely, soccer kicking did not induce a detectable level of head acceleration. Both groups showed improvements in KDT speed (heading group: 0 hours, -1.2 [95% CI, -2.2 to -0.1] seconds; P = .03; 2 hours, -1.3 [95% CI, -2.6 to 0] seconds; P = .05; 24 hours, -3.2 [95% CI, -4.3 to -2.2] seconds; P < .001; kicking-control group: 0 hours, -3.3 [95% CI, -4.1 to -2.5] seconds; P < .001; 2 hours, -4.1 [95% CI, -5.1 to -3.1] seconds; P < .001; 24 hours, -5.2 [95% CI, -6.2 to -4.2] seconds; P < .001). Group differences occurred at all postintervention points; the kicking-control group performed KDT faster at 0 hours (-2.2 [95% CI, -0.8 to -3.5] seconds; P = .001), 2 hours (-2.8 [95% CI, -1.2 to -4.4] seconds; P < .001), and 24 hours after the intervention (-2.0 [95% CI, -0.5 to -3.4] seconds; P = .007) compared with those of the heading group. Conclusions and Relevance: These data support the hypothesis that neuro-ophthalmologic function is affected, at least in the short term, by subconcussive head impacts that may affect some individuals in some contact sports. Further studies may help determine if these measures can be a useful clinical tool in detecting acute subconcussive injury. Trial Registration: ClinicalTrials.gov Identifier: NCT03488381.


Assuntos
Traumatismos em Atletas/fisiopatologia , Concussão Encefálica/fisiopatologia , Transtornos Traumáticos Cumulativos/fisiopatologia , Transtornos da Motilidade Ocular/fisiopatologia , Futebol/lesões , Aceleração , Traumatismos em Atletas/etiologia , Concussão Encefálica/etiologia , Convergência Ocular , Transtornos Traumáticos Cumulativos/etiologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Telemetria , Adulto Jovem
11.
Sci Rep ; 10(1): 2206, 2020 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-32042033

RESUMO

Traumatic brain injury (TBI) has been designated as a signature injury of modern military conflicts. Blast trauma, in particular, has come to make up a significant portion of the TBIs which are sustained in warzones. Though most TBIs are mild, even mild TBI can induce long term effects, including cognitive and memory deficits. In our study, we utilized a mouse model of mild blast-related TBI (bTBI) to investigate TBI-induced changes within the cortex and hippocampus. We performed rapid Golgi staining on the layer IV and V pyramidal neurons of the parietal cortex and the CA1 basilar tree of the hippocampus and quantified dendritic branching and distribution. We found decreased dendritic branching within both the cortex and hippocampus in injured mice. Within parietal cortex, this decreased branching was most evident within the middle region, while outer and inner regions resembled that of control mice. This study provides important knowledge in the study of how the shockwave associated with a blast explosion impacts different brain regions.


Assuntos
Traumatismos por Explosões/patologia , Concussão Encefálica/patologia , Região CA1 Hipocampal/patologia , Dendritos/patologia , Lobo Parietal/patologia , Animais , Conflitos Armados , Traumatismos por Explosões/etiologia , Concussão Encefálica/etiologia , Região CA1 Hipocampal/citologia , Modelos Animais de Doenças , Explosões , Complexo de Golgi/patologia , Humanos , Masculino , Camundongos , Lobo Parietal/citologia , Células Piramidais/citologia , Células Piramidais/patologia
12.
J Public Health Manag Pract ; 26(2): E23-E27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31995550

RESUMO

OBJECTIVE: Current prevalence estimates of youth sports-related concussions are inconsistent because of variation in methodology and potentially unreported concussions. METHODS: In 2013, Connecticut, Ohio, and Utah each added different questions that assessed self-reported concussions to the Youth Risk Behavior Survey. Two questions referenced recognition of a concussion by the student, 1 referenced identification by a doctor, and 1 referenced suspicion by a coach. Chi-square analyses were used to identify whether there was an association between demographic characteristics and the concussion questions among high school students who played on at least 1 sports team. RESULTS: The percentage of students who reported concussions ranged from 17.6% to 20.1%. CONCLUSIONS: These estimates are higher than rates of concussions diagnosed in emergency departments or reported by athletic trainers but were similar across the 4 questions. The field would benefit from a better understanding of the impact of question wording and format on estimates of concussion prevalence.


