Diagnosis Of Concussion Research Articles

Spontaneous Headshake after a Kinematic Event (SHAAKE): Evaluating the Utility of a Potential New Sign in the Diagnosis of Concussion.

Background/Objectives: Diagnosing concussions is problematic, in part due to the invisible nature of concussion symptoms, in addition to personal and interpersonal factors that influence symptom reporting. As a result, observable signs of concussion can ensure concussions are identified and appropriately treated. Here, we define a potential novel sign, the spontaneous headshake after a kinematic event (SHAAKE) and evaluate its utility in the diagnosis of concussion. Methods: A cross-sectional survey study of 347 athletes (age 27, IQR: 25-29; 47.6% female; highest level of play: college-46.1%, high school-41.2%) identified whether SHAAKE occurred, the reasons underlying SHAAKEs, and its utility for self-reported concussion. Sensitivity and positive predictive value were calculated across all sports and these parameters, as well as estimates for specificity and negative predictive value leveraging published helmet sensor data, were calculated for football players. Results: The median number of times participants reported SHAAKE was 5 (IQR: 3-10), with 4 (IQR: 2-7) associated with a self-reported concussion. Overall, 84.9% of participants reported concussion symptoms as the most common reason for their SHAAKEs. Across all sports, SHAAKE had a sensitivity of 49.6% and positive predictive value 72.4% for diagnosing concussion. In football players, SHAAKE had a sensitivity of 52.3%, estimated specificity of 99.9%, positive predictive value of 91.9%, and estimated negative predictive value of 99.5% for diagnosing self-reported concussion. Conclusions: These results demonstrate that nearly three-quarters of athletes reported a SHAAKE associated with a self-reported concussion, which supports the potential for SHAAKE to be used as a concussion screening tool.

Early Childhood Concussion.

The unconsolidated motor and cognitive skills that are typical of the early childhood period place infants, toddlers, and preschoolers at risk for a variety of traumatic injuries. Such injuries may include mild traumatic brain injury or concussion. Knowledge regarding the risk, diagnosis, outcomes, and management of early childhood concussion is limited, especially compared with what is known about concussion in school-age children, adolescents, and adults. This state-of-the-art review aims to provide current knowledge on the epidemiology, physical signs, behavior, and clinical outcomes associated with early childhood concussion. Research on this condition has been challenged by the need to adapt methods to the unique physical, behavioral, and developmental characteristics of young children. We provide information on observable symptoms associated with concussion, recommended approaches to care, and suggestions for overcoming barriers to research in this area. Developmentally appropriate efforts are needed to improve our ability to identify, evaluate, and treat early childhood concussion.

A Machine Learning Approach to Concussion Risk Estimation Among Players Exhibiting Visible Signs in Professional Hockey.

The identification of concussion risk factors, such as visible signs and mechanisms of injury, improves concussion identification. Exploring individual risk factors, such as concussion history, may help to improve existing concussion risk models and algorithms. The primary aim of the current study was to use machine learning techniques to develop a comprehensive, prospectively coded concussion risk model in professional hockey among players exhibiting visible signs. The secondary aim was to examine whether including concussion history improves model performance. Data from the National Hockey League (NHL) spotter program, including coded visible signs and mechanisms of injury associated with possible concussive events, were extracted from the 2018-2019 to the 2021-2022 seasons. Each unique spotter event was matched with data extracted from the medical record to determine whether the event was associated with a subsequent physician diagnosed concussion. We compared the ability of three machine learning-based approaches to identify the likelihood of physician diagnosed concussion: conditional inference tree, conditional inference random forest, and logistic regression. A total of 1563 unique events with visible signs were identified by spotters (183 leading to a concussion diagnosis). A randomly selected training sample had 1250 events (146 concussions) and the remaining set-aside test sample had 313 events (37 concussions). The obtained models performed at a high level with large effects in the training [area under the receiver operating characteristic curve (AUC) = 0.79] and set-aside test data (AUC = 0.82). Concussion history was retained in the tree and logistic regression models, with each additional prior concussion associated with a 1.32 times increased odds of concussion diagnosis. We present simple tree and logistic algorithms for concussion screening and as diagnostic aids. Our results show that player concussion history can explain additional risk above and beyond that explained by visible signs and mechanisms of injury alone.

