Pre-injury Factors Research Articles

Sex differences in work-related traumatic brain injury: a concurrent mixed methods study employing the person-environment-occupation model

ABSTRACT Background Work-related traumatic brain injury (wrTBI) is considered a critical injury that can be prevented. Few studies have integrated clinical data and workers’ injury narratives to inform sex-specific wrTBI prevention. Objective To examine sex differences in pre-injury factors and provide recommendations for primary prevention of wrTBI. Methods Concurrent mixed methods study. The Person-Environment-Occupation (PEO) model served as a theoretical framework for qualitative and quantitative data analyses. Results The sample consisted of 93 workers (51% female, 67% aged over 40) with wrTBI sustained as a result of being struck by/against an object (SBA, 46%), falls (30%), motor vehicle accident (13%), and assault (11%). Qualitative analysis of injury events revealed distinct patterns between male and female workers in the nature and physical/social load of occupational activities performed at the time of injury. Quantitative analysis enriched interpretation of observed sex differences across PEO factors. New insights emerged by stratifying SBA injury cases, revealing sex differences in Environment- and Occupation-related factors unique to workers struck by an object. Implications Sex- and cause-specific analysis of injury events is essential for surveillance and prevention of wrTBI. Addressing fitness for duty, supervisor–worker relationships, and industry-specific hazards in prevention strategies is essential to ensure workplace safety.

Long-term neurocognitive follow-up in children with traumatic brain injury: A literature review and monocentric cohort study

Children with mild traumatic brain injury (mTBI) may experience long-term cognitive sequelae. However, previous study results have been controversial. It remains unclear whether clinical follow-up is useful, how long patients should be followed-up, and which psychological dimensions should be investigated. Herein, we described neurocognitive evolution in a small sample of Italian children who were hospitalized for mTBI and systematically reviewed the existing evidence in this setting. In total, 15 children aged 4 – 16 (median, 9) years who were evaluated for mTBI at our institution between March 2017 and September 2018 were retrospectively enrolled. All patients underwent computed tomography or magnetic resonance imaging for clinical reasons; moreover, they underwent neurocognitive evaluation within few days from the event (T0), after 3 – 6 months (T1), and after 18 – 24 months (T2). Neuropsychological assessment included the Child Behavior Checklist, Developmental Neuropsychology Assessment II Edition, and Wechsler Intelligence Scale for Children. An electronic search was conducted to identify studies published in the past 12 years. Neurocognitive assessments revealed low scores in memory, sensorimotor, and social perception tasks at T1 and T2. Univariate analysis of neuroradiological and clinical findings revealed no risk factors for cognitive deficits. Overall, 17 studies involving 1336 children were reviewed and analyzed. Following mTBI, psychiatric disorders were frequently newly diagnosed and were associated with significant deficits in adaptive functioning and other pre-injury psychosocial risk factors. Our study findings demonstrate that children with mTBI exhibit subtle persistent cognitive difficulties that may affect academic and social functioning. Thus, follow-up using extensive neuropsychological evaluation is essential.

Preinjury and Event-Related Characteristics of Pediatric Firearm Injuries: The American College of Surgeons Firearm Study, United States, March 2021‒February 2022.

Objectives. To assess differences in contextual factors by intent among pediatric firearm injury patients and determine factors associated with data missingness. Methods. We retrospectively queried the American College of Surgeons Firearm Study database (March 1, 2021-February 28, 2022) for patients aged 18 years or younger. We stratified preinjury, firearm-related, and event-related factors by intent and compared them by using Fisher exact, χ2, or 1-way analysis of variance testing. Secondary analysis estimated the adjusted odds of missingness by using generalized linear modeling with binominal logit link. Results. Among 17 395 patients, 2974 (17.1%) were aged 18 years or younger; 1966 (66.1%) were injured by assault, 579 (19.5%) unintentionally, and 76 (2.6%) by self-inflicted means. Most contextual factors differed by intent, including proportion of youths with previous adverse childhood experiences, mental illness, and violent assaults or injury, firearm type and access, perpetrator relationship, and injury location. In adjusted analyses, age, trauma center designation, intent, and admission status were associated with missingness. Conclusions. Contextual factors related to pediatric firearm injury vary by intent. Specific predictors associated with missingness may inform improved future data collection. Public Health Implications. Contextual factors related to pediatric firearm injury can be obtained in a systematic manner nationally to inform targeted interventions. (Am J Public Health. 2024;114(10):1097-1109. https://doi.org/10.2105/AJPH.2024.307754).