Assuntos
Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Concussão Encefálica/psicologia , Autorrelato/normas , Esportes/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Concussão Encefálica/epidemiologia , Connecticut/epidemiologia , Feminino , Humanos , Masculino , Ohio/epidemiologia , Prevalência , Fatores de Risco , Instituições Acadêmicas/organização & administração , Instituições Acadêmicas/estatística & dados numéricos , Inquéritos e Questionários , Utah/epidemiologia
13.
Br J Neurosurg ; 34(2): 127-134, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31916459

RESUMO

Introduction: A radiological scoring system to define a 'surgically significant' mild Traumatic Brain Injury (TBI) could stratify neurosurgical referrals, and improve communication between referral centres and neurosurgical units, as most referrals are not accepted.Materials and methods: A computed tomography (CT) scoring system based on radiological injuries sustained in a TBI was developed and validated. All neurosurgical referrals to a major tertiary neurosurgery centre in England, UK with a mild TBI (GCS 13-15) during the period of 1st January to 30th October 2017 were scored retrospectively and stratified according to their mean score, and if they were accepted for transfer to the neurosurgical centre. A total of 1248 patients were identified during the study period, with 1144 being included in the final analysis.Results: Of the referrals to the neurosurgical centre, 17% (n = 195) were accepted for transfer and 83% (n = 946) were not accepted. The scoring system was 99% sensitive and 51.9% specific for determining a surgically significant TBI. Diagnostic power of the model was fair with an area under the curve of 0.79 (95% CI 0.76 to 0.82). The score identified 495 (52.2%) patients in ten months of referrals that could have been successfully managed locally without neurosurgical referral if the scoring system was correctly used at the time of injury.Conclusions: The Liverpool Head Injury Tomography Score (HITS) score is a CT-based scoring system that can be used to define a surgically significant mild TBI. The scoring system has high sensitivity and could be incorporated into local, regional and national head injury guidance.


Assuntos
Concussão Encefálica/diagnóstico , Traumatismos Craniocerebrais/diagnóstico por imagem , Encaminhamento e Consulta/estatística & dados numéricos , Medição de Risco/métodos , Concussão Encefálica/etiologia , Concussão Encefálica/terapia , Lesões Encefálicas/etiologia , Traumatismos Craniocerebrais/cirurgia , Traumatismos Craniocerebrais/terapia , Inglaterra , Escala de Coma de Glasgow , Humanos , Neurocirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
15.
Emerg Med Clin North Am ; 38(1): 207-222, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757251

RESUMO

A systematic approach is required for patients with a suspected concussion. Although standardized tools can aid in assessment, the diagnosis of concussion remains a clinical one. At the time of diagnosis, patients should be given both verbal and written review of the common symptoms of concussion, expected course of recovery, as well as strategies to manage symptoms. Most patients benefit from a brief period of rest, followed by a gradual reintroduction of activities, and a graduated return-to-sport protocol. Patients with prolonged recovery from a concussion may benefit from exercise, vestibular, and cognitive rehabilitation programs.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Diagnóstico por Imagem/métodos , Gerenciamento Clínico , Emergências , Medicina Esportiva/métodos , Traumatismos em Atletas/complicações , Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Humanos , Índices de Gravidade do Trauma
16.
Arch Phys Med Rehabil ; 101(5): 789-796, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31821800

RESUMO

OBJECTIVES: To determine whether the measurement properties of the Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) and its participation index (M2PI), which have been adopted as 2 outcome measures in the Veterans Health Administration (VHA) National Polytrauma Rehabilitation Systems of Care, are adequate in veterans with mild traumatic brain injury (mTBI). DESIGN: Cross-sectional. SETTING: Outpatient rehabilitation. PARTICIPANTS: Postdeployment veterans with blast-related mTBI (N=177). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Mayo-Portland Adaptability Inventory Version 4 (MPAI-4) and Community Integration Questionnaire (CIQ). RESULTS: The unidimensional factor structure of the MPAI-4 total and 3 index scores (abilities, adjustment, participation) were confirmed. Eight of the 30 items were removed for violating monotonicity (6 items) and exceeding Rasch infit (2 items). The rating scale was collapsed from 5 to 3 ratings because of structure issues. The remaining 22 MPAI-4 items demonstrated excellent item/person reliability (0.98/0.91) and separated person ability into 4 strata. Two of the MPAI-4 index scores (abilities and adjustment) had good measurement properties. The third index, M2PI, retained only 3 items that had adequate person reliability (0.75) but separated person ability into only 2 strata. A significant but fair association with the CIQ was demonstrated with the modified MPAI-4. CONCLUSIONS: The MPAI-4 has been validated in moderate to severe traumatic brain injury but required modification when used in active military personnel with mTBI. We also identified the need for modification of the MPAI-4 to support adequate psychometrics when measuring outcomes in veterans with mTBI. Additional validation of the M2PI is needed in veterans and active military personnel with mTBI, to determine whether the M2PI should continue to be used as an outcome measure in the VHA polytrauma rehabilitation systems.


