Symptom Resolution Time Research Articles

Incidence and Clinical Profile of Antituberculosis Treatment-Induced Hepatitis in a Tertiary Care Hospital in Southern India

Introduction: Tuberculosis (TB) is a major health problem. After the widespread use of Antituberculosis Treatment (ATT) effective control has been achieved. As with any drug ATT has its own side effects among which hepatitis is of main concern as it can cause significant morbidity and mortality. Aim: To assess the incidence of hepatitis in patients receiving ATT as per Revised National Tuberculosis Control Programme (RNTCP) and to know the possible risk factors for the development of drug-induced hepatotoxicity. Materials and Methods: This study was done on 318 presumed and confirmed cases of TB patients with baseline bilirubin, liver enzymes (transaminases) and albumin values. Out of these 48 lost follow-up and remaining 270 were followed-up and repeat bilirubin, liver enzymes and albumin were done at two weeks or even earlier in patients with symptoms after starting ATT. ATT was reintroduced in a stepwise manner as per American Thoracic Society guidelines. Results were analysed using MS Excel. Results: Out of the 270 cases, 30 (11.1%) developed ATT-induced hepatitis, among which 26 (86.67%) were followed-up and 4 (13.33%) lost to follow-up. Among 26, 3 (11.53%) developed hepatitis after reintroduction of ATT, two patients with Rifampicin and one with Isoniazid (INH) hence they were treated with alternative regimen and cured. According to this study, CNS tuberculosis had higher incidence of ATT-induced hepatitis. Old age and alcoholism were the independent risk factors. ATT-induced hepatitis commonly developed within two weeks of start of treatment. Average time for resolution of symptoms and restart of ATT was one month. There was no mortality in the study. Conclusion: The incidence was comparable to other studies. Alcoholism, old age and CNS tuberculosis needs caution when starting ATT. Patients usually require follow-up of two weeks after starting ATT. Caution is required while reintroducing ATT and it is advisable to introduce in a stepwise manner.

Oral Hypertonic Saline Is Effective in Reversing Acute Mild-to-Moderate Symptomatic Exercise-Associated Hyponatremia.

To determine whether oral administration of 3% hypertonic saline (HTS) is as efficacious as intravenous (IV) 3% saline in reversing symptoms of mild-to-moderate symptomatic exercise-associated hyponatremia (EAH) in athletes during and after a long-distance triathlon. Noninferiority, open-label, parallel-group, randomized control trial to IV or oral HTS. We used permuted block randomization with sealed envelopes, containing the word either "oral" or "IV." Annual long-distance triathlon (3.8-km swim, 180-km bike, and 42-km run) at Mont-Tremblant, Quebec, Canada. Twenty race finishers with mild to moderately symptomatic EAH. Age, sex, race finish time, and 9 clinical symptoms. Time from treatment to discharge. We successfully randomized 20 participants to receive either an oral (n = 11) or IV (n = 9) bolus of HTS. We performed venipuncture to measure serum sodium (Na) at presentation to the medical clinic and at time of symptom resolution after the intervention. The average time from treatment to discharge was 75.8 minutes (SD 29.7) for the IV treatment group and 50.3 minutes (SD 26.8) for the oral treatment group (t test, P = 0.02). Serum Na before and after treatment was not significantly different in both groups. There was no difference on presentation between groups in age, sex, or race finish time, both groups presented with an average of 6 symptoms. Oral HTS is effective in reversing symptoms of mild-to-moderate hyponatremia in EAH.

Comparison of Symptomology, Symptom Resolution Time, and Return to Play Time between Concussions Sustained in the Same Academic Year

