Recommendations for Medical Discharge Documentation and Academic Supports for University Students Recovering From Concussion.

OBJECTIVE: This study sought to (1) collate the experiences of university students with concussion history and academic stakeholders through interviews and (2) develop concussion management recommendations for institutions of higher learning using a multidisciplinary Delphi procedure. SETTING: Remote semistructured interviews and online surveys. PARTICIPANTS: The first aim of this study included undergraduate university students with concussion history who did not participate in varsity athletics ( n = 21; 57.1% female), as well as academic faculty/staff with experience assisting university students with their postconcussion academic needs ( n = 7; 71.4% female). The second aim enrolled 22 participants (54.5% female) to serve on the Delphi panel including 9 clinicians, 8 researchers, and 5 academic faculty/staff. DESIGN: An exploratory-sequential mixed-methods approach. MAIN MEASURES: Semistructured interviews were conducted to unveil barriers regarding the return-to-learn (RTL) process after concussion, with emergent themes serving as a general framework for the Delphi procedure. Panelists participated in 3 stages of a modified Delphi process beginning with a series of open-ended questions regarding postconcussion management in higher education. The second stage included anonymous ratings of the recommendations, followed by an opportunity to review and/or modify responses based on the group's consensus. RESULTS: The results from the semistructured interviews indicated students felt supported by their instructors; however, academic faculty/staff lacked information on appropriate academic supports and/or pathways to facilitate the RTL process. Of the original 67 statements, 39 achieved consensus (58.2%) upon cessation of the Delphi procedure across 3 main categories: recommendations for discharge documentation (21 statements), guidelines to facilitate a multidisciplinary RTL approach (10 statements), and processes to obtain academic supports for students who require them after concussion (8 statements). CONCLUSIONS: These findings serve as a basis for future policy in higher education to standardize RTL processes for students who may need academic supports following concussion.

Racial Disparities in Diagnosis of Concussion and Minor Head Trauma and Mechanism of Injury in Pediatric Patients Visiting the Emergency Department.

OBJECTIVE: To determine if racial/ethnic differences exist in the diagnosis and mechanism of injury among children and adolescents visiting the emergency department (ED) for concussion and minor head trauma (MHT). STUDY DESIGN: A retrospective, cross-sectional study of patient (age ≤19 years) visits to the ED for concussion between 2010-2015, using the National Hospital Ambulatory Medical Care Survey, was completed. The primary study exposure was race/ethnicity. Outcome measures included ED visits that resulted in a concussion/MHT diagnosis and mechanism of injury. Mechanism categories included sport, motor vehicle collision, fall, assault, and other mechanism. A multivariable logistic regression and multinomial logistic regression were conducted to assess relationships between race/ethnicity and outcomes. Findings were weighted to reflect population estimates. RESULTS: In total, 1263 child/adolescent visits for concussion/MHT were identified, representing an estimated 6.6 million child/adolescent visits nationwide. Compared with non-Hispanic White pediatric patients, non-Hispanic Black patients were least likely to have an ED visit for a concussion/MHT (P < .001; OR, 0.66; 95% CI, 0.52-0.83) The odds of non-Hispanic Black children/adolescents (OR, 3.80; 95% CI, 1.68-8.55) and children/adolescents of other race/ethnicity (OR, 4.93; 95% CI, 1.09-22.23) sustaining a concussion/MHT resulting from assault vs sport was higher. CONCLUSIONS: Amid the emerging focus on sport-related concussion, these ethnic/racial differences in ED diagnosis of concussion/MHT demonstrate sociodemographic differences that warrant further attention. Assault may be a more common mechanism of concussion among children/adolescents of a racial minority.

Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities.