A - 17 Pre-injury Predictors of Protracted Recovery from Pediatric Concussion: a Latent Class Analysis

Abstract Purpose This person-centered study examined pre-injury psychological and neurodevelopmental risk factors in youth experiencing persistent concussion symptoms (PCS). Latent class analysis (LCA) was used to empirically define groups of children and adolescents experiencing PCS, and compare their functional outcomes. Method 126 pediatric patients (Mean age = 15.94 years; 65.1% female) experiencing PCS (Mean time since injury = 315 days) participated in a clinical neuropsychological consultation and evaluation within the Minds Matter Concussion Program at Children’s Hospital of Philadelphia. LCA models were run using pre-injury variables (mood and anxiety concerns, attention and learning challenges). Functional outcomes (neuropsychological performance, academic decline, symptom magnification) were then compared across the resulting classes. Results Statistical indicators [Akaike Information Criteria (804.59), adjusted Bayesian Information Criteria (801.01), Bootstrap Likelihood Ratio Test (p < 0.001)] indicated that a two-class model provided the best fit. Class 1 (n = 58) was predominately females (78.3%) with comorbid pre-injury developmental (46.6% learning challenges, 54.6% attention concerns) and psychological concerns (75.6% anxiety, 48.9% mood concerns). Class 2 (n = 68) was half females (49.8%) with fewer comorbid pre-injury developmental (14.6% learning challenges, 22.5% attention concerns) and psychological concerns (39.3% anxiety, 0% mood concerns). The two classes did not significantly differ on functional outcomes. Standardized testing scores were within the average range across the sample. Conclusions Pre-injury risk factors contribute to persistent symptom experience and functional complaints in the absence of objective cognitive impairment. Given the incidence across groups, these findings highlight the importance of understanding psychological and neurodevelopmental factors, as well as sex-based differences when directing referrals and treatment of PCS within a multidisciplinary program.

Psychological Predictors of Mental Health Difficulties After Pediatric Concussion.

Children often experience mental health difficulties after a concussion. Yet, the extent to which a concussion precipitates or exacerbates mental health difficulties remains unclear. This study aimed to examine psychological predictors of mental health difficulties after pediatric concussion. Children (5 to <18 years of age, M = 11.7, SD = 3.3) with concussion were recruited in a single-site longitudinal prospective cohort study conducted at a tertiary children's hospital (n = 115, 73.9% male). The primary outcomes included internalizing (anxious, depressed, withdrawn behaviors), externalizing (risk-taking, aggression, attention difficulties), and total mental health problems, as measured by the Child Behavior Checklist at 2 weeks (acute) and 3 months (post-acute) after concussion. Predictors included parents' retrospective reports of premorbid concussive symptoms (Post-Concussion Symptom Inventory; PCSI), the child and their family's psychiatric history, child-rated perfectionism (Adaptive-Maladaptive Perfectionism Scale), and child-rated resilience (Youth Resilience Measure). Higher premorbid PCSI ratings consistently predicted acute and post-acute mental health difficulties. This relationship was significantly moderated by child psychiatric history. Furthermore, pre-injury learning difficulties, child psychiatric diagnoses, family psychiatric history, lower resilience, previous concussions, female sex, and older age at injury were associated with greater mental health difficulties after concussion. Pre-injury factors accounted for 23.4-39.9% of acute mental health outcomes, and 32.3-37.8% of post-acute mental health outcomes. When acute mental health was factored into the model, a total of 47.0-68.8% of variance was explained by the model. Overall, in this sample of children, several pre-injury demographic and psychological factors were observed to predict mental health difficulties after a concussion. These findings need to be validated in future research involving larger, multi-site studies that include a broader cohort of children after concussion.