ObjectiveThe purpose of this study is to examine symptomology, symptom resolution time, and return to play (RTP) time between concussions sustained in the same academic year.BackgroundPrevious research shows that among those with a history of previous concussions, outcomes for a recurrent concussion are worse, especially when concussions occur within two weeks of each other. Despite this research, there has been little investigation into concussions that occur in the same academic year.Design/MethodsConcussion data was collected from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) during the 2009/10-2017/18 academic years. Concussions were reported by athletic trainers (ATs) and were included if the student-athlete sustained two concussions in the same academic year. Proportions and means of symptoms, symptom resolution time, and RTP time were calculated, and, as appropriate, McNemar’s tests and Wilcoxon sign-rank tests were used to compare these between the first and second concussions.ResultsOverall, 138 student-athletes sustained 276 concussions across 15 different sports a mean of 43 days apart (SD: 37.3). Fewer symptoms were reported in the second concussion compared to the first (4.3 vs. 5.2, respectively; p = 0.01). RTP time was, on average, five days longer for the second concussion (p = 0.01), and a larger proportion of second concussions resulted in participation restriction of ≥30 days (first: 7.3%, second: 26.8%; p < 0.01). Symptom resolution time did not differ between the first and second concussions.ConclusionsAlthough the RTP time was greater in second concussions compared to first, symptom resolution time did not differ. This suggests that there may be a difference in AT management of second concussions, with a more conservative, extended RTP progression. Further research is needed to examine the association between time between concussions and differences in concussion presentation.

Preliminary Evidence-Based Recommendations for Return to Learn: a novel pilot study tracking concussion recovery in college students

ObjectiveInvestigate the potential factors influencing resolution of chief concussion symptoms in a longitudinal design. Second, assess subjects’ perception of their concussion recovery and what types of activities and accommodations appeared beneficial.BackgroundAthletes re-entering the academic setting after a concussion is commonly referred as return-to-learn (RTL), which has appeared secondary to the abundantly researched return-to-play protocols implemented ubiquitously. Importantly, every concussed collegiate, adolescent, and pediatric athlete is first and foremost a student-athlete, with “student” holding the emphasis. To date, very few studies have examined the RTL aspect of concussion recovery, and the effects premature classroom attendance may cause.Design/MethodsNine concussed, college aged (18-26 years), full-time students were monitored longitudinally throughout their recovery from diagnosis to full symptom-free academic participation. Symptom severity for five prevalent symptoms were recorded 4 times per day, along with a daily phone call to report participant’s diet, duration of screen-time usage and music listened to, physical activity participation, and types of classes attended.ResultsResponse rates to text messages and phone calls yielded a mean 92% and 93% respectively across the nine subjects. Additionally, five variables were significantly associated with symptom resolution (music, sleep, physical activity, water, and time) (p = 0.0004 to p = 0.036). Lastly, subjects reported math and computer-oriented courses as the most difficult (33% and 44% respectively). Additional time on assignments/exams and reducing screen brightness were the most beneficial accommodations (66% and 56% respectively).ConclusionsOur findings introduce a novel and robust approach to monitoring concussed students throughout their recovery. Furthermore, this methodology is the first to produce holistic evidence-based results concerning re-integrating students to the classroom. Lastly, it appears that dietary and social behaviors can indeed influence symptom resolution.

Preliminary evidence-based recommendations for return to learn: a novel pilot study tracking concussed college students.

Aim:Students re-entering the academic setting after a concussion is commonly referred to as return-to-learn and, to date, very few studies have examined the return-to-learn aspect of concussion recovery.Methodology:Nine college-aged, full-time students who were diagnosed with concussions were monitored throughout their concussion recovery. The severity for five chief symptoms (headache, dizziness, difficulty concentrating, fatigue, anxiety) were recorded six-times per day through text messages, and daily phone calls recorded participant's behavioral traits.Results:We identified five behavioral variables which significantly influenced symptom resolution (music, sleep, physical activity, water and time) (p = 0.0004 to p = 0.036). Additionally, subjects reported math and computer-oriented courses as the most difficult (33 and 44%, respectively).Conclusion:We introduce a novel approach to monitor concussed students throughout their recovery, as well as factors that may influence concussion recovery process.

Exercise in the first week following concussion among collegiate athletes: Preliminary findings