Incidence and Prevalence of Concussion in Denmark from 1999-2018: A Nationwide Cohort Study.

Concussion is a common diagnosis in emergency rooms, yet contemporary incidence and prevalence estimates are sparse and rely on self-reported data. A nationwide cohort study was conducted to provide up-to-date information, covering the entire Danish population from 1999 to 2018. Hospital contacts with a concussion diagnosis, including emergency room visits, hospital admissions, and outpatient contacts, were retrieved from the Danish National Patient Registry (DNPR), and incidence rates were age-standardized and stratified. The 20-year prevalence was defined as the percentage of Danes alive in 2018 who had experienced a concussion since 1999. The diagnostic codes used were the ICD-10 code S06.0 and a local Danish code for 'observation for concussion' (DZ033D). Additional data on activities related to concussion injuries were obtained from the Accident Analysis Group at Odense University Hospital through DNPR. Findings from the study indicated that during the period 1999-2018, the total age-standardized concussion incidence rate increased by 10% to 308 per 100,000 person-years (95% confidence interval (CI): 304-313). Notable time trends included 1) a reduced sex difference from 40% to 6% (95% CI: 3%-9%), 2) a doubled incidence rate in children aged 0-1 and in seniors aged over 80, 3) an increased utilization of head imaging across all age groups, except children, 4) a decline in the proportion of traffic-related concussions, and 5) a prevalence of concussion of 4.9% (95% CI: 4.89% - 4.93%) in 2018. The increasing incidence of concussions among the elderly is concerning in light of an aging population, and warrants further investigation, as evidence-based preventive interventions for falls exist. Additionally, the increased utilization of head imaging across all age groups except children calls for attention toward avoidance of unnecessary radiation exposure. Despite a drop in traffic-related cases, concussions remain highly prevalent. In conclusion, these findings indicate that concussions are an important public health concern, necessitating ongoing surveillance, research, and targeted resource allocation to address concussion management and prevention effectively.

Associations between concussion and more severe TBIs, mild cognitive impairment, and early-onset dementia among military retirees over 40 years.

As the population of U.S. service members (SMs) who have sustained concussions and more severe traumatic brain injuries (TBIs) during military service ages, understanding the long-term outcomes associated with such injuries will provide critical information that may promote long-term assessment, support, and rehabilitation following military service. The objective of this research was to examine whether concussion and more severe TBIs are associated with greater risk of precursors to dementia (i.e., mild cognitive impairment, memory loss), early-onset dementia, and any dementia. This study used a retrospective cohort design wherein archival medical and career records from 1980 to 2020 identified U.S. military personnel who retired from military service and their corresponding Tricare-reimbursable medical encounters in inpatient and/or outpatient settings in military treatment facilities and/or purchased care settings both before and after retirement. All military personnel who served on active duty between 1980 and 2020 and were at least 45 years of age by 2020 were eligible for inclusion (N = 6,092,432). Those who were discharged from military service with a retirement designation, and were thus eligible for Tricare for Life, were included in the analytic sample (N = 1,211,972). Diagnoses of concussion and more severe TBI during active duty service recorded in inpatient settings between 1980 and 2020 and in outpatient settings from 2001 to 2020 were identified. Focal outcomes of interest included memory loss, mild cognitive impairment, Alzheimer's, Lewy Body dementia, frontotemporal dementia, and vascular dementia. Dementia diagnoses before age 65 were labeled early-onset. Those with (vs. without) concussion diagnoses during military service were significantly more likely to be diagnosed with memory loss and mild cognitive impairment and any of the dementias examined. However, they were not at greater risk of being diagnosed with early-onset dementia. Military SMs diagnosed with concussion may be at elevated risk for long-term neurodegenerative outcomes including memory loss, mild cognitive impairment, and dementia. As the population of SMs who sustained TBI during the Global War on Terror continue to age, the prevalence of dementia will increase and may bring a unique burden to the VHA.