Considering the Importance of Personal and Injury Factors Influencing Outcome After Traumatic Brain Injury

ObjectiveGiven the high variability in traumatic brain injury (TBI) outcomes and relative lack of examination of the influence of noninjury factors on outcome, this study aimed to examine factors associated with functional outcome at 1 and 2 years after moderate to severe TBI, including both preinjury and injury-related factors. DesignObservational cohort study. SettingInpatient hospital recruitment with outpatient follow-up at 1 and 2 years post injury. ParticipantsIndividuals with moderate to severe TBI were recruited prospectively into a Longitudinal Head Injury Outcome Study. Of the eligible 3253 individuals who were eligible, 1899 participants consented to the study (N=1899). Main Outcome MeasureFunctional outcome was measured using the Glasgow Outcome Scale–Extended (GOS-E). Results1476 participants (73.6% males) and 1365 participants (73% males) completed the GOS-E at 1 and 2 years post injury. They had a mean age at injury of 40 years and mean duration of post-traumatic amnesia (PTA) of 26 days. Good recovery, representing return to previous activities on the GOS-E (score 7-8), was present in 31% of participants at 1 year post injury and 33.5% at 2 years post injury. When predictor variables were entered into regression together, good outcome was significantly associated with not being from a culturally and linguistically diverse background and not having preinjury mental health or alcohol treatment, shorter PTA duration, and absence of limb injuries at both 1 and 2 years; higher education was also a significant predictor at 1 year post injury. ConclusionsAlongside consideration of injury severity, understanding and addressing preinjury factors is important to maximize outcomes.

Chitosan revokes controlled-cortical impact generated neurological aberrations in circadian disrupted mice via TLR4-NLRP3 axis

The severity of inevitable neurological deficits and long-term psychiatric disorders in the aftermath of traumatic brain injury is influenced by pre-injury biological factors. Herein, we investigated the therapeutic effect of chitosan lactate on neurological and psychiatric aberrations inflicted by circadian disruption (CD) and controlled-cortical impact (CCI) injury in mice. Firstly, CD was developed in mice by altering sporadic day-night cycles for 2 weeks. Then, CCI surgery was performed using a stereotaxic ImpactOne device. Mice subjected to CCI displayed a significant disruption of motor coordination at 1-, 3- and 5-days post-injury (DPI) in the rotarod test. These animals showed anxiety- and depression-like behaviors in the elevated plus maze and forced-swim test at 14 and 15 DPI, respectively. Notably, mice subjected to CD + CCI exhibited severe cognitive impairment in Y-maze and novel object recognition tasks. The compromised neurological, psychiatric, and cognitive functions were mitigated in chitosan-treated mice (1 and 3 mg/mL). Immunohistochemistry and real-time PCR assay results revealed the magnified responses of prima facie biomarkers like glial-fibrillary acidic protein and ionized calcium-binding adaptor molecule 1 in the pericontusional brain region of the CD + CCI group, indicating aggravated inflammation. We also noted the depleted levels of brain-derived neurotrophic factor and augmented expression of toll-like receptor 4 (TLR4)-leucine-rich-containing family pyrin domain-containing 3 (NLRP3) signaling [apoptosis-associated-speck-like protein (ASC), caspase-1, and interleukin 1-β] in the pericontusional area of CD + CCI group. CCI-induced changes in the astrocyte-glia and aggravated immune responses were ameliorated in chitosan-treated mice. These results suggest that the neuroprotective effect of chitosan in CCI-induced brain injury may be mediated by inhibition of the TLR4-NLRP3 axis.

A - 167 Neuropsychological Correlates of Challenging Behavior in Moderate to Severe ABI.

Cognitive and behavioral changes, common after severe acquired brain injury (ABI), are important predictors of functional recovery, independence, and quality of life. The Overt Behavior Scale (OBS) is a standardized measure of challenging behaviors following ABI, and has been associated with pre-injury risk factors and psychosocial stressors. Information about the neuropsychological underpinnings of OBS scores is unknown, however. The current study is a preliminary analysis of relationships among OBS scores and neuropsychological data associated with behavioral dysregulation in adults with chronic moderate to severe ABI in a residential neurorehabilitation setting. Participants were 81 adults, ages 27-71 (SD = 10.46), 55 males, with average education of 12.6years, and average time since injury of 26.34 (SD = 13.35). Participants were administered neuropsychological tests (including NAB Screening Module Memory, Executive Functioning, and Attention Index and subtests, NAB Judgment, and Trails B). The OBS was administered by the psychology provider with input from the treatment team. Exploratory correlations examined the relationship between neuropsychological tests and OBS scores. Results found a significant relationship between the number of challenging behaviors on the OBS and NAB delayed story recall (p < 0.040, r = -0.266). Other correlations between OBS and the NAB and Trails B were not significant. The results raise the possibility that the OBS captures unique aspects of behavioral change that are not measured by traditional neuropsychological tests. Other possible explanations of the data include that the severity of cognitive impairment and physical limitations may be moderating factors, which will be examined in future studies.