ObjectivesOur purpose was to examine the association between exercise after concussion with symptom severity, postural control, and time to symptom-resolution. DesignLongitudinal cohort. MethodsCollegiate athletes (n = 72; age = 20.2 ± 1.3 years; 46% female) with concussion completed a symptom questionnaire at initial (0.6 ± 0.8 days post-injury) and follow-up (2.9 ± 1.4 days post-injury) evaluations, and a postural control assessment at follow-up. Participants were grouped into those who exercised in between the time of injury and the follow-up evaluation and those who did not. Decisions regarding post-concussion exercise were made by a sports medicine team consisting of a single team physician and athletic trainers. ResultsThirteen athletes were not included in the current study, resulting in an 85% response rate. Thirteen of the athletes who completed the study exercised between evaluations (18%). There was no symptom resolution time difference between groups (median = 13 [IQR = 7–18] days vs. 13 [7–23] days; p = 0.83). Symptom ratings were similar between groups at the acute post-injury assessment (median PCSS = 18.5 [7.5–26] vs. 17 [14–40]; p = 0.21), but a main effect of group after adjusting for time from injury to assessment indicated the exercise group reported lower symptom severity than the no exercise group across both assessments (p = 0.044). The dual-task gait speed of the exercise group was higher than the no exercise group (0.90 ± 0.15 vs. 0.78 ± 0.16 m/s; p = 0.02). ConclusionsAthletes who were recommended aerobic exercise after concussion did not have worse outcomes than those who were not. Exercise within the first week after concussion does not appear to be associated with detrimental clinical outcomes.

Resolution of Symptoms and Resumption of Sex After Diagnosis of Nongonococcal Urethritis Among Men Who Have Sex With Men.

Standard counseling at nongonococcal urethritis (NGU) diagnosis includes advice to abstain from sex for at least 7 days and until symptoms resolve. From December 2014 to July 2018, we enrolled men who have sex with men and received azithromycin (1 g) for NGU at the Public Health-Seattle and King County STD Clinic. Over 12 weeks of follow-up, participants reported daily urethral symptoms and sexual activity on web-based diaries. Nongonococcal urethritis was defined as urethral symptoms or visible urethral discharge plus 5 or greater polymorphonuclear leukocytes per high-power field. Time of symptom resolution was defined as the first of 5 consecutive asymptomatic days. Of 100 participants with NGU and no Chlamydia trachomatis (CT)/Mycoplasma genitalium (MG) coinfection, 36 (36%), 22 (22%), and 42 (42%) had CT-NGU, MG-NGU, and non-CT/non-MG NGU, respectively. Among men with MG-NGU, 94% had a macrolide resistance mutation. For all etiologies, median time to symptom resolution after azithromycin was 7 days (95% confidence interval [CI], 5-9); 37% had symptoms lasting longer than 7 days. For men with CT-NGU, MG-NGU, and non-CT/non-MG NGU, median time to symptom resolution was 4 days (95% CI, 2-6; 16% >7 days), undefined days (95% CI, 7 to undefined; 60% >7 days), and 7 days (95% CI, 5-11; 46% >7 days), respectively. Median time to first sexual activity (any type) was 12 days (95% CI, 11-17); it was 16 days (95% CI, 12-18) to first urethral sexual exposure. Twenty-seven percent did not avoid urethral exposure for the recommended period. Counseling at NGU diagnosis should educate patients that symptoms may persist more than 7 days, particularly for non-CT NGU, and emphasize the rationale for the 7-day abstinence period.

Clinical predictors of symptom resolution for children and adolescents with sport-related concussion.

The goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients. Data collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable. The sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85-0.96]), headache frequency (HR 0.83 [95% CI 0.71-0.96]), confusion (HR 0.79 [95% CI 0.69-0.92]), forgetfulness (HR 0.79 [95% CI 0.68-0.92]), attention difficulties (HR 0.83 [95% CI 0.72-0.96]), trouble remembering (HR 0.84 [95% CI 0.72-0.98]), getting tired often (HR 0.86 [95% CI 0.76-0.97]), getting tired easily (HR 0.86 [95% CI 0.76-0.98]), dizziness (HR 0.86 [95% CI 0.75-0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40-0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44-0.98]; p = 0.038). For children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.