ABSTRACT: Co-occurrence of chronic pain and clinically significant symptoms of anxiety and/or depression is regularly noted in the literature. Yet, little is known empirically about population prevalence of co-occurring symptoms, nor whether people with co-occurring symptoms constitute a distinct subpopulation within US adults living with chronic pain or US adults living with anxiety and/or depression symptoms (A/D). To address this gap, this study analyzes data from the 2019 National Health Interview Survey, a representative annual survey of self-reported health status and treatment use in the United States (n = 31,997). Approximately 12 million US adults, or 4.9% of the adult population, have co-occurring chronic pain and A/D symptoms. Unremitted A/D symptoms co-occurred in 23.9% of US adults with chronic pain, compared with an A/D prevalence of 4.9% among those without chronic pain. Conversely, chronic pain co-occurred in the majority (55.6%) of US adults with unremitted A/D symptoms, compared with a chronic pain prevalence of 17.1% among those without A/D symptoms. The likelihood of experiencing functional limitations in daily life was highest among those experiencing co-occurring symptoms, compared with those experiencing chronic pain alone or A/D symptoms alone. Among those with co-occurring symptoms, 69.4% reported that work was limited due to a health problem, 43.7% reported difficulty doing errands alone, and 55.7% reported difficulty participating in social activities. These data point to the need for targeted investment in improving functional outcomes for the nearly 1 in 20 US adults living with co-occurring chronic pain and clinically significant A/D symptoms.

Achieving Consensus Through a Modified Delphi Technique to Create the Post-concussion Collegiate Return-to-Learn Protocol.

BACKGROUND: Sport-related concussions (SRCs) affect millions of adolescents and young adults annually in the USA; however, current SRC consensus statements provide limited guidance on academic support for students within higher education. OBJECTIVE: To generate consensus on appropriate academic recommendations for clinicians, students, and academic stakeholders to support university students during their recovery. METHODS: Panelists participated in three stages of a modified Delphi procedure: the first stage included a series of open-ended questions after reviewing a literature review on post-SRC return-to-learn (RTL) in higher education; the second stage asked panelists to anonymously rate the recommendations developed through the first Delphi stage using a 9-point scale; and the final stage offered panelists the opportunity to change their responses and/or provide feedback based on the group's overall ratings. RESULTS: Twenty-two panelists including clinicians, concussion researchers, and academic stakeholders (54.5% female) from 15 institutions and/or healthcare systems participated in a modified Delphi procedure. A total of 42 statements were developed after round one. Following the next two rounds, 27 statements achieved consensus amongst the panel resulting in the four-stage Post-Concussion Collegiate RTL Protocol. CONCLUSION: There are several unique challenges when assisting university students back to the classroom after SRC. Explicit guidelines on when to seek additional medical care (e.g., if they are experiencing worsening or persistent symptoms) and how to approach their instructor(s) regarding academic support may help the student self-advocate. Findings from the present study address barriers and provide a framework for universities to facilitate a multidisciplinary approach amongst medical and academic stakeholders.

Associations Between Major Depressive Episodes and School- or Community-Based Activity Participation Among Adolescents Using Nationwide Representative Data.

BACKGROUND: This study examined the association between participation in school-based and/or community-based activity and major depressive episodes (MDE) in adolescents using nationally representative data. METHODS: This study utilized cross-sectional data from the National Survey of Drug Use and Health from 2015 to 2019. Nine screening questions determined the presence of past-year MDE in adolescents ages 12-17 (n = 67,033). Participants indicated past-year participation in school-based (eg, team sports, cheerleading, choir, band, student government, or clubs) and/or community-based activities (eg, volunteer activities, sports, clubs, or groups). Sociodemographic variables included sex, race/ethnicity, family income, and age. Descriptive statistics, univariable and multivariable regression analyses were conducted. The multivariable model included interaction terms between age and sex, and age and race/ethnicity. RESULTS: Overall, 14% of the sample met the criteria for having MDE. The odds of MDE increased with age. Joint effects of age and sex, and age and race/ethnicity significantly influenced the association between MDE and school- or community-based activities. Participation in 1+ community-based activities was protective for MDE across all races/ethnicities. CONCLUSIONS: Findings help illuminate the direct association of school- and community-based activity participation on MDE risk in adolescents, improving our understanding of MDE across various sociodemographic subgroups in an adolescent population. Schools should aim to facilitate equitable programming and endorse adolescent participation in multiple activities throughout the year. Schools should examine the resources available and consider partnerships that would bolster resources, access, and social capital throughout the community.