A-27 Using The Concussion Clinical Profiles Screening Tool And Pre-injury Risk Factors To Identify Concussion Profiles

Abstract Purpose To determine the ability of the Concussion Clinical Profiles Screening Tool (CP Screen) and pre-injury risk factors to accurately predict concussion profiles. Methods Sample included 297 patients (59.3% male, mean age=16.6 years), 73.7% sport-related injuries, previously diagnosed with concussion. Patients completed the CP Screen and medical histories. Receiver operating characteristics (ROC curves) provided area under the curves, and sensitivity and specificity values. Results The post-traumatic migraine (PTM) composite resulted in an AUC of .63 (95% CI=.55-.68); sensitivity was 0.19 and specificity was .86 at a 4.5 symptom cutoff score. The anxiety/mood composite resulted in an AUC of 0.84 (95% CI=.78-.88); sensitivity was .56 and specificity was .88 at a 4.5 symptom and risk-factor cutoff score. The vestibular composite resulted in an AUC of 0.71 (95% CI=.66-.78); sensitivity was .37 and specificity was .87 at a 4.5 symptom and risk-factor cutoff score. The ocular composite resulted in an AUC of .55 (95% CI=.52-0.66); sensitivity was .30 and specificity was .79 at a 4.5 symptom and risk factor cutoff score. The cognitive composite resulted in an AUC of .52 (95% CI=.40-.57); sensitivity was .35 and specificity was .63 at a 4.2 symptom cutoff score. Conclusions The anxiety/mood and vestibular composites demonstrated strong predictive utility, while PTM, ocular, and cognitive fatigue composites did not. The combined CP Screen and health histories may be sufficient to predict concussion profiles within the domains of anxiety/mood and vestibular.

A-15 Predictive Utility of Risk Factors Associated with Vestibular and Oculomotor Outcomes Following Sport-Related Concussion

Abstract Purpose The purpose of the present study was to determine the ability of these risk factors to predict vestibular/oculomotor symptom provocation on the Vestibular/Oculomotor Screening (VOMS). It was hypothesized that both pre- and post-injury risk factors would predict symptom provocation on the VOMS. Methods This was a retrospective chart review of patients (n=78; 41 male) aged 15.2±1.7 years (range 12-18 years) seeking care at a concussion specialty clinic. Participants were seen 5.1±3.2 days (range 1-14 days) post-injury and completed a clinical interview, history questionnaire, symptom inventory, and VOMS as part of routine clinical care. Data analysis included chi-square tests with odds ratios to examine the association between identified risk factors and VOMS outcomes. An alpha value of .05 was used for all analyses. Results Personal history of motion sickness (χ2=7.6, p=.006, OR=11.4), personal history of oculomotor dysfunction (Fisher’s exact test, p=.01, OR=1.2), post-traumatic migraine (PTM) symptoms (χ2=11.7, p&amp;lt;.001, OR=5.4), and post-injury fogginess (χ2=10.1, p=.001, OR=4.8), were associated with presence of one or more post-injury VOMS individual item scores above clinical cutoff (i.e., symptom elevation &amp;gt;2). History of oculomotor dysfunction (Fisher’s exact test p=.013, OR=6.6) and PTM symptoms (χ2=5.0, p=.025, OR=3.3) were associated with obtaining a post-injury near-point convergence (NPC) distance &amp;gt;5 cm. Gender, loss of consciousness status, concussion history, history of migraine, and psychiatric history were not associated with VOMS symptom provocation or abnormal NPC. Conclusions Findings indicate that both pre-injury risk factors (i.e., personal history of motion sickness and history of oculomotor dysfunction) and post-injury risk factors (i.e., fogginess, PTM symptoms) were associated with clinically meaningful symptom provocation on the VOMS. In addition, history of oculomotor dysfunction and PTM symptoms were both associated with abnormal NPC distance. These results reinforce the importance of a comprehensive evaluation including a clinical history and vestibular and oculomotor screening following SRC. Consistent with prior research, loss of consciousness status and concussion history were not associated with increased risk for vestibular/oculomotor outcomes.