Determinants of Concussion Symptomology and Resolution Time in US High School Soccer Players

Concussions are a concern among soccer players of all ages. However, determinants of concussion symptomology and other sequelae have not been examined in high school soccer players. PURPOSE: Examine the impact of sex, injury history, injury mechanism, and setting on concussion symptomology and resolution time among HS soccer players. METHODS: The NATION-SP captured soccer-related injury data collected by athletic trainers (ATs) during the 2011/12-2013/14 academic years. We specifically examined injuries diagnosed as concussions. Outcomes of interest included symptoms reported with concussions as well as resolution time, categorized as resolved in 7 days, 14 days, 28 days and > 28 days. Exposures of interest included sex, injury history, injury mechanism associated with concussion, and setting (competition vs. practice). We used multivariate logistic regression models to assess the odds of reporting specific symptoms as a function of exposures, as well as other observed symptoms. We then used ordinal logistic regression models to assess exposure effects on the odds of reporting a longer symptom resolution time. Odds Ratio (OR) estimates with 95% confidence intervals (CI) excluding 1.00 were deemed significant. RESULTS: A total of 189 concussions were reported, with most observed in girls (56%). Symptoms resolved within 7 days in 41% of reported concussions. Interestingly, we detected several symptom dependencies, such as higher odds of light sensitivity (OR= 20.71, 95% CI: 8.58, 50.00) with concurrent noise sensitivity, and higher odds of irritability (OR= 9.04, 95% CI: 3.74, 21.85) and drowsiness (OR= 7.46, 95% CI: 3.48, 15.98) with concurrent insomnia. We also observed lower odds of longer symptom resolution time in concussions due to player contact mechanisms than those due to non-player-contact mechanisms (Adj. OR= 0.33, 95% CI: 0.18, 0.59). CONCLUSIONS: Determinants of soccer-related concussions and their sequelae appear to be multifactorial. The observed symptom dependencies may encourage clinicians to evaluate players for specific symptoms in the presence of others while also indicating common neurological pathways affected by trauma in this context. Injury mechanism may also be associated with concussion outcomes, although future investigation is warranted.

Determinants of concussion diagnosis, symptomology, and resolution time in U.S. high school soccer players

ABSTRACTDeterminants of concussion diagnosis, symptomology, and other sequelae have not been examined in high school soccer players. Using a sample of soccer-related head/neck injuries from the NATION Surveillance Program, we evaluated potential determinants (sex, injury history, injury mechanism, setting) of concussion characteristics. A total of 378 head/neck injuries were recorded, and 189 (50.0%) injuries from this sample, resulted in a concussion diagnosis. Odds of concussion diagnosis were 84% higher among female players compared with their male counterparts, and over two-fold higher in game settings compared with practice settings. We also observed several significant symptom dependencies, such as higher odds of difficulty concentrating (OR = 5.84, 95% CI = [2.99, 11.42]) given concurrent light sensitivity. Furthermore, we identified injury mechanism as a determinant of concussion symptom resolution time. Our results suggest that determinants of soccer-related concussions and their sequelae are multifactorial, and extend the existing literature with the potential to inform clinical practice.