Concussion acutely disrupts auditory processing in division I football student-athletes

ABSTRACT Introduction Diagnosis, assessment, and management of sports-related concussion require a multi-modal approach. Yet, currently, an objective assessment of auditory processing is not included. The auditory system is uniquely complex, relying on exquisite temporal precision to integrate signals across many synapses, connected by long axons. Given this complexity and precision, together with the fact that axons are highly susceptible to damage from mechanical force, we hypothesize that auditory processing is susceptible to concussive injury. Methods We measured the frequency-following response (FFR), a scalp-recorded evoked potential that assesses processing of complex sound features, including pitch and phonetic identity. FFRs were obtained on male Division I Collegiate football players prior to contact practice to determine a pre-season baseline of auditory processing abilities, and again after sustaining a sports-related concussion. We predicted that concussion would decrease pitch and phonetic processing relative to the student-athlete’s preseason baseline. Results We found that pitch and phonetic encoding was smaller post-concussion. Student-athletes who sustained a second concussion showed similar declines after each injury. Conclusions Auditory processing should be included in the multimodal assessment of sports-related concussion. Future studies that extend this work to other sports, other injuries (e.g. blast exposure), and to female athletes are needed.

Clinical Utility of Ocular Assessments in Sport-Related Concussion: A Scoping Review.

Background/objectives: Ocular tools and technologies may be used in the diagnosis of sport-related concussions (SRCs), but their clinical utility can vary. The following study aimed to review the literature pertaining to the reliability and diagnostic accuracy of such assessments. Methods: The preferred reporting items for systematic reviews and meta-analysis (PRISMA) extension for scoping reviews was adhered to. Reference standard reliability (RSR ≥ 0.75) and diagnostic accuracy (RSDA ≥ 0.80) were implemented to aid interpretation. Results: In total, 5223 articles were screened using the PCC acronym (Population, Concept, Context) with 74 included in the final analysis. Assessments included the King-Devick (KD) (n = 34), vestibular-ocular motor screening (VOMs) and/or near point of convergence (NPC) (n = 25), and various alternative tools and technologies (n = 20). The KD met RSR, but RSDA beyond amateur sport was limited. NPC met RSR but did not have RSDA to identify SRCs. The VOMs had conflicting RSR for total score and did not meet RSR in its individual tests. The VOMs total score did perform well in RSDA for SRCs. No alternative tool or technology met both RSR and RSDA. Conclusion: Ocular tools are useful, rapid screening tools but should remain within a multi-modal assessment for SRCs at this time.

Follow-up visits after pediatric concussion and the factors associated with early follow-up: a population-based study in British Columbia.

To explore the rates and timing of a first follow-up visit for children and adolescents with a concussive injury and to identify factors associated with follow-up timing. A descriptive, correlational design drawing on linked, population-based administrative data of concussed children and adolescents (ages 5-18 years) from the province of British Columbia (BC), Canada. Data were accessed through Population Data BC. Descriptive statistics and binary logistic regression were used to analyze the data. From January 1, 2016 to December 31, 2017, we retrieved 22,601 cases of concussion, of which 19% had an early follow-up visit (N = 4,294), 4.9% had later follow-up (N = 1,107), and 76.1% had no follow-up (N = 17,200). The factors of older age, living in a rural area, higher socioeconomic status, and seeing a specialist physician at an initial concussion diagnosis were more likely to have an early follow-up visit. Early follow-up is important for recovery, but most children and adolescents with a concussion do not receive follow-up in BC.