A-48 Comparative Analysis of Adolescents With a Sport-Related Concussion Versus Non-Sport-Related Concussion During Initial Visit

Abstract [Outstanding Trainee Award Winner] Purpose To investigate differences in pre-injury risk factors and clinical outcomes in adolescents with a Sport-Related Concussion (SRC) versus non-Sport-Related Concussion (non-SRC). Methods Participants (n=136, aged 10-18) presented to a specialty concussion clinic 2-30 (M=9.25) days post-injury. They completed a clinical interview with a trained clinician and were administered the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT), Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profile Screening (CP Screen), Vestibular/Ocular-Motor Screening (VOMS), Screen for Child Related Anxiety Disorders - Child Version (SCARED-C), and the Generalized Anxiety Disorder Assessment (GAD-7). Data analyses utilized independent sample t-tests, chi-square tests, and descriptive statistics to compare clinical outcomes of both groups during initial visit. Alpha was set to p&amp;lt;.05 for all analyses. Results Adolescents with non-SRC took longer to seek specialty concussion care, were majority female, and were older than the SRC group. Non-SRC participants also reported a higher rate of migraine, depression, and anxiety history (i.e., SCARED-C Panic Disorder, SCARED-C Generalized Anxiety Disorder, and SCARED-C Anxiety Disorder). Additionally, non-SRC participants reported more symptoms on the PCSS Total score, and on most VOMS items, including Smooth Pursuits, Horizontal and Vertical Saccades, Horizontal and Vertical Vestibular-Ocular Reflex, Visual Motion Sensitivity, as well as VOMS Total. Non-SRC group also reported higher post-injury anxiety scores (i.e., GAD-7). All findings were below the p-value of .05. Conclusions The study findings suggest that mechanism of injury and individual risk factors play a significant role in determining the clinical presentation of a concussion in an SRC and non-SRC adolescent population.

Ballistic diaphyseal forearm fractures result in high incidence of neurovascular injury and compartment syndrome but have low rates of early infection: A single level I trauma center experience

IntroductionBallistic injuries to the upper extremity represent a small subset of injuries, and there is little data to provide guidance on management and outcomes. The purpose of this study is to assess the incidence of neurovascular injuries, compartment syndrome, and early postoperative infection, as well as patient and injury factors predictive of neurovascular injury following ballistic fractures of the forearm. Patients and methodsA retrospective review of operatively treated ballistic forearm fractures at a single level I trauma center between 2010 and 2022 was performed. Thirty-three patients with 36 forearm fractures were identified. Only diaphyseal injuries in patients greater than 18 years old were included. Medical and radiographic records were reviewed to identify pre-injury patient-specific factors, including age, sex, smoking status, and history of diabetes. Injury characteristics, including the type of firearm used, forearm fracture location, and any associated neurologic or vascular injury, as well as compartment syndrome, were collected and analyzed. Short-term outcomes such as post-operative infection and recovery of neurologic function were also collected and analyzed. ResultsThe median age was 27 years (range: 18–62), with a majority of male patients (78.8%, n = 26). 4 patients (12.1%) sustained high-energy injuries. 4 patients (12.1%) were found to have compartment syndrome pre-operatively or intra-operatively. 11 patients (33.3%) had nerve palsies postoperatively with 8 patients (24.2%) continuing to have nerve palsies at their final follow-up (mean follow-up= 149.9 +/- 187.2 days). The median length of stay was 4 days. There were no patients with infection at follow-up. ConclusionBallistic forearm fractures are complex injuries and can result in severe complications such as neurovascular injury and compartment syndrome. As such, a comprehensive evaluation and appropriate management of ballistic forearm fractures are essential to minimize the risk of severe complications and optimize patient outcomes. In our experience, when treated operatively, these injuries have a low rate of infection.

Prior Concussion History and Clinical Recovery After Sport-Related Concussion in High School Athletes.