CLINICAL PREDICTORS OF SYMPTOM RESOLUTION FOR CHILDREN AND ADOLESCENTS WITH SPORT-RELATED CONCUSSION

Background: Early prognosis of expected recovery duration after a sport-related concussion is a challenging task for sports medicine clinicians, as various pre-morbid, injury characteristic, and functional factors have been identified to help predict recovery. The purpose of this investigation was to determine which variables obtained as a part of a routine concussion clinical evaluation were independently associated with symptom resolution time among pediatric patients evaluated after sport-related concussion by a sports medicine physician. Methods: We conducted an analysis of data collected from a prospective clinical registry of children with concussion. Patients included in the current investigation were seen for care at a pediatric sports medicine concussion clinic between January 1, 2015 to August 31, 2017, were less than 19 years of age, evaluated within 10 days of a sport-related concussion, and followed until they no longer reported symptoms. The primary outcome variable was the number of days from injury until symptom resolution. The predictor variables included those assessed during the initial clinical evaluation. They were obtained via a medical history form (pre-injury history of attention-deficit/hyperactivity disorder, learning disability, anxiety, depression, and migraine or headaches), the Health and Behavior Inventory (HBI) symptom frequency questionnaire, headache severity rating (rated on a scale from 0-10), sleep disturbance questionnaire, and performance on a set of balance, vestibular, and oculomotor function tests (Balance Error Scoring System, Romberg, tandem gait, gaze stability, and near point of convergence). Tests were considered abnormal if patients could not maintain balance or demonstrated exaggerated upper body movement (Romberg/tandem gait tests), if they reported symptom provocation after test administration (gaze stability), or if the near point of convergence was greater than 5 cm from the tip of the nose. To identify the independent factors associated with symptom resolution time, we first constructed univariate Cox proportional models with time to symptom resolution as the outcome and each clinical variable as a separate predictor variable. Predictor variables with a univariate significance level of p < 0.05 were then used to construct a multivariate Cox proportional hazards model where total duration of concussion symptoms remained the outcome variable. Results: We examined data from 351 children and adolescents (mean age= 14.6±2.2 years, 33% female, evaluated 5.6±2.6 days after concussion) who required a median of 11.5 [interquartile range= 7-21] days for symptom resolution. One hundred and sixty-three (46%) of patients reported a prior history of concussion, while other pre-injury health conditions were reported less often (Table 1). The most commonly endorsed symptoms by patients at the initial visit were headaches, difficulty paying attention, difficulty concentrating, and getting distracted easily (Table 2). The most common abnormal vestibular or oculomotor test was symptom provocation brought on by gaze stability testing, while 20% of patients had an abnormal Romberg test, 15% demonstrated abnormal tandem gait, and 15% had abnormal near point of convergence (Table 3). Results from univariate Cox proportional hazards models indicated headache severity, headache frequency, confusion, forgetfulness, attentional difficulties, trouble remembering, getting tired often, getting tired easily, dizziness, and an abnormal Romberg test were associated with a longer symptom duration (Tables 2 and 3). The multivariate Cox proportional hazard model indicated that an abnormal Romberg test was independently associated with a longer symptom duration after adjusting for the effect of all other covariates included in the model (Table 4 and Figure 1). Headache frequency and “being tired easily” were not included in the final model due to collinearity with headache severity and “being tired a lot”, respectively. Conclusions: For adolescent and child patients assessed within 10 days of concussion, an abnormal Romberg test was independently associated with longer symptom duration during recovery. This is in line with other recent studies investigating early predictors of symptom resolution, demonstrating that postural instability appears to provide valuable prognostic information for sports medicine clinicians. [Table: see text]

Machine Learning in Modeling High School Sport Concussion Symptom Resolve.

Concussion prevalence in sport is well recognized, so too is the challenge of clinical and return-to-play management for an injury with an inherent indeterminant time course of resolve. A clear, valid insight into the anticipated resolution time could assist in planning treatment intervention. This study implemented a supervised machine learning-based approach in modeling estimated symptom resolve time in high school athletes who incurred a concussion during sport activity. We examined the efficacy of 10 classification algorithms using machine learning for the prediction of symptom resolution time (within 7, 14, or 28 d), with a data set representing 3 yr of concussions suffered by high school student-athletes in football (most concussion incidents) and other contact sports. The most prevalent sport-related concussion reported symptom was headache (94.9%), followed by dizziness (74.3%) and difficulty concentrating (61.1%). For all three category thresholds of predicted symptom resolution time, single-factor ANOVA revealed statistically significant performance differences across the 10 classification models for all learners at a 95% confidence interval (P = 0.000). Naïve Bayes and Random Forest with either 100 or 500 trees were the top-performing learners with an area under the receiver operating characteristic curve performance ranging between 0.656 and 0.742 (0.0-1.0 scale). Considering the limitations of these data specific to symptom presentation and resolve, supervised machine learning demonstrated efficacy, while warranting further exploration, in developing symptom-based prediction models for practical estimation of sport-related concussion recovery in enhancing clinical decision support.

Epidemiology of Concussions in High School Boys' Ice Hockey, 2008/09 to 2016/17 School Years.

This study examined the epidemiology of concussions in high school boys' ice hockey during the 2008/09 to 2016/17 school years. Prospective cohort study. Athletic trainers from an average 33 high schools annually reported boys' ice hockey concussion and athlete-exposure (AE) data for the High School Reporting Information Online system. Convenience sample of high school boys' ice hockey programs during the 2008/09 to 2016/17 school years. High school boys' ice hockey players (aged ∼14-18 years). Concussion data on event type, injury mechanism, symptom resolution time, and time loss were obtained. Concussion rates with 95% confidence intervals (CIs) and distributions were calculated. Overall, 348 concussions were reported in boys' ice hockey during the 2008/09 to 2016/17 academic years, leading to a concussion rate of 0.68/1000 AEs (95% CI, 0.61-0.75). Most occurred in competitions (85.6%), particularly after the first period (72.1% of all competition concussions). Among practice concussions, most occurred after the first hour of practice (60.0%). Most concussions were due to player contact (47.7%) and boards/glass contact (31.9%). Although 69.0% of concussed athletes had symptoms resolve in less than 7 days, only 14.1% returned to activity within a week. Most concussions occurred within the second and third periods. Preventive strategies that counter an increased risk of concussion due to a greater intensity of gameplay coupled with increased fatigue may be warranted. Moreover, athletes may further benefit from prevention efforts that focus on anticipating impacts during gameplay.