Utilizing multimodal radiomics technology from cervical MRI for diagnosis of cervical spinal cord injury and spinal cord concussion

The primary aim of this study is to assess the viability of employing multimodal radiomics techniques for distinguishing between cervical spinal cord injury and spinal cord concussion in cervical magnetic resonance imaging. This is a multicenter study involving 288 patients from a major medical center as the training group, and 75 patients from two other medical centers as the testing group. Data regarding the presence of spinal cord injury symptoms and their recovery status within 72 h were documented. These patients underwent sagittal T1-weighted and T2-weighted imaging using cervical magnetic resonance imaging. Radiomics techniques are used to help diagnose whether these patients have cervical spinal cord injury or spinal cord concussion. 1197 radiomics features were extracted for each modality of each patient. The accuracy of T1 modal in testing group is 0.773, AUC is 0.799. The accuracy of T2 modal in testing group is 0.707, AUC is 0.813. The accuracy of T1 + T2 modal in testing group is 0.800, AUC is 0.840. Our research indicates that multimodal radiomics techniques utilizing cervical magnetic resonance imaging can effectively diagnose the presence of cervical spinal cord injury or spinal cord concussion.

Single-Task and Dual-Task Gait Performance After Sport-Related Concussion: A Machine Learning Statistical Approach.

This study evaluated 2 different dual-task (DT) conditions during tandem gait (TG) to predict sport-related concussion (SRC) diagnosis. The best (fastest) single-task (ST) gait will differ between groups (controls vs SRC; baseline vs SRC), with auditory pure switching task (APST) response rate being the most important behavioral variable to aid prediction of SRC. Cohort design. Level 3. A total of 409 National Collegiate Athletic Association Division I student-athlete controls and 21 team-physician-diagnosed SRC participated. All data were collected at preseason physicals (baseline) and within 7 days of injury for SRC. Each participant completed 3 conditions of TG in a pseudorandomized order: (1) ST, (2) DT with serial-7s (SS) subtractions, and (3) DT with APST. Outcomes of time-to-complete for TG and behavioral (eg, responses per second) for SS and APST were recorded for each trial. ST Trials 2 (P = 0.03) and 3 (P = 0.01) were significantly different between controls and SRC. ST Trial 3 (P = 0.04) was significantly different between baseline and SRC. Average responses per second for APST were significantly different between- (P < 0.01) and within- (P = 0.01) group. The results suggest that ST is significantly slower after SRC. However, DT (both SS and APST) time-to-complete are also important variables when predicting the SRC diagnosis. It is advised that both ST and DT be administered when making clinical decisions regarding postural instability after SRC. The best ST TG time to complete gait is an important objective marker of concussion while DT paradigms, specifically SS and APST, are highly variable. DT may be more useful for clinical observable signs of SRC. Both SS and APST have unique usefulness, but APST response rate per second can be relied upon numerically for clinical decisions.

A - 34 Differences in Symptom and Well-Being Report at Initial Post-Injury Concussion Medical Evaluations

Abstract Purpose To investigate differences in subjective symptom report and percentage ratings of subjective well-being (SWB) at initial post-injury concussion medical evaluations in professional football players. Method A retrospective, quasi-experimental design was used for the study. Participants included Canadian Football League players who underwent initial locker room post-injury medical evaluations. CFL concussion protocol requires any player suspected of a concussion to undergo a full evaluation including SCAT5. There were 2 groups including 43 players subsequently diagnosed with concussions who were compared with 22 players not diagnosed with concussion. Data included total symptom score from the SCAT5 and SWB (ratings out of 100%). T-tests and descriptive statistics evaluated differences between groups. Results At baseline, there were no significant differences on ratings of SWB between groups. In contrast, there was a significant difference in ratings of subjective well being between concussed players (M = 75.5%, SD = 19.5) and non concussed players (M = 92.7, SD = 7.7); t(63) = [3.8], p = [0.1]. Furthermore, significant differences on total symptom report from the SCAT5 were identified between concussed players (M = 16.9, SD = 15.4) and non concussed players (M = 3.5, SD = 5.7); t(63) - [3.9], p = [&amp;lt;0.01]. The sensitivity was 85% with a specificity of 63% using a post-injury SWB score of 75%. Conclusions Results indicated that at initial post-injury concussion evaluations, players subsequently diagnosed with concussion have lower SWB. Further research is needed to determine whether this metric would be helpful in the diagnosis of concussion.