Assuntos
Adaptação Psicológica , Concussão Encefálica/complicações , Avaliação da Deficiência , Veteranos , Adulto , Traumatismos por Explosões/complicações , Concussão Encefálica/etiologia , Concussão Encefálica/psicologia , Estudos Transversais , Depressão/complicações , Análise Fatorial , Feminino , Humanos , Masculino , Psicometria , Reprodutibilidade dos Testes , Autorrelato , Participação Social , Estados Unidos
17.
Brain Imaging Behav ; 14(1): 164-174, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30377933

RESUMO

Mitigating the effects of repetitive exposure to head trauma has become a major concern for the general population, given the growing body of evidence that even asymptomatic exposure to head accelerations is linked with increased risk for negative life outcomes and that risk increases as exposure is prolonged over many years. Among women's sports, soccer currently exhibits the highest growth in participation and reports the largest number of mild traumatic brain injuries annually, making female soccer athletes a relevant population in assessing the effects of repetitive exposure to head trauma. Cerebrovascular biomarkers may be useful in assessing the effects of repetitive head trauma, as these are thought to contribute directly to neurocognitive symptoms associated with mild traumatic brain injury. Here we use fMRI paired with a hypercapnic breath hold task along with monitoring of head acceleration events, to assess the relationship between cerebrovascular brain changes and exposure to repetitive head trauma over a season of play in female high school soccer athletes. We identified longitudinal changes in cerebrovascular reactivity that were significantly associated with prolonged accumulation to high magnitude (> 75th percentile) head acceleration events. Findings argue for active monitoring of athletes during periods of exposure to head acceleration events, illustrate the importance of collecting baseline (i.e., pre-exposure) measurements, and suggest modeling as a means of guiding policy to mitigate the effects of repetitive head trauma.


Assuntos
Concussão Encefálica/etiologia , Encéfalo/diagnóstico por imagem , Traumatismos Craniocerebrais/fisiopatologia , Aceleração , Adolescente , Atletas , Traumatismos em Atletas/complicações , Concussão Encefálica/diagnóstico por imagem , Feminino , Humanos , Hipercapnia/fisiopatologia , Imageamento por Ressonância Magnética/métodos , Futebol/lesões , Futebol/fisiologia
18.
Clin J Sport Med ; 30(4): 366-371, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-29952843

RESUMO

OBJECTIVE: Evaluate the rate of concussions across Big 12 Conference football programs based on (1) equipment worn, (2) contact level, (3) preseason practice versus in-season practice versus games, and (4) mechanism of injury for concussion. DESIGN: Descriptive epidemiology study. SETTING: Big 12 Conference football practices and competitions. PATIENTS (OR PARTICIPANTS): Big 12 Conference football teams. ASSESSMENT OF RISK FACTORS: All Big 12 Conference institutions collected data on practice types, equipment worn, practice and game participation, and concussions during the fall, preseasons and regular seasons, from 2013 to 2016. MAIN OUTCOME MEASURES: Injury rates and injury rate ratios were reported with 95% confidence intervals (CIs). RESULTS: From 2013 to 2016, there were 375 concussions reported [0.98/1000 athlete exposures (AEs) (95% CI, 0.88-1.08)], an average of approximately 9 concussions per team per year. Concussion rates were highest in games (5.73/1000 AE), but among practices, concussion rates were highest in full-pad (1.18/1000 AEs) and live-contact (1.28/1000 AEs) practices. Concussion rates increased with increasing contact and equipment worn. Concussion rates were higher in the preseason than in the regular season, even when stratifying by contact level and equipment worn. CONCLUSIONS: Practice concussion rates are highest during fully padded and live-contact practices, supporting limitations on practice contact and equipment worn to reduce the risk associated with head-impact exposure. Higher concussion rates in the preseason and during games indicate an effect of play intensity on concussion risk, and further research is needed to evaluate the direct effect of practice contact level and equipment guidelines and restrictions on concussion incidence.