Gender Differences in Concussion Symptomology Over Time Among U.S. High School Athletes

To examine trends over time for concussion symptomology, symptom resolution time (SRT), and return to play (RTP) by gender.

Head Impact Locations in U.S. High School Boys' and Girls' Soccer Concussions, 2012/13-2015/16.

This study describes concussions and concussion-related outcomes sustained by high school soccer players by head impact location, sex, and injury mechanism. Data were obtained for the 2012/13-2015/16 school years from the National High School Sports-Related Injury Surveillance System, High School RIO™. This Internet-based sports injury surveillance system captures data reported by athletic trainers from an annual average of 162 U.S. high schools. Data were analyzed to describe circumstances of soccer concussion (e.g., symptomology, symptom resolution, and return-to-play time) by impact location (i.e., front- [face included], back-, side-, and top-of-the-head) and sex. Most concussions were from front-of-the-head impacts (boys, 30.5%; girls, 34.0%). Overall, 4.1 ± 2.2 and 4.6 ± 2.3 symptoms were reported in boys and girls, respectively. In boys, symptom frequency was not associated with head impact location (p = 0.66); an association was found in girls (p = 0.02), with the highest symptom frequency reported in top-of-the-head impacts (5.4 ± 2.2). Head impact location was not associated with symptom resolution time (boys, p = 0.21; girls, p = 0.19) or return-to-play time (boys, p = 0.18; girls, p = 0.07). Heading was associated with 28.0% and 26.5% of concussions in boys and girls, respectively. Most player-player contact concussions during heading occurred from side-of-the-head impacts (boys, 49.4%; girls, 43.2%); most heading-related ball contact concussions occurred from front-of-the-head (boys, 41.4%; girls, 42.6%) and top-of-the-head (boys, 34.5%; girls, 36.9%) impacts. Head impact location was generally independent of symptom resolution time, return-to-play time, and recurrence among high school soccer concussions. However, impact location may be associated with reported symptom frequency. Further, many of these clinical concussion descriptors were associated with sex.

Time Trends in Concussion Symptom Presentation and Assessment Methods in High School Athletes

Background: Concussion rates have increased significantly over the past decade. This may reflect an increase in the knowledge and diagnosis of the symptoms of a concussion rather than a true increase in the incidence. Assessing trends in the way that concussions are presenting to and being identified by clinicians over the same period may provide additional insight into the apparent rise in concussions. Purpose: To evaluate patterns of change in concussion symptom presentation, diagnostic/evaluation methods, and symptom resolution time reported for United States high school athletes from the 2007-2008 through 2014-2015 academic years. Study Design: Descriptive epidemiology study. Methods: This study is a retrospective analysis of a web-based longitudinal high school sports injury surveillance database (High School RIO [Reporting Information Online]) collected from 2007-2008 through 2014-2015. For each concussion, athletic trainers entered data regarding symptom presentation, resolution time, and diagnostic/evaluation tools utilized. Academic year was the primary exposure in assessing each aim. Time trends were then assessed using linear regression or the Cochran-Armitage test for trends, depending on the outcome distribution. Results: The proportion of concussed athletes presenting with amnesia, loss of consciousness (LOC), and tinnitus significantly decreased from 2007-2008 through 2014-2015, while the proportion presenting with drowsiness, irritability, light sensitivity, and noise sensitivity increased significantly. The use of diagnostic radiography, magnetic resonance imaging, and computed tomography all significantly decreased during the study period, while the use of computerized neurocognitive tests increased. Concussion symptoms took significantly longer to resolve in more recent years. Conclusion: The decrease in what have traditionally been considered severe symptoms (LOC, amnesia) and the increase in what were traditionally considered minor symptoms (drowsiness, irritability, light sensitivity) suggest that clinicians may have a lower threshold in diagnosing sports-related concussions in more recent years. The significant reduction in the use of all forms of diagnostic head imaging demonstrates an increased recognition of concussions as functional disturbances rather than structural abnormalities. Improved concussion education and the nationwide passage of state-level concussion legislation have likely led to the increased recognition of lingering symptoms in athletes with a diagnosed concussion, thereby leading to a longer symptom resolution time.