A - 55 Pre- to Post-Season Reliability of Blink Reflex Parameters in Non-Concussed Athletes

Abstract Purpose Examining quantitative parameters of the blink reflex may improve sport-related concussion (SRC) diagnosis and management because it may serve as an objective measure of injury severity and recovery. However, the psychometric properties of several FDA-cleared devices assessing the blink reflex are understudied. The current study compared blink reflex parameters pre- and post-season using the BlinkTBI EyeStatTM device to assess its reliability in non-concussed athletes. Method A cohort of high school athletes underwent pre- and post-season BlinkTBI EyeStatTM testing. Statistical analysis included Spearman correlations, Wilcoxon signed-rank tests, and interclass correlations for ten blink parameters. Multivariable linear regressions assessed the influence of contact (i.e., soccer, football) vs. non-contact sports (i.e., baseball, softball, basketball) on changes in blink parameters. Results Among 32 athletes with pre- and post-season testing (age: mean = 15.3, SD = 1.1; 53.1% female), 19 played non-contact and 21 played contact sports. Most parameters were not statistically different between pre- and post-season, except for delta 30 (W = 229.5, p = 0.015), time under threshold (W = 191.0, p = 0.003), and oscillations (W = 667.0, p &amp;lt; 0.001). Parameters exhibited moderate to excellent reliability (interclass correlations = 0.575–0.872, p-values = 0.001–0.004). Spearman’s rho values ranged from 0.435 to 0.828 (p-values = 001–0.005). Participation in contact vs. non-contact sports was not associated with changes in blink parameters (all p-values&amp;gt;0.05). Conclusions Preliminary evidence suggest stable blink parameters across a sports season in non-concussed athletes when measured by the BlinkTBI EyeStatTM device. Contact sport participation was not significantly associated with changes in blink parameters. The findings add to the psychometric evidence that the blink reflex can be reliably measured, warranting further study on its utility in concussion.

Diagnosis of Sports-Related Concussion Using Symptom Report or Standardized Assessment of Concussion

The Sports Concussion Assessment Tool-5 (SCAT5) has been recommended for concussion evaluation and utilizes both a subjective reported symptom grading scale and objective measures of concussion including a cognitive evaluation: the Standardized Assessment of Concussion (SAC). The SAC includes testing for orientation, immediate memory, concentration, and delayed recall; a 10-word list is used to assess immediate memory and delayed recall. To determine the diagnostic accuracy of components of the SCAT5 and to provide a framework for clinical interpretation. This prospective case-control study of National Collegiate Athletic Association Division I athletes from any sport was conducted from July 2020 to December 2022 at 4 universities. Athletes completed baseline SCAT5 testing using the 10-word list. When an athlete presented acutely with suspected concussion (sideline or within 2 days), the tests were repeated. If a concussion was diagnosed, a control athlete underwent the same tests. Controls were identified and matched on comorbid conditions, sex and gender, sport, season, and baseline scores. Data analysis was conducted from August to October 2023. The primary outcomes were area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive value, and test-retest reliability of the symptom score; symptom severity score; the total SAC score; and the orientation, immediate memory, concentration, and delayed memory subcomponent scores on the SCAT5 compared with clinical diagnosis of concussion. Baseline and postinjury data were collected on 92 athletes with concussion and 92 matched control athletes (96 men [52%] and 88 women [48%]; 110 who played a sport other than football [59%]). Diagnostic utility was considered excellent for symptom score (AUC, 0.93; 95% CI, 0.89-0.96) and symptom severity score (AUC, 0.94; 95% CI, 0.90-0.97). An increase of 2 points on the symptom score was associated with a sensitivity of 86% (95% CI, 78%-92%), specificity of 80% (95% CI, 70%-87I%), and positive predictive value of 81% (95% CI, 72%-88%). The total SAC score had poor to fair diagnostic utility (AUC, 0.70; 95% CI, 0.63-0.77); however, 41 athletes with concussion (45%) had a total SAC score at or above their baseline score (ie, within normal limits). The diagnostic utility was poor to fair for immediate memory (AUC, 0.68, 95%CI, 0.61-0.75) and delayed recall (AUC, 0.69; 95% CI, 0.62-0.77) and not useful for orientation (AUC, 0.49; 95% CI, 0.43-0.56) and concentration (AUC, 0.52 95% CI, 0.44-0.61). Test-retest reliability was fair for total SAC and poor for immediate memory and delayed recall, orientation, and concentration. In this case-control study of the diagnostic accuracy of reported symptoms and the SAC, reported symptoms were the most accurate indicator of concussion while the 10-word SAC had limited sensitivity. These findings suggest that understanding the properties of the SAC is important when making the diagnosis of concussion.