Clinical recovery after sport-related concussion varies as a function of pre-injury and acute factors. Whether, or the extent to which, concussion history is associated with clinical outcome after sport-related concussion is uncertain, because research has produced mixed findings. The present study aimed to assess whether a history of previous concussions was associated with prolonged clinical recovery after a subsequent sport-related concussion. The sample comprised 780 adolescent student athletes (mean age = 16.3, standard deviation = 1.3 years; 56.8% boys, 43.2% girls) whose school participated in the Maine Concussion Management Initiative (MCMI). Survival analyses were used to compare recovery times among adolescents with a history of 0, 1, or ≥2 previous concussions after a subsequent sport-related concussion. The two primary outcomes of interest were the number of days to return to school and sports. There were no statistically significant differences in total time to return to school and sports, or the proportion of adolescents who returned to school and sports at most intervals (e.g., 7, 14, 28 days), between those with 0, 1, or ≥2 previous concussions. A greater proportion of adolescents, however, with a history of ≥2 previous concussions remained out of sports at 28 days compared with those with no previous concussions (23.5% vs. 12.7%; odds ratio [OR] = 2.10, 95% confidence interval [CI] 1.18-3.73). Having sustained prior concussions was not associated with time to return to school after a subsequent sport-related concussion. A greater proportion of adolescents, however, with two or more previous concussions experienced a prolonged return to sports. Further research is warranted to identify risk factors for worse outcomes among the subset of adolescents with a history of multiple previous concussions who experience prolonged recoveries.

Primary Care Providers’ Referral Practices for Concussion Management: A Health Services Study

<h3>Research Objectives</h3> To examine primary care providers' (PCPs) referral practices for concussion specialty care for patients who have a new concussion and potential pre-injury risk factors (i.e., anxiety, depression, ADHD, migraine), across the first year after diagnosis. <h3>Design</h3> Retrospective data analysis of an electronic health record system. <h3>Setting</h3> University medical center. <h3>Participants</h3> 1761 adults who received a new diagnosis of concussion between January 1 and December 31, 2018 and remained alive during the study period. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Concussion specialty referrals early (0 to 3 months) vs. later (4-12 months) after diagnosis. <h3>Results</h3> 448 (25.4%) patients received at least one specialty care referral by a PCP within one-year of their injury. Of those patients, most were female (64.3%), White (73.2%), non-Hispanic (85.0%), and had at least one pre-injury risk factor (53.6%). Most of these patients received between 1 and 2 (60.5%) specialty referrals. Of all referrals placed by PCPs, the most common specialty referral was to physical therapy both early (12.6%) and later (11.2%), followed by referrals to specialty medical disciplines (neurology 6.1% & 4.0%, sports medicine 3.5% & 4.1%, rehabilitation medicine 4.7% & 1.4%). <h3>Conclusions</h3> To our knowledge, this is the first health services study to examine PCPs' referral practices for concussion management. In this sample PCPs did not commonly refer to concussion specialists despite the high prevalence of pre-injury risk factors associated with protracted recovery. When they did, PCPs most often referred to physical therapy. Referrals are inconsistent with known symptom profiles following concussion with few referrals for cognitive and behavioral management of symptoms. <h3>Author(s) Disclosures</h3> The authors do not have any disclosures.

Predicting Severity of Head Collision Events in Elite Soccer Using Preinjury Data: A Machine Learning Approach.

To develop machine learning (ML) models that predict severity of head collision events (HCEs) based on preinjury variables and to investigate which variables are important to predicting severity. Data on HCEs were collected with respect to severity and 23 preinjury variables to create 2 datasets, a male dataset using men's tournaments and mixed dataset using men's and women's tournaments, to perform ML analysis. Machine learning analysis used a random forest classifier based on preinjury variables to predict HCE severity. Four elite international soccer tournaments. Elite athletes participating in analyzed tournaments. The 23 preinjury variables collected for each HCE. Predictive ability of the ML models and association of important variables. The ML models had an average area under the receiver operating characteristic curve for predicting HCE severity of 0.73 and 0.70 for the male and mixed datasets, respectively. The most important variables for prediction were the mechanism of injury and the event before injury. In the male dataset, the mechanisms "head-to-head" and "knee-to-head" were together significantly associated ( P = 0.0244) with severity; they were not significant in the mixed dataset ( P = 0.1113). In both datasets, the events "corner kicks" and "throw-ins" were together significantly associated with severity (male, P = 0.0001; mixed, P = 0.0004). ML models accurately predicted the severity of HCE. The mechanism and event preceding injury were most important for predicting severity of HCEs. These findings support the use of ML to inform preventative measures that will mitigate the impact of these preinjury factors on player health.

Increased all-cause mortality following occupational injury: a comparison of two states

ObjectivesTo measure the impact of lost-time occupational injuries on all-cause mortality in Washington State and, using the same data elements and study design, to determine whether the estimated impact was...

