Harry Bramley

High School Soccer Players With Concussion Education Are More Likely to Notify Their Coach of a Suspected Concussion

Previously published studies have found that concussion symptoms are underreported in youth athletics. This study evaluated the likelihood high school soccer players would identify themselves as having concussion related symptoms during game situations. A questionnaire inquiring about past concussion education and the likelihood of notifying their coach of concussion symptoms was administered to 183 high school soccer players. Of the 60 (33%) who completed the survey, 18 (72%) athletes who had acknowledged receiving concussion training responded that they would always notify their coach of concussion symptoms, as compared with 12 (36%) of the players who reported having no such training (P = .01). The results of this study suggest that athletes with past concussion training are more likely to notify their coach of concussion symptoms, potentially reducing their risk for further injury. Concussion education should be considered for all high school soccer players.

Evaluating Communication Between Pediatric Primary Care Physicians and Hospitalists

To determine the preferences for and satisfaction with communication between pediatric primary care physicians (PCPs) and hospitalists, 2 surveys (PCP and hospitalist versions with matching questions) were developed. Overall, PCPs were less satisfied than hospitalists with communication (P < .01). The 2 provider types had differing opinions on responsibility for care after hospital discharge, with hospitalists more likely than PCPs to assign responsibility to the PCP for pending labs (65% vs 49%; P < .01), adverse events (85% vs 67%; P < .01), or status changes (85% vs 69%; P < .01). Whereas satisfaction with and preferences for patient-related communication differed between hospitalists and PCPs, the incongruent views on the responsibility for care after patient discharge have major implications for safety particularly if poor communication occurs at discharge. Successful transitions from the hospital to primary care require communication between hospitalists and PCPs to be consistent, timely, and informative with responsibility for care discussed at discharge.

Return to Learning After a Concussion and Compliance With Recommendations for Cognitive Rest.

Objective:To determine the compliance of schools and school nurses in the United States with national recommendations for cognitive rest in students who sustain a concussion. Design:Cross-sectional questionnaire based. Participants:Members of the National Association of School Nurses working at the high school level. Intervention:A questionnaire, developed by the authors and based on recommendations for cognitive rest, was electronically distributed 3 times during the 2012 to 2013 academic year. Main Outcome Measures:Self-reported responses were collected regarding demographics and compliance of schools and school nurses with recommendations for the management of the postconcussion student, including the presence of specific guidelines for individualized care and the responsibility of the nurse for the prevention, detection, and management of concussions. Results:Analysis was performed on 1033 completed questionnaires (36% usable response rate). Fifty-three percent of schools have guidelines to assist students when returning to school after a concussion. These guidelines include extension of assignment deadlines (87%), rest periods during the school day (84%), postponement or staggering of tests (75%), reduced workload (73%), and accommodation for light or noise sensitivity (64%). Sixty-six percent of nurses in our sample have had special training in the recognition and management of concussions. Nurses reported involvement in the following roles: identifying suspected concussions (80%), providing emotional support for recovering students dealing with concussion-related depression (59%), and guiding the students postconcussion graduated academic and activity re-entry process (58%). Conclusions:We detected a wide variability in compliance of schools and school nurses with national recommendations for cognitive rest. Clinical Relevance:Ensuring that schools have policies established for a students return to learning, having specific guidelines to provide an individualized approach to return to learning based on postconcussion signs/symptoms, training school nurses in the recognition and management of concussions, and involving school nurses in the re-entry process are identified areas for improvement. Schools in the United States should be aware of these recommendations to guide a students postconcussion graduated academic re-entry process.

Demographics and Treatment of Adolescent Posttraumatic Headache in a Regional Concussion Clinic

OBJECTIVE Mild traumatic brain injury affects over one million pediatric patients annually. Minimal data and no guidelines exist regarding treatment of posttraumatic headache (PTH). The current study investigated treatment and outcomes in patients with posttraumatic headache. METHODS Medical records of all patients (age 13-18 years of age) seen at a regional concussion program from 2006 to 2011 were reviewed. Statistical analysis using SAS 9.2 was conducted to determine the effectiveness of treatment as well as the association of gender, concussion history, and football participation on the duration of posttraumatic headache. RESULTS Four hundred subjects met the inclusion criteria. Females were more likely to report posttraumatic headache than males (90% vs. 79%, P = 0.004), more likely to be prescribed amitriptyline (24% vs. 13%, P = 0.004), and had a significantly longer recovery time (median, 80 days versus 34 days, P < 0.001). Seventeen percent of subjects were prescribed amitriptyline for treatment of posttraumatic headache, of which 82% reported a beneficial effect. There was no difference in the percentage of posttraumatic headache or recovery time in football players versus other male athletes from other sport mechanisms. CONCLUSION Females are more likely to report posttraumatic headache than males and also take longer to recover. Amitriptyline appears to be well-tolerated and an effective treatment strategy for patients with posttraumatic headache. Among pediatric patients evaluated in a concussion clinic, there is no difference in the proportion of football players reporting headaches compared with male players of other sports.