Assuntos
Concussão Encefálica/epidemiologia , Comportamento Competitivo , Futebol Americano/lesões , Condicionamento Físico Humano/efeitos adversos , Equipamentos de Proteção , Concussão Encefálica/etiologia , Concussão Encefálica/prevenção & controle , Humanos , Incidência , Masculino , Fatores de Risco , Estados Unidos/epidemiologia
19.
Scand J Med Sci Sports ; 30(1): 185-192, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31494968

RESUMO

The purpose of this study was to determine the factors related to the occurrence of concussion in rugby tacklers. Match video records showing tackles leading to concussion were used to identify injury-inciting events. Additionally, noninjury tackles by concussed tacklers (prior to concussion) and position-matched tacklers from the same matches were used as a control cohort. All tackles were coded according to the tackling characteristics. The odds ratio (OR) was reported by logistic regression. The results demonstrated that a side step of the ball-carrier reduced the risk of concussion for tacklers (OR = 0.13 [95% CI, 0.03-0.58]; P = .008). Conversely, the tackler's head/neck contacting the ball-carrier (OR = 18.62 [95% CI, 4.59-75.49]; P < .001) and not remaining bound to the ball-carrier since making initial contact (OR = 4.38 [95% CI, 1.69-11.34]; P = .002) were identified as risk factors for the concussion of tacklers. These results suggest that avoidance movements of the ball-carrier prior to tackling reduced the risk of concussion and that incorrect tackling techniques contributed to an increased occurrence of concussion. Furthermore, the probability of concussion for tacklers increased when their head was in front or to one side of the ball-carrier, and the direction of the tackle also affected the risk of concussion, especially from the side. Therefore, it is important to emphasize the tackler's head position in conjunction with the direction of tackle.


Assuntos
Traumatismos em Atletas/etiologia , Concussão Encefálica/etiologia , Futebol Americano/lesões , Atletas , Humanos , Japão , Modelos Logísticos , Razão de Chances , Fatores de Risco , Gravação em Vídeo
20.
JAMA Netw Open ; 2(12): e1917626, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31851345

RESUMO

Importance: Concussion on university campuses is a significant health problem. Characterizing the incidence of concussion on college campuses may inform education and resource allocation policy at student health care centers. Objectives: To establish a measure of concussion incidence among collegiate undergraduate students and to describe characteristics associated with concussion incidence, including sex, cause, and month. Design, Setting, and Participants: This prospective cohort study included data from 3 academic years from August 2015 to April 2018 at a large, public university in the United States. Participants included any undergraduate student or varsity athlete who was diagnosed with at least 1 concussion during the academic year. Exposures: Sport- and non-sport-related activities of undergraduate students. Main Outcomes and Measures: Concussion diagnosis. Results: Among 954 undergraduate students from the general undergraduate population with at least 1 concussion, including 502 men and 452 women, 1020 concussions were diagnosed in 3 academic years. During 2 academic years, a total of 80 concussions occurred among the varsity athlete population, including 26 men and 54 women. Overall, concussion incidence among both the general undergraduate population and varsity athletes was 132.4 (95% CI, 123.2-142.0) concussions per 10 000 students. Men sustained concussions at a rate of 126.1 (95% CI, 114.1-139.0) concussions per 10 000 students and women sustained concussions at a rate of 140.0 (95% CI, 126.2-155.3) concussions per 10 000 students for the 2016 to 2017 and 2017 to 2018 academic years. Concussion incidence peaked in August at the start of the academic year and the rate of non-sport-related concussions (81.0 [95% CI, 73.9-88.7] concussions per 10 000 students for academic years 2016-2017 and 2017-2018) was higher than the rate of sport-related concussions (51.5 [95% CI, 49.5-57.7] concussions per 10 000 students for academic years 2016-2017 and 2017-2018). Conclusions and Relevance: This cohort study found concussions to be common among this US collegiate population. While concussion is often associated with sport, the incidence of non-sport-related concussion was higher than that of sport-related concussion throughout the academic year. Additional research is warranted to determine if this incidence measure among undergraduate students is generalizable to other university populations.


Assuntos
Concussão Encefálica/epidemiologia , Estudantes/estatística & dados numéricos , Adolescente , Adulto , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/epidemiologia , Traumatismos em Atletas/etiologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Colorado/epidemiologia , Feminino , Humanos , Incidência , Masculino , Estudos Prospectivos , Fatores de Risco , Universidades , Adulto Jovem
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