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Article ; Online: Contemporary Diagnosis and Management of Mild TBI (Concussions): What You Need to Know.

Panzera, Joseph C / Podolak, Olivia E / Master, Christina L

The journal of trauma and acute care surgery

2024

Abstract: Abstract: Concussion is a common injury in children and adolescents and is a form of mild traumatic brain injury that surgeons will see in their acute care practice. With a rapidly changing evidence base for diagnosis and management, we will focus on ... ...

Abstract	Abstract: Concussion is a common injury in children and adolescents and is a form of mild traumatic brain injury that surgeons will see in their acute care practice. With a rapidly changing evidence base for diagnosis and management, we will focus on the importance of timely identification and diagnosis, as well as the early initiation of active management of pediatric concussion immediately after injury through recovery. This approach involves the application of targeted therapies for specific deficits identified after concussion, addressing the individual pattern of symptoms experienced by patients following concussion. We will review what is known about the underlying pathophysiology that drives the clinical manifestations of concussion, the targeted clinical assessments that can both aid in the diagnosis of concussion, as well as drive the active rehabilitation of deficits seen after concussion. The standardized approach to the return to activities will also be described, including return to learning and sports.
Language	English
Publishing date	2024-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004297
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Article ; Online: Neurovascular Coupling in Acutely Concussed Adolescent Patients.

Roby, Patricia R / Mozel, Anne E / Grady, Matthew F / Master, Christina L / Arbogast, Kristy B

Journal of neurotrauma

2024

Abstract: Neurovascular coupling (NVC) uniquely describes cerebrovascular response to neural activation and has demonstrated impairments following concussion in adult patients. It is currently unclear how adolescent patients experience impaired NVC acutely ... ...

Abstract	Neurovascular coupling (NVC) uniquely describes cerebrovascular response to neural activation and has demonstrated impairments following concussion in adult patients. It is currently unclear how adolescent patients experience impaired NVC acutely following concussion during this dynamic phase of physiological development. The purpose of this study was to investigate NVC in acutely concussed adolescent patients relative to controls. We recruited patients presenting to a sports medicine practice within 28 days of a concussion or a musculoskeletal injury (controls). Transcranial Doppler ultrasound was used to measure changes in patients' posterior cerebral artery (PCA) velocity in response to two progressively challenging visual tasks: (1) reading and (2) visual search. Each task was presented in five 1-min trials (20 sec eyes closed/40 sec eyes open). Resting PCA velocity data were derived by averaging PCA velocity across a 2-min baseline period that preceded the visual tasks. Filtered task data were converted to time-series curves representing 40 consecutive 1-sec averages for each trial. Curves were then averaged across the five trials and time-aligned to stimulus onset (eyes open) to generate a single ensemble-averaged 40-sec curve representing NVC response for each participant for each task. Independent
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	645092-1
ISSN	1557-9042 ; 0897-7151
ISSN (online)	1557-9042
ISSN	0897-7151
DOI	10.1089/neu.2023.0192
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Zs.A 2016: Show issues

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Article ; Online: Menstrual Cycle Patterns After Concussion in Adolescent Patients.

Roby, Patricia R / Grimberg, Adda / Master, Christina L / Arbogast, Kristy B

The Journal of pediatrics

2023 Volume 262, Page(s) 113349

Abstract: Objective: To describe menstrual cycle patterns in adolescents with concussion and investigate whether menstrual cycle phase at injury influenced postconcussion cycle pattern changes or concussion symptoms.: Study design: Data were collected ... ...