A SPORTS CONCUSSION BASELINE IMPLEMENTED AT THE CONCLUSION OF A COLLEGIATE ATHLETE'S CAREER

As concussion diagnosis persists as a major clinical challenge for sports medicine practitioners, there has been a heightened emphasis on concussion baselines. This has led to an increase in computerized neuro-psychological baselines that are initiated at the beginning of an athlete’s career and administered again upon a suspected concussion. However, their utility and reliability have been called into scrutiny. As the brain health of athletes rightly remains a key priority, there have been no studies positing a concussion baseline as part of an athlete’s exit health physical to document their brain health after their athletic career. The purpose of this report is to present a noncomputerized, objective, neurologically supported concussion baseline that can be used to document athletes’ brain health at the end of their careers. A total of 31 division-1 male collegiate football players were assessed using this baseline, and their data was reported.

Analysis of Concussions Reported in American Professional Football Injury Reports in the 2019 Through 2023 Regular Seasons

ObjectiveThe National Football League (NFL) has seen increasing scrutiny regarding its handling of concussions, especially following an on-field incident involving Miami Dolphins’ (™) Quarterback Tua Tagovailoa in the 2022 Season. The authors hoped to elucidate recent trends in the diagnosis and management of concussions over the course of five NFL seasons across 2019-2023. MethodsThe authors queried NFL injury reports from the 2019 through 2023 database recording players listed with Concussions. Weeks missed were calculated using NFL game logs. Player’s concussions that did not occur in games, complicated by other injuries, or roster status were excluded. ResultsSearches of NFL injury reports resulted in the identification of 664 of 692 (96%) concussions that occurred in regular season games across the 2019-2023 seasons. Over the course of these five seasons 31% of players returned without missing a game, 39% of players missed one game, and 30% of players missed two or games. No significant difference in the number of concussions per game or weeks missed was observed across the seasons observed. Players with concussions on teams that made the playoffs saw less weeks missed than those on non-playoff teams (0.86 v. 1.37, p=0.002). ConclusionsSince the start of the 2021 NFL season, an increasing incidence of concussions has been noted, yet there was no change observed in the number of weeks missed following concussions. Trends in the rates of concussions across seasons remain largely stable, despite increased scrutiny over concussions in the sport.

Contemporary diagnosis and management of mild TBI (concussions): What you need to know.

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.

Female RNA concussion (FeRNAC) study: assessing hormone profiles and salivary RNA in females with concussion by emergency departments in New Zealand: a study protocol

BackgroundFemales of reproductive age with concussion report a greater number of symptoms that can be more severe and continue for longer than age matched males. Underlying mechanisms for sex differences are not well understood. Short non-coding Ribonucleic Acids (sncRNAs) are candidate salivary biomarkers for concussion and have been studied primarily in male athletes. Female sex hormones influence expression of these biomarkers, and it remains unclear whether a similar pattern of sncRNA expression would be observed in females following concussion. This study aims to evaluate recovery time, the ratio of salivary sncRNAs and symptom severity across different hormone profiles in females presenting to emergency departments (ED) with concussion and, to investigate the presence of low energy availability (LEA) as a potential modifier of concussion symptoms.MethodsThis prospective cohort study recruits participants from New Zealand EDs who are biologically female, of reproductive age (16–50 years) and with a confirmed diagnosis of concussion from an ED healthcare professional. Participants are excluded by ED healthcare professionals from study recruitment as part of initial routine assessment if they have a pre-diagnosed psychiatric condition, neurological condition (i.e., epilepsy, cerebral palsy) or more than three previously diagnosed concussions. Participants provide a saliva sample for measurement of sncRNA’s, and online survey responses relating to hormone profile and symptom recovery at 7-day intervals after injury until they report a full return to work/study. The study is being performed in accordance with ethical standards of the Declaration of Helsinki with ethics approval obtained from the Health and Disability Ethics Committee (HDEC #2021 EXP 11655), Auckland University of Technology Ethics Committee (AUTEC #22/110) and locality consent through Wellington hospital research office.DiscussionIf saliva samples confirm presence of sncRNAs in females with concussion, it will provide evidence of the potential of saliva sampling as an objective tool to aid in diagnosis of, and confirmation of recovery from, concussion. Findings will determine whether expression of sncRNAs is influenced by steroid hormones in females and may outline the need for sex specific application and interpretation of sncRNAs as a clinical and/or research tool.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) registration number ACTRN12623001129673.