Do Youth Hockey Coaches Allow Players With a Known Concussion to Participate in a Game

Ice hockey is a high-risk sport for concussion. It is important that coaches have an understanding of concussion, although previous studies have demonstrated poor knowledge of concussion recognition and management by youth coaches. A cross-sectional survey with 7 case scenarios was completed by 314 youth hockey coaches. Each case scenario described a player with a concussion during a game, and scores reflected how the coach would respond to each scenario. Although most coaches would not allow a player to continue participating in a game after suffering a concussion, there was a small percentage that would. Statistical analysis found an inverse relationship between the coaches’ age and consideration of continued participation. This places athletes at significant risk for further injury and is not consistent with current concussion guidelines. USA Hockey should provide additional concussion training for their coaches as well as mandatory health care clearance following a concussion.

Superior mesenteric artery syndrome in intellectually disabled children.

Objectives Superior mesenteric artery syndrome (SMAS) is a rare cause of small intestinal obstruction in pediatric patients. Children with intellectual disabilities are a challenging patient population in which to make this diagnosis. The goal of this study was to determine the frequency, presenting symptoms, and outcomes of SMAS in intellectually disabled and non–intellectually disabled children. Methods Retrospective chart review of pediatric patients with SMAS admitted to Penn State Hershey Children’s Hospital between January 1999 and July 2010. Results Sixteen children with SMAS were identified. The majority were male (n = 9) and more than two thirds had an intellectual disability (n = 11). Presenting symptoms were similar between groups, but 78% (7/9) of intellectually disabled patients who had a gastrostomy tube presented with feeding intolerance. Although intellectually disabled patients had a higher number of comorbidities and the number of health care visits before diagnosis was higher, this did not reach statistical significance. There were also no significant differences in length of symptoms before diagnosis and amount of weight loss. However, the weight-for-age percentiles in intellectual disabled children were significantly lower in those without an intellectual disability (9.09 [20.31] vs 48 [20.19], respectively, P ⩽ 0.001). Seventy-five percent of patients responded favorably to conservative treatment, but 36% (4/11) of intellectually disabled patients required multiple treatments before there was an improvement in their condition. Conclusions Superior mesenteric artery syndrome was found more often in children with an intellectual disability. These data highlight the need to consider SMAS if there is difficulty tolerating gastrostomy tube feedings in patients with weight-for-age percentiles less than 5%.

Short-term Outcomes of Sport- and Recreation-Related Concussion in Patients Admitted to a Pediatric Trauma Service

The outcomes of patients admitted to the hospital following a sport-related concussion are largely unknown. Medical records of patients admitted to the pediatric trauma service between 2008 and 2011 after sustaining a sport-related concussion were reviewed. In all, 59 participants were in the high-velocity activities group, and 21 in the field or court sport group. Abnormal CT scans were found in 14 patients in the high-velocity group and 2 in the field or court sport group. The majority of participants in the field or court sport group were football players, all of whom had normal CT scans. Headache was predictive of an abnormal CT scan. Among the patients, 56% clinically improved and were discharged the following day. Patients with field or court sport–related concussion admitted to a pediatric trauma service appear to be at low risk for clinically significant intracranial pathology and do well in the acute setting.

Mild traumatic brain injury and post-concussion syndrome: treatment and related sequela for persistent symptomatic disease

Sport-related concussion typically resolves within a few weeks of the injury; however, persistent symptoms have been reported to occur in 10% to 15% of concussions. These ongoing symptoms can cause significant disability and be frustrating for the patient and family. In addition, factors other than brain injury can cause complications for these patients, such as adjustment disorder or exacerbation of preexisting conditions such as depression or migraine. Individuals with prolonged symptoms of concussion may be classified as having post-concussion syndrome. A careful and thoughtful evaluation is important, as the clinician must determine whether these prolonged symptoms reflect brain injury pathophysiology versus another process. Although there have been numerous studies on the acute management of concussion, much less is available on the treatment of persistent disease. This review will provide an evaluation approach for the patient with prolonged concussion symptoms and review recent literature on treatment strategies.

Sleep Disturbance Following Concussion Is a Risk Factor for a Prolonged Recovery

Sleep disturbance is a common problem following concussion. A retrospective chart review was conducted at a regional concussion clinic on patients 13 to 18 years of age between 2005 and 2011. Statistical analysis evaluated sleep disturbance and duration of concussion, as well as the use and effectiveness of melatonin. A total of 417 patients met inclusion criteria. One hundred twenty-three (34%) reported disturbance in sleep. There was no difference in sleep disturbance based on age, gender, or past number of concussions. Sleep disturbance was associated with a 3- to 4-fold increase in recovery time. Non–sport-related concussions were more likely to be associated with sleep disturbance compared to sport-related concussions (45% vs 29%, P = .01). Melatonin improved sleep disturbance in 67% of the patients. Evaluating sleep disorders following concussion is an important part of the assessment. These findings will help clinicians provide anticipatory guidance and treatment for adolescents recovering from concussion.

Pediatric posttraumatic headache: two cases using steroids as abortive therapy.

Abstract Pediatric traumatic brain injury is a common occurrence, and even an ostensibly mild injury may result in disabling posttraumatic headaches. The headache may result in a number of subsequent unremitting symptoms refractory to many standard headache therapies. Current treatment recommendations are sparse because there is a lack of clinical trial data recommendations and outcomes. From these 2 cases, we report the effectiveness of steroids for severe posttraumatic headache, along with recommended treatment strategies for acute pain management and prevention.