Abstract	Objective: To describe menstrual cycle patterns in adolescents with concussion and investigate whether menstrual cycle phase at injury influenced postconcussion cycle pattern changes or concussion symptoms. Study design: Data were collected prospectively from patients aged 13-18 years presenting to a specialty care concussion clinic for an initial visit (≤28 days postconcussion) and, if clinically indicated, at a follow-up visit 3-4 months postinjury. Primary outcomes included menstrual cycle pattern change since injury (change/no change), menstrual cycle phase at time of injury (calculated using date of last period before injury), and symptom endorsement and severity, measured by Post-Concussion Symptom Inventory (PCSI). Fisher exact tests were used to determine the association between menstrual phase at injury and change in cycle pattern. Multiple linear regression was used to determine whether menstrual phase at injury was associated with PCSI endorsement and symptom severity, adjusting for age. Results: Five hundred twelve postmenarchal adolescents were enrolled (age 15.2 ± 1.4 years), with 111 (21.7%) returning for follow-up at 3-4 months. Menstrual pattern change was reported by 4% of patients at initial visit and 10.8% of patients at follow-up. At 3-4 months, menstrual phase at injury was not associated with menstrual cycle changes (P = .40) but was associated with endorsement of concussion symptoms on the PCSI (P = .01). Conclusions: At 3-4 months' postconcussion, 1 in 10 adolescents experienced a change in menses. Menstrual cycle phase at injury was associated with postconcussion symptom endorsement. Leveraging a large sample of postconcussion menstrual patterns, this study represents foundational data regarding potential menstrual cycle effects of concussion in female adolescents.
MeSH term(s)	Humans ; Adolescent ; Female ; Athletic Injuries/complications ; Athletic Injuries/diagnosis ; Brain Concussion/complications ; Brain Concussion/diagnosis ; Post-Concussion Syndrome/diagnosis ; Menstrual Cycle ; Risk Factors
Language	English
Publishing date	2023-02-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2023.02.002
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Article ; Online: Impact of traumatic brain injury on vision.

Viswanathan, Suresh / Port, Nicholas / Master, Christina L / Pardue, Machelle T

Vision research

2022 Volume 204, Page(s) 108176

MeSH term(s)	Humans ; Brain Injuries, Traumatic ; Vision, Ocular ; Vision Disorders/etiology
Language	English
Publishing date	2022-12-23
Publishing country	England
Document type	Editorial
ZDB-ID	200427-6
ISSN	1878-5646 ; 0042-6989
ISSN (online)	1878-5646
ISSN	0042-6989
DOI	10.1016/j.visres.2022.108176
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Article ; Online: Documented Visio-Vestibular Examination and Anticipatory Guidance for Pediatric Concussion Patients.

Donner, Julia R / Corwin, Daniel J / Master, Christina L / Zonfrillo, Mark R

Pediatric emergency care

2022 Volume 39, Issue 3, Page(s) 179–183

Abstract: Objectives: Pediatric concussion patients are frequently managed in the primary care or acute care settings. Optimal care includes vision and vestibular assessments, as well as targeted anticipatory guidance for return to school and activity. We aimed ... ...

Abstract	Objectives: Pediatric concussion patients are frequently managed in the primary care or acute care settings. Optimal care includes vision and vestibular assessments, as well as targeted anticipatory guidance for return to school and activity. We aimed to examine clinical practices related to the evaluation and management of concussion patients at children's hospital-based emergency department (ED) and primary care/urgent care settings. Methods: We conducted a retrospective chart review of children aged 5 to 18 years who presented to either the ED or the primary and urgent care settings during a 2-year period. We evaluated 2 concussion management practices: (1) completion of the visio-vestibular examination and (2) provision of anticipatory guidance and follow-up. Results: Among patients seen in the ED (n = 500), only 12.4% had at least 1 component of the visio-vestibular examination performed compared with 51.3% of patients (n = 78) in the primary and urgent care settings ( P < 0.05). Regarding anticipatory guidance, 86.2% of ED patients were advised to engage in cognitive rest, and 94.2% were told to physically rest compared with 67.9% and 72.8% in the primary and urgent care settings ( P < 0.05), respectively. Follow-up recommendations were provided similarly for both settings (92.0% in the ED and 85.9% in the primary/urgent care, P = 0.077). Conclusions: Although most pediatric concussion patients receive instructions acutely about cognitive and physical rest, there is opportunity to increase the frequency of visio-vestibular testing in both the ED and the primary care settings. Future efforts should focus on strategies to consistently optimize visio-vestibular assessment given its value in concussion diagnosis.
MeSH term(s)	Humans ; Child ; Retrospective Studies ; Brain Concussion/diagnosis ; Brain Concussion/therapy ; Emergency Service, Hospital ; Physical Examination ; Rest
Language	English
Publishing date	2022-09-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	632588-9
ISSN	1535-1815 ; 0749-5161
ISSN (online)	1535-1815
ISSN	0749-5161
DOI	10.1097/PEC.0000000000002845
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Zs.A 2083: Show issues