Factors associated with post-concussion syndrome in high school student-athletes

ObjectivesTo identify factors associated with post-concussion syndrome (PCS) among a national sample of high school student-athletes from the 2011/12–2013/14 academic years. DesignAmbispective cohort study from sports injury surveillance data. MethodsSport-related concussion data originated from the National Athletic Treatment, Injury and Outcomes Network (NATION) surveillance program, consisting of 27 sports from a convenience sample of 196 high schools across 26 states. All SRCs were reported by certified athletic trainers. The PCS and non-PCS groups consisted of concussed individuals with symptoms resolution time of >4 weeks and ≤2 weeks, respectively. Logistic regression estimated the association of athlete and concussion characteristics on the odds of PCS, and calculated adjusted odds ratios (OR) and 95% confidence intervals (CI). ResultsOverall, 1334 concussed high school athletes met inclusion criteria: 215 in the PCS group and 1119 in the non-PCS group. In the multivariable analysis, concussion symptoms associated with increased odds of PCS included: retrograde amnesia (OR=3.01, 95%CI: 1.31–6.91), difficulty concentrating (OR=2.72, 95%CI: 1.56–4.77), disorientation (OR=1.86; 95%CI: 1.04–3.33), insomnia (OR=2.79; 95%CI: 1.62–4.80), loss of balance (OR=1.76; 95%CI: 1.00–3.10), sensitivity to noise (OR=1.80; 95%CI: 1.02–3.17), and visual disturbance (OR=2.21; 95%CI: 1.23–3.97). Sex and recurrent concussion were not associated with PCS. ConclusionsAs in previous research, somatic and cognitive symptoms were associated with PCS. The identification of factors associated with PCS may assist clinicians in identifying concussed athletes at greater risk of having longer symptom resolution time.

Concussion Symptoms and Symptom Resolution Time in US High School Athletes, 2007/08-2014/15

Objectives:There has been increased interest in sports-related concussions from the professional level down to youth leagues in recent years. Symptom types and resolution time are the metrics most often used to monitor concussions. The purpose of this study is to investigate how concussion symptoms, symptom resolution time, and use of diagnostic imaging have changed among US high school athletes from the 2007/08 through 2014/15 academic years.Methods:This study analyzed concussions occurring in all sports available in the High School Reporting Information Online (RIO) database from 2007/08 through 2014/15. Chi-square tests for trend were used to calculate symptom and diagnostic imaging trends over time. Statistical significance was determined at p<0.05.Results:The prevalence of each of the following symptoms was found to significantly decrease over the time period analyzed in athletes diagnosed with a concussion: amnesia (p<0.0001), confusion/disorientation (p<0.0001), dizziness/unsteadiness (p<0.01), loss of consciousness (LOC, p<0.0001), and tinnitus (p<0.0001). Among all athletes diagnosed with a concussion, the prevalence of LOC was 6.6% in 2007/08 and decreased to 2.4% in 2014/15. The prevalence of each of the following symptoms was found to significantly increase over the time period analyzed in athletes diagnosed with a concussion: drowsiness (p<0.01), irritability (p<0.0001), light sensitivity (p<0.0001), and noise sensitivity (p<0.0001). The prevalence of concentration difficulty, headaches, hyper-excitability, and nausea did not change significantly over time. The average concussion symptom resolution time has significantly increased over time (p<0.0001). The use of diagnostic plain radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) scans all significantly decreased over the time period analyzed (p<0.0001 for each diagnostic test).Conclusion:From the 2007/08 to 2014/15 academic years, the prevalence of various symptoms changed significantly in US high school athletes diagnosed with a concussion. The decrease in severe symptoms (LOC, amnesia, disorientation) and the increase in less recognizable symptoms (drowsiness, irritability) may point to a lower threshold used by healthcare providers in diagnosing concussions in more recent years. Improved education among healthcare providers has likely led to increased recognition of lingering symptoms in athletes diagnosed with concussions, thereby leading to a longer average symptom resolution time. Furthermore, the significant reduction in use of all forms of diagnostic head imaging demonstrates an increased recognition of concussions as functional disturbances rather than physical abnormalities detectable on imaging.