Return to play after head injury in adolescent sports: evaluating football versus other sports.

Increased adolescent sports participation has raised concerns about higher rates of concussions, a prevalent injury among young athletes with potential long-term effects. Discrepancies in concussion recovery and management protocols across various sports underscore a critical issue in youth athletics. This study aimed to examine the relationship between sport type and the number of games missed following a concussion to inform targeted management strategies. Data from 7445 postinjury ImPACT tests for athletes aged 12-22 years, collected from 2009 to 2019, were analyzed across different sports: baseball, basketball, cheerleading, football, ice hockey, lacrosse, soccer, softball, swimming, track and field, volleyball, and wrestling. The number of days and normalized missed games (NMG), a metric accounting for the different number of games in a season for different sports, were used to evaluate the effect of concussions across different sports. ANOVA, t-tests, and linear regression analyses were performed to model the effect of sport type on games missed in a season while controlling for sex, age, concussion history, diagnosed learning disability (DLD), and attention-deficit/hyperactivity disorder (ADHD). Multivariable linear regression analysis demonstrated that football participation significantly increased NMG (β 1.681, 95% CI 0.807-2.554; p < 0.001) and days missed (β 1.637, 95% CI 1.044-2.231; p < 0.001) after head injury. Concussion diagnoses were also found to significantly increase NMG (β 2.344, 95% CI 1.629-3.059; p < 0.001) and days missed (β 1.560, 95% CI 1.074-2.045; p < 0.001), as well as history of prior concussion (NMG: β 7.791, 95% CI 7.368-8.215; p < 0.001; days missed: β 5.232, 95% CI 4.945-5.520; p < 0.001). In contrast, factors such as age, sex, DLD, ADHD, and concussions causing loss of consciousness did not significantly affect NMG or days missed. ANOVA with Tukey Honest Significant Difference indicated that compared with football, ice hockey (mean difference [MD] 5.4 days, p = 0.011) and track and field (MD 4.1 days, p = 0.006) were associated with significantly more days being missed after head injury. Conversely, basketball (MD -3.0, p < 0.001) and volleyball (MD -2.6, p = 0.005) were associated with fewer missed games. Adolescents playing football missed fewer days and games after concussion than other contact and noncontact sports, including ice hockey and track and field, raising questions about variations in return-to-play protocols and cultural attitudes within sports. Further research is needed to determine the factors affecting games missed across sport types in adolescent athletics and return-to-play protocols.

Identification and Connectomic Profiling of Concussion Using Bayesian Machine Learning.