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Article ; Online: The effect of a home exercise program on visio-vestibular function in concussed pediatric patients.

Roby, Patricia R / Podolak, Olivia E / Grady, Matthew / Arbogast, Kristy B / Master, Christina L

Frontiers in sports and active living

2023 Volume 5, Page(s) 1064771

Abstract: Background: A visio-vestibular home exercise program (VV-HEP) can provide an equitable and cost-effective method for therapy targeted towards visio-vestibular deficits that are common following concussion. The effects of a VV-HEP on improving concussion ...

Abstract	Background: A visio-vestibular home exercise program (VV-HEP) can provide an equitable and cost-effective method for therapy targeted towards visio-vestibular deficits that are common following concussion. The effects of a VV-HEP on improving concussion symptoms and visio-vestibular function are unclear. Purpose: Determine the effect of VV-HEP on symptoms and visio-vestibular function in concussed pediatric patients. Methods: This study included 527 patients [294 female (55.8%); age = 14.4 ± 2.1 years] reporting to a specialty care concussion center within 28 days of injury and for a first follow-up within 60 days of injury. Patients completed the Post-Concussion Symptom Inventory (PCSI) and Visio-Vestibular Examination (VVE). Patients were prescribed the VV-HEP at initial visit, with exercises including saccades, gaze stability, convergence, and balance, and instructed to complete these 1-2 times/day. At follow-up, patients self-reported their VV-HEP progress as (1) has not done, (2) in progress, or (3) completed. Primary outcomes included VV-HEP progress at follow-up, PCSI endorsement and severity, VVE subtests (normal/abnormal), and total VVE score (abnormal = 2 + abnormal subtests). Kruskal-Wallis tests and chi-square were used to determine if concussion symptoms or the proportion of abnormal VVE outcomes, respectively, were associated with VV-HEP status. Results: At follow-up, patients who had completed the VV-HEP reported lower symptom endorsement (median = 1, IQR = 0-3) and lower symptom severity (median = 1, IQR = 0-4) relative to patients who had not started the VV-HEP (endorsement median = 7, IQR = 1-13, Conclusion: Our findings indicate that patients who completed the VV-HEP had lower symptom burden and improved visio-vestibular function relative to those who did not start or were in progress. This suggests that a VV-HEP can effectively reduce visio-vestibular dysfunction following concussion and may serve as a means to minimize inequities in access to care.
Language	English
Publishing date	2023-03-03
Publishing country	Switzerland
Document type	Journal Article
ISSN	2624-9367
ISSN (online)	2624-9367
DOI	10.3389/fspor.2023.1064771
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Article: Altered Auditory and Visual Evoked Potentials following Single and Repeated Low-Velocity Head Rotations in 4-Week-Old Swine.

Oeur, Anna / Torp, William H / Arbogast, Kristy B / Master, Christina L / Margulies, Susan S

Biomedicines

2023 Volume 11, Issue 7

Abstract: Auditory and visually evoked potentials (EP) have the ability to monitor cognitive changes after concussion. In the literature, decreases in EP are commonly reported; however, a subset of studies shows increased cortical activity after injury. We studied ...

