Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology

Departments of Pediatrics and Neurology (S.A.), Loma Linda University, Loma Linda, CA
Neurology (Impact Factor: 8.29). 03/2013; 80(24). DOI: 10.1212/WNL.0b013e31828d57dd
Source: PubMed


To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article.

We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations.

Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.

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Available from: Gerard Gioia, Dec 04, 2014
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    • "Students with attention-defi cit and/or hyperactivity disorder , depression, or learning disabilities are at greater risk for concussion than those without these conditions (Grady, 2010). Student athletes with an increased body mass index seem to be at increased risk (Giza et al., 2013). "
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    ABSTRACT: Concussions are among the most complex injuries to assess and manage in sports medicine and primary care. Sports concussion in youth has received much attention in recent years because research shows that improperly managed concussion can lead to long-term cognitive deficits and mental health problems. There are several notable risk factors affecting the incidence and severity of concussion in school-age children and adolescents, including a history of a previous concussion. A more conservative approach for return to activities following concussion has been proposed for children and adolescents. Programs of individualized, stepwise increases in physical activity have largely replaced use of algorithms for assigning a grade and activity expectations to concussions. Although validity and reliability testing is ongoing to support use of concussion assessment instruments in pediatric patients, it is practical and appropriate that clinicians incorporate symptom checklists, sideline and balance assessment tools, and neurocognitive assessment instruments into their practice in accordance with evidence-based guidelines.
    MCN The American Journal of Maternal/Child Nursing 12/2014; 40(2):76-86. DOI:10.1097/NMC.0000000000000114 · 0.90 Impact Factor
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    • "Indeed, while the acute effects of concussions have been extensively studied to make better informed return-to-play decisions (review in Giza et al., 2013), the chronic effects of these mild head traumas have only recently been addressed systematically (review in De Beaumont et al., 2012a). Moreover, the potential interaction between the long-term effects of sports concussions and the ageing process has only been touched on by a few investigators thus far (Guskiewicz et al., 2005; De Beaumont et al., 2009, 2013; Broglio et al., 2012; Didehbani et al., 2013; Hart et al., 2013; Strain et al., 2013; Tremblay et al., 2013). "
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    ABSTRACT: Sports-related concussions have been shown to lead to persistent subclinical anomalies of the motor and cognitive systems in young asymptomatic athletes. In advancing age, these latent alterations correlate with detectable motor and cognitive function decline. Until now, the interacting effects of concussions and the normal ageing process on white matter tract integrity remain unknown. Here we used a tract-based spatial statistical method to uncover potential white matter tissue damage in 15 retired athletes with a history of concussions, free of comorbid medical conditions. We also investigated potential associations between white matter integrity and declines in cognitive and motor functions. Compared to an age- and education-matched control group of 15 retired athletes without concussions, former athletes with concussions exhibited widespread white matter anomalies along many major association, interhemispheric, and projection tracts. Group contrasts revealed decreases in fractional anisotropy, as well as increases in mean and radial diffusivity measures in the concussed group. These differences were primarily apparent in fronto-parietal networks as well as in the frontal aspect of the corpus callosum. The white matter anomalies uncovered in concussed athletes were significantly associated with a decline in episodic memory and lateral ventricle expansion. Finally, the expected association between frontal white matter integrity and motor learning found in former non-concussed athletes was absent in concussed participants. Together, these results show that advancing age in retired athletes presenting with a history of sports-related concussions is linked to diffuse white matter abnormalities that are consistent with the effects of traumatic axonal injury and exacerbated demyelination. These changes in white matter integrity might explain the cognitive and motor function declines documented in this population.
    Brain 09/2014; 137(11):2997-3011. DOI:10.1093/brain/awu236 · 9.20 Impact Factor
    • "According to the Centers for Disease Control and Prevention, mTBI is estimated to result in 1.6 to 3.8 million cases each year and is described in a 2003 report to the U.S. Congress as a silent epidemic (National Center for Injury Prevention and Control, 2003; Ruff, 2011). In recent years, public and legislative concern about sportrelated concussions and mTBI has greatly increased (Giza et al., 2013; Harmon et al., 2013). Public interest has been further catalyzed by the increased focus on the morbidity of injured athletes, recent highly publicized deaths of professional athletes associated with repetitive brain injury (Guskiewicz et al., 2005; Guskiewicz et al., 2007; Omalu et al., 2006; Omalu et al., 2005; Ruff, 2011). "
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    ABSTRACT: Objective: This study investigated the association between mild traumatic brain injury (mTBI) and ADHD, which increases risk of injuries and accidents. Method: We conducted a systematic review and meta-analysis of studies that examined the relationship between mTBI and ADHD. Results: Five studies, comprising 3,023 mTBI patients and 9,716 controls, fit our a priori inclusion and exclusion criteria. A meta-analysis found a significant association between ADHD and mTBI, which was significant when limited to studies that reported on ADHD subsequent to mTBI and when the direction of the association was not specified, but not for studies that reported mTBI subsequent to ADHD. Heterogeneity of effect size and publication biases were not evident. Conclusion: The literature documents a significant association between mTBI and ADHD. Further clarification of the relationship and direction of effect between mTBI and ADHD and treatment implications could have large clinical, scientific, and public health implications.
    Journal of Attention Disorders 07/2014; 18(7). DOI:10.1177/1087054714543371 · 3.78 Impact Factor
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