Factors impacting educational outcomes for students with traumatic brain injury in BrainSTEPS

Purpose: To describe child pre-injury and injury factors impacting post-injury educational outcomes for students with traumatic brain injury (TBI) participating in a state-wide, school-based, school re-entry consultation program, BrainSTEPS in Pennsylvania. Method: Retrospective analysis of a BrainSTEPS annual follow-up survey. Result: A total of 296 parent surveys were completed. Analysis revealed a significant difference between levels of severity of TBI and current educational placement (p < 0.001), receipt of current therapy (p < 0.05) and need for additional consult (p < 0.05). Severity of TBI was not related to other examined educational outcome variables (i.e. school performance, current symptoms). History of TBI, symptoms and treatment were not found to be associated with educational outcomes. Conclusion: These results both support findings from previous studies, and extend previous work by highlighting ongoing needs, including continued, individualised support, of children who sustain a moderate–severe TBI during childhood, and are currently in the chronic stages of injury, with consideration of pre- and post- injury factors. Programs such as BrainSTEPS provide identification of educational needs and provide needed services and supports for children with TBI. Sensitive, validated measures are needed to further understand the role of pre-injury and injury factors on educational outcomes, particularly in programs like BrainSTEPS.

Persisting symptoms after concussion: Time for a paradigm shift.

Persisting symptoms after concussion: Time for a paradigm shift.

A-187 Prior Concussion History and Recovery Time Following Sport-Related Concussion in High School Athletes

Abstract Objective: To examine whether adolescents with prior concussions take longer to return to school and/or sports following a subsequent sport-related concussion. Method: Injury surveillance data for 780 adolescents (M age=16.3, SD=1.3 years) were analyzed. Adolescents were divided into three groups: (a) no prior concussion history (69%; n=538), (b) history of one prior concussion (19.2%; n=150), and (c) history of two or more prior concussions (11.8%; n=92). We analyzed between-group differences in time to return to school and sports. Results: Groups did not differ in time to return to school (K-W: χ2(2)=0.95, p=.62; Log Rank: χ2 (2)=2.83, p=.24) or sports (K-W: χ2(2)=2.19, p=0.33; Log Rank: χ2 (2)=3.95, p=.14). However, a greater proportion of student athletes with two or more prior concussions had not returned to their sport at 28 days postinjury compared to those with no prior concussions (23.5% vs. 12.7%; OR=2.10, 95% CI 1.18-3.73). Of note, the two or more prior concussion group contained a higher proportion of adolescents with potential pre-injury risk factors for complicated recovery, namely, depression and migraines. Conclusions: Prior concussion history was not associated with longer time to return to school nor return to sport when examined as a continuous variable. However, at 28 days postinjury, a greater proportion of athletes with two or more prior concussions remained out of sports compared to those with no prior concussions.

Machine learning to predict sports-related concussion recovery using clinical data.

Sport-related concussions (SRCs) are a concern for high school athletes. Understanding factors contributing to SRC recovery time may improve clinical management. However, the complexity of the many clinical measures of concussion data precludes many traditional methods. This study aimed to answer the question, what is the utility of modeling clinical concussion data using machine-learning algorithms for predicting SRC recovery time and protracted recovery? This was a retrospective case series of participants aged 8 to 18 years with a diagnosis of SRC. A 6-part measure was administered to assess pre-injury risk factors, initial injury severity, and post-concussion symptoms, including the Vestibular Ocular Motor Screening (VOMS) measure, King-Devick Test and C3 Logix Trails Test data. These measures were used to predict recovery time (days from injury to full medical clearance) and binary protracted recovery (recovery time > 21 days) according to several sex-stratified machine-learning models. The ability of the models to discriminate protracted recovery was compared to a human-driven model according to the area under the receiver operating characteristic curve (AUC). For 293 males (mean age 14.0 years) and 362 females (mean age 13.7 years), the median (interquartile range) time to recover from an SRC was 26 (18-39) and 21 (14-31) days, respectively. Among 9 machine-learning models trained, the gradient boosting on decision-tree algorithms achieved the best performance to predict recovery time and protracted recovery in males and females. The models' performance improved when VOMS data were used in conjunction with the King-Devick Test and C3 Logix Trails Test data. For males and females, the AUC was 0.84 and 0.78 versus 0.74 and 0.73, respectively, for statistical models for predicting protracted recovery. Machine-learning models were able to manage the complexity of the vestibular-ocular motor system data. These results demonstrate the clinical utility of machine-learning models to inform prognostic evaluation for SRC recovery time and protracted recovery.