Abstract	Auditory and visually evoked potentials (EP) have the ability to monitor cognitive changes after concussion. In the literature, decreases in EP are commonly reported; however, a subset of studies shows increased cortical activity after injury. We studied auditory and visual EP in 4-week-old female Yorkshire piglets (N = 35) divided into anesthetized sham, and animals subject to single (sRNR) and repeated (rRNR) rapid non-impact head rotations (RNR) in the sagittal direction. Two-tone auditory oddball tasks and a simple white-light visual stimulus were evaluated in piglets pre-injury, and at days 1, 4- and 7 post injury using a 32-electrode net. Traditional EP indices (N1, P2 amplitudes and latencies) were extracted, and a piglet model was used to source-localize the data to estimate brain regions related to auditory and visual processing. In comparison to each group's pre-injury baselines, auditory Eps and brain activity (but not visual activity) were decreased in sham. In contrast, sRNR had increases in N1 and P2 amplitudes from both stimuli. The rRNR group had decreased visual N1 amplitudes but faster visual P2 latencies. Auditory and visual EPs have different change trajectories after sRNR and rRNR, suggesting that injury biomechanics are an important factor to delineate neurofunctional deficits after concussion.
Language	English
Publishing date	2023-06-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2720867-9
ISSN	2227-9059
ISSN	2227-9059
DOI	10.3390/biomedicines11071816
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Article ; Online: Sports concussions: sex differences in outcome are not a biological given.

Master, Christina L / Arbogast, Kristy / Broglio, Steven

Nature

2021 Volume 598, Issue 7879, Page(s) 32

MeSH term(s)	Brain Concussion/epidemiology ; Brain Concussion/therapy ; Female ; Humans ; Male ; Sex Characteristics ; Sports
Language	English
Publishing date	2021-10-06
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	120714-3
ISSN	1476-4687 ; 0028-0836
ISSN (online)	1476-4687
ISSN	0028-0836
DOI	10.1038/d41586-021-02713-1
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Article ; Online: Dose-Response Effect of Mental Health Diagnoses on Concussion Recovery in Children and Adolescents.

Master, Christina L / Corwin, Daniel J / Fedonni, Daniele / Ampah, Steven B / Housel, Kaitlyn C / McDonald, Catherine / Arbogast, Kristy B / Grady, Matthew F

Sports health

2024 Volume 16, Issue 2, Page(s) 254–268

Abstract: Background: Pre-existing mental health diagnoses may contribute to greater emotional symptom burden and prolonged recovery after concussion.: Hypothesis: Youth with pre-existing mental health diagnoses will have greater emotional symptom burden, ... ...

Abstract	Background: Pre-existing mental health diagnoses may contribute to greater emotional symptom burden and prolonged recovery after concussion. Hypothesis: Youth with pre-existing mental health diagnoses will have greater emotional symptom burden, greater risk for delayed return to exercise, and more prolonged recovery from concussion than those without those diagnoses. Study design: Prospective cohort. Level of evidence: Level 3. Methods: A prospective registry of youth concussion was examined for differences in emotional symptom burden after injury to develop a predictive risk model for prolonged recovery. The impact of individual and total number of pre-existing mental health diagnoses (0, 1, 2, and 3+) was assessed, and multivariable logistic regression was performed to identify factors associated with prolonged recovery. Results: Among a cohort of 3105 youth with concussion, those with a history of mental health diagnoses, in a dose-response fashion, had greater postinjury emotional symptom burden (7 emotional symptoms vs 4; Conclusion: Pre-existing mental health diagnoses are associated with greater postinjury emotional symptom burden and longer concussion recovery in a dose-response fashion. Visiovestibular deficits and delayed return to exercise are also associated with pre-existing mental health diagnoses and prolonged recovery. Boys with prolonged recovery from concussion experience greater emotional symptom burden than girls. Clinical relevance: Addressing pre-existing mental health diagnoses is essential to concussion management. Boys with prolonged recovery from concussion may particularly benefit from interventions to address their higher emotional symptom burden. Interventions, including a home visio-vestibular exercise program and symptom-limited exercise, may contribute to improving time to concussion recovery.
MeSH term(s)	Male ; Female ; Child ; Adolescent ; Humans ; Post-Concussion Syndrome ; Athletic Injuries/diagnosis ; Mental Health ; Brain Concussion/complications ; Brain Concussion/diagnosis ; Brain Concussion/psychology ; Emotions
Language	English
Publishing date	2024-02-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2508802-6
ISSN	1941-0921 ; 1941-7381
ISSN (online)	1941-0921
ISSN	1941-7381
DOI	10.1177/19417381241228870
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Zs.A 6996: Show issues