Primary Nonendoscopic Endonasal Versus Delayed External Dacryocystorhinostomy in Acute Dacryocystitis.

Conventional treatment for acute dacryocystitis consists of medical management followed by elective delayed external dacryocystorhinostomy (EXT-DCR). The purpose of this study was to compare the outcome after primary nonendoscopic endonasal dacryocystorhinostomy (NEN-DCR) versus conventional treatment in acute dacryocystitis. Retrospective chart analysis of all consecutive patients of acute dacryocystitis presenting between 2011 and 2015 was performed. Group A had patients who underwent primary NEN-DCR within 2 weeks of presentation. Group B comprised age- and gender-matched patients who received conventional treatment. Forty-six patients were included with 23 patients in each group. Mean age (45.2 ± 14.7 vs. 47.5 ± 14 years) and gender distribution (women 17/23 in group A vs. 15/23 in group B) in both groups were comparable. Mean duration from presentation to surgery was 7.82 ± 4.65 days for group A versus 27.3 ± 12 days for group B (p = 0.00001, independent T test). Mean time for complete resolution of symptoms was 21.4 ± 6 days for group A versus 38.69 ± 15.8 for group B (p = 0.000014, independent T test). Mitomycin-C usage (0.04%; 17 vs. 14) and mean follow up of both groups (6.4 vs. 5.7 months) were comparable. While functional success was similar (20/23) in both, anatomical success was seen in 22/23 and 21/23 in groups A and B, respectively. Complications included disfiguring scar in 4, recurrent acute dacryocystitis in 3, and punctal ectropion in one patient in the EXT-DCR group. Primary NEN-DCR leads to faster resolution facilitating earlier rehabilitation with comparable anatomical and functional outcomes compared with conventional delayed EXT-DCR in acute dacryocystitis.

Epidemiology of athletic trainer services for concussions among us high school student-athletes

ObjectiveThis study examined athletic trainer (AT) services for sports-related concussion among high school (HS) student-athletes during the 2011/12–2013/14 academic years.DesignDescriptive epidemiology.SettingConcussion data originated from the National Athletic Trainers Injury and Outcomes Network (NATION), a US-wide surveillance program comprised of a convenience sample of 127 HS. All concussions were diagnosed and reported by ATs.ParticipantsOur sample included 1662 concussions with service data among HS student-athletes from 22 sports; 48.0% were in football; 8.2% were recurrent. Of 607 concussions in sex-comparable sports, 52.7% were among females.Assessment of risk factorsWe examined outcome measures by sport (American football vs. non-football), sex, and whether the concussion was reported as recurrent.Outcome measuresATs reported the number and types of AT room visits and services. We compared the means of these measures by sport, sex, and recurrence using independent samples t-tests.Main resultsThere were 15,698 AT room visits reported (mean=9.5 per concussion; Standard Deviation [SD]=7.4). ATs provided an average 1.2 (SD=0.3) services per visit. No differences existed by sport or recurrence. In sex-comparable sports, females had a mean 12.2 (SD=10.5) visits compared to 9.5 (SD=7.0) among males (p&lt;0.001). No sex differences existed in services per visit.ConclusionsThere are more AT room visits per concussion among females than males in sex-comparable sports. This is likely related to previous research finding symptom resolution time is longer in females than males. Identifying concussions that will require more AT services may help with resource allocation and planning for ATs.Competing interestsThis project was funded by the National Athletic Trainers’ Association Research and Education Foundation (NATAREF), and the Central Indiana Corporate Partnership (CICP) Foundation in cooperation with BioCrossroads. The content of this report is solely the responsibility of the authors and does not necessarily reflect the views of the NATAREF, CICP Foundation or BioCrossroads.