Dynamic cognitive inhibition in the context of frustration: Increasing racial representation of adolescent athletes using mobile community-engaged EEG methods.

Introduction: Concussive events and other brain injuries are known to reduce cognitive inhibition, a key aspect of cognition that supports ones' behaviors and impacts regulation of mood or affect. Our primary objective is to investigate how induction of negative affect (such as frustration) impacts cognitive inhibition and the dynamic process by which youth athletes modulate responses. Secondary objective is to address the lack of Black representation in the scientific literature that promotes brain health and investigates pediatric sports-related brain injury. In particular, neuroscience studies predominantly include White participants despite broad racial representation in sport, in part due to technological hurdles and other obstacles that challenge research access for Black participants. Methods: Using electroencephalography (EEG), we evaluate the dynamic brain processes associated with cognitive inhibition in the context of frustration induction in adolescent athletes during pre-season conditioning (i.e., prior to contact; N = 23) and a subset during post-season (n = 17). Results: The N2 component was sensitive to frustration induction (decreased N2 amplitude, slower N2 latency), although effects were less robust at postseason. Trial-by-trial changes indicated a steady decrease of the N2 amplitude during the frustration block during the preseason visit, suggesting that affective interference had a dynamic effect on cognitive inhibition. Lastly, exploratory analyses provide preliminary evidence that frustration induction was less effective for athletes with a previous history of concussion or migraines (trending result) yet more effective for athletes endorsing a history with mental health disorders. Discussion: We emphasize the urgent need to improve representation in cognitive neuroscience, particularly as it pertains to brain health. Importantly, we provide detailed guides to our methodological framework and practical suggestions to improve representative participation in studies utilizing high-density mobile EEG.

Examining racial and ethnic disparities in adult emergency department patient visits for concussion in the United States.

Background: Racial and ethnic differences in emergency department (ED) visits have been reported among adolescent patients but are unsubstantiated among adults. Therefore, our purpose in this study was to examine the relationship between race/ethnicity and adult ED visits for concussions, their injury mechanisms, and computed tomography (CT) scan use among a nationally representative sample. Methods: We used the National Hospital Ambulatory Medical Care Survey database from 2010-2015 to examine 63,725 adult (20-45 years old) patient visits, representing an estimated 310.6 million visits presented to EDs. Of these visits, 884 (4.5 million national estimate) were diagnosed with a concussion. Visit records detailed patient information (age, sex, race/ethnicity, geographic region, primary payment type), ED visit diagnoses, injury mechanism (sport, motor vehicle, fall, struck by or against, "other"), and head CT scan use. The primary independent variable was race/ethnicity (non-Hispanic Asian, non-Hispanic Black or African American, Hispanic/Latinx, non-Hispanic multiracial or another, and non-Hispanic White). We used multivariable logistic and multinomial regression models with complex survey sampling design weighting to examine the relationship between concussion ED visits, injury mechanisms, and CT scan use separately by race/ethnicity while accounting for covariates. Results: There were no associations between race/ethnicity and concussion diagnosis among adult ED visits after accounting for covariates. Relative to sports-related injuries, non-Hispanic Black or African American patient visits were associated with a motor vehicle (OR = 2.69, 95% CI: 1.06-6.86) and "other" injury mechanism (OR = 4.58, 95% CI: 1.34-15.69) compared to non-Hispanic White patients. Relative to sports-related injuries, non-Hispanic Asian, multiracial, or patients of another race had decreased odds of falls (OR = 0.20, 95% CI: 0.04-0.91) and "other" injuries (OR = 0.09, 95% CI: 0.01-0.55) compared to non-Hispanic White patients. The odds of a CT scan being performed were significantly lower among Hispanic/Latinx patient visits relative to non-Hispanic White patients (OR = 0.52, 95% CI: 0.30-0.91), while no other race/ethnicity comparisons differed. Conclusion: Our findings indicate that the overarching concussion ED visit likelihood may not differ by race/ethnicity in adults, but the underlying mechanism causing the concussion and receiving a CT scan demonstrates considerable differences. Prospective future research is warranted to comprehensively understand and intervene in the complex, multi-level race/ethnicity relationships related to concussion health care to ensure equitable patient treatment.