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Article ; Online: Optimizing the Combination of Common Clinical Concussion Batteries to Predict Persistent Postconcussion Symptoms in a Prospective Cohort of Concussed Youth.

Corwin, Daniel J / Mandel, Francesca / McDonald, Catherine C / Barnett, Ian / Arbogast, Kristy B / Master, Christina L

The American journal of sports medicine

2024 Volume 52, Issue 3, Page(s) 811–821

Abstract: Background: Studies have evaluated individual factors associated with persistent postconcussion symptoms (PPCS) in youth concussion, but no study has combined individual elements of common concussion batteries with patient characteristics, comorbidities, ...

Abstract	Background: Studies have evaluated individual factors associated with persistent postconcussion symptoms (PPCS) in youth concussion, but no study has combined individual elements of common concussion batteries with patient characteristics, comorbidities, and visio-vestibular deficits in assessing an optimal model to predict PPCS. Purpose: To determine the combination of elements from 4 commonly used clinical concussion batteries and known patient characteristics and comorbid risk factors that maximize the ability to predict PPCS. Study design: Cohort study; Level of evidence, 2. Methods: We enrolled 198 concussed participants-87 developed PPCS and 111 did not-aged 8 to 19 years assessed within 14 days of injury from a suburban high school and the concussion program of a tertiary care academic medical center. We defined PPCS as a Post-Concussion Symptom Inventory (PCSI) score at 28 days from injury of ≥3 points compared with the preinjury PCSI score-scaled for younger children. Predictors included the individual elements of the visio-vestibular examination (VVE), Sport Concussion Assessment Tool, 5th Edition (SCAT-5), King-Devick test, and PCSI, in addition to age, sex, concussion history, and migraine headache history. The individual elements of these tests were grouped into interpretable factors using sparse principal component analysis. The 12 resultant factors were combined into a logistic regression and ranked by frequency of inclusion into the combined optimal model, whose predictive performance was compared with the VVE, initial PCSI, and the current existing predictive model (the Predicting and Prevention Postconcussive Problems in Pediatrics (5P) prediction rule) using the area under the receiver operating characteristic curve (AUC). Results: A cluster of 2 factors (SCAT-5/PCSI symptoms and VVE near point of convergence/accommodation) emerged. A model fit with these factors had an AUC of 0.805 (95% CI, 0.661-0.929). This was a higher AUC point estimate, with overlapping 95% CIs, compared with the PCSI (AUC, 0.773 [95% CI, 0.617-0.912]), VVE (AUC, 0.736 [95% CI, 0.569-0.878]), and 5P Prediction Rule (AUC, 0.728 [95% CI, 0.554-0.870]). Conclusion: Among commonly used clinical assessments for youth concussion, a combination of symptom burden and the vision component of the VVE has the potential to augment predictive power for PPCS over either current risk models or individual batteries.
MeSH term(s)	Humans ; Child ; Adolescent ; Cohort Studies ; Prospective Studies ; Brain Concussion/etiology ; Post-Concussion Syndrome/diagnosis ; Post-Concussion Syndrome/etiology ; Risk Factors
Language	English
Publishing date	2024-02-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/03635465231222936
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