Accurate early diagnosis of concussion is useful to prevent sequelae and improve neurocognitive outcomes. Early after head impact, concussion diagnosis may be doubtful in persons whose neurological, neuroradiological, and/or neurocognitive examinations are equivocal. Such individuals can benefit from novel accurate assessments that complement clinical diagnostics. We introduce a Bayesian machine learning classifier to identify concussion through cortico-cortical connectome mapping from magnetic resonance imaging in persons with quasi-normal cognition and without neuroradiological findings. Classifier features are generated from connectivity matrices specifying the mean fractional anisotropy of white matter connections linking brain structures. Each connection's saliency to classification was quantified by training individual classifier instantiations using a single feature type. The classifier was tested on a discovery sample of 92 healthy controls (HCs; 26 females, age μ ± σ: 39.8 ± 15.5 years) and 471 adult mTBI patients (158 females, age μ ± σ: 38.4 ± 5.9 years). Results were replicated in an independent validation sample of 256 HCs (149 females, age μ ± σ: 55.3 ± 12.1 years) and 126 patients with concussion (46 females, age μ ± σ: 39.0 ± 17.7 years). Classifier accuracy exceeds 99% in both samples, suggesting robust generalizability to new samples. Notably, 13 bilateral cortico-cortical connection pairs predict diagnostic status with accuracy exceeding 99% in both discovery and validation samples. Many such connection pairs are between prefrontal cortex structures, fronto-limbic and fronto-subcortical structures, and occipito-temporal structures in the ventral ("what") visual stream. This and related connectivity form a highly salient network of brain connections that is particularly vulnerable to concussion. Because these connections are important in mediating cognitive control, memory, and attention, our findings explain the high frequency of cognitive disturbances after concussion. Our classifier was trained and validated on concussed participants with cognitive profiles very similar to those of HCs. This suggests that the classifier can complement current diagnostics by providing independent information in clinical contexts where patients have quasi-normal cognition but where concussion diagnosis stands to benefit from additional evidence.

Postconcussive Symptoms After Early Childhood Concussion

Research on postconcussive symptoms (PCS) following early childhood concussion has been hindered by a lack of measures suitable for this age group, resulting in a limited understanding of their evolution in young children. To document PCS in the first 3 months after early childhood concussion using a developmentally appropriate measure. This cohort study used data collected at 3 Canadian and 1 US urban pediatric emergency departments (EDs) and 8 Canadian daycares from December 2018 to December 2022 as part of the Kids' Outcomes and Long-Term Abilities (KOALA) project, a prospective, multicenter, longitudinal cohort study. Participants included children aged 6 to 72 months with early childhood concussion or orthopedic injury (OI) or uninjured children from the community to serve as controls. Data were analyzed from March 2023 to January 2024. Concussion sustained between ages 6 and 72 months. Primary outcomes were cognitive, physical, behavioral and total PCS assessed prior to injury (retrospectively), acutely (within 48 hours), and at 10 days, 1 month, and 3 months after injury or recruitment through caregiver observations using the Report of Early Childhood Traumatic Injury Observations & Symptoms inventory. Group comparisons were analyzed using ordinal regression models. The study included 303 children (mean [SD] age, 35.8 [20.2] months; 152 [50.2%] male). Of these, 174 children had a concussion (mean [SD] age, 33.3 [19.9] months), 60 children had an OI (mean [SD] age, 38.4 [19.8] months) and 69 children were uninjured controls (mean [SD] age, 39.7 [20.8] months). No meaningful differences were found between the concussion and comparison groups in retrospective preinjury PCS. Significant group differences were found for total PCS at the initial ED visit (concussion vs OI: odds ratio [OR], 4.33 [95% CI, 2.44-7.69]; concussion vs control: OR, 7.28 [95% CI, 3.80-13.93]), 10 days (concussion vs OI: OR, 4.44 [95% CI, 2.17-9.06]; concussion vs control: OR, 5.94 [95% CI, 3.22-10.94]), 1 month (concussion vs OI: OR, 2.70 [95% CI, 1.56-4.68]; concussion vs control: OR, 4.32 [95% CI, 2.36-7.92]), and 3 months (concussion vs OI: OR, 2.61 [95% CI, 1.30-5.25]; concussion vs control: OR, 2.40 [95% CI, 1.36-4.24]). Significant group differences were also found for domain-level scores (cognitive, physical, behavioral) at various time points. In this early childhood cohort study, concussion was associated with more PCS than OIs or typical development up to 3 months after injury. Given the limited verbal and cognitive abilities typical of early childhood, using developmentally appropriate manifestations and behaviors is a valuable way of tracking PCS and could aid in concussion diagnosis in young children.