Describing Pediatric and Adolescent Concussion

In addition to our main lines of Concussion research at CIRP, we are actively engaged in research activity to capture and describe characteristics of concussion in youth. Our researchers are studying the diversity and variability of the pediatric concussion patient population at Children's Hospital of Philadelphia and more broadly. By doing so, clinicians will be better equipped to recognize and treat specific concussion symptoms, as well as to predict recovery outcomes.

cirp concussion research
A few members of the Minds Matter Concussion Program team (l-r): Kristy Arbogast, PhD, Christina Master, MD, Olivia Podolak, MD, and Ronnie Kessler, MS.

Research Projects

Leveraging Electronic Health Records (EHR) for Concussion SurveillanceMore

The Minds Matter team and the Centers for Disease Control and Prevention (CDC) leverage CHOP's EHR system to expand concussion surveillance research and improve how clinicians manage concussion in children and adolescents. 

Concussion Assessment Research Education (CARE) Consortium Longitudinal Clinical StudyMore

Since 2016, CHOP has served as a CARE Consortium Study site in collaboration with the University of Pennsylvania (Penn Athletics). This multi-year longitudinal clinical study is a collaboration of National Collegiate Athletic Association (NCAA), Department of Defense (DoD) and multiple research sites to address public concerns and existing gaps in the basic and clinical science related to the natural history, evaluation and management, and prevention of sport-related concussions.

Select Describing Pediatric and Adolescent Concussion Publications

Evaluation and Management of Pediatric Concussion in the Acute Setting

The Economic Burden of Pediatric Postconcussive Syndrome

The Variability of Recovery From Pediatric Concussion Using Multimodal Clinical Definitions

Comparison of Anxiety and Depression Symptoms in Concussed and Nonconcussed Adolescents

In this study, researchers sought to compare anxiety and depression in acutely concussed and non-concussed adolescents to better understand psychiatric symptoms during the acute phase following a concussion for this age group. Research participants (111 concussed and 171 non-concussed adolescents ages 13 to 18 years old) completed assessments for depression and anxiety from the Patient-Reported Outcome Measurement Information System (PROMIS) within 28 days of injury. Researchers found that the proportion of concussed adolescents above normal limits for depressive symptoms was greater than in the non-concussed groups. In addition, more than 30% of the concussed adolescents were above normal limits for depressive or anxiety symptoms. The findings underscore the need for more comprehensive screening when caring for adolescents who suffer a concussion.

Concussion Referral and Practice Patterns by Pediatric Emergency Medicine Providers

In this study, researchers sought to assess pediatric emergency care providers’ referral patterns and current usage of standardized evaluation tools. Among 162 providers that completed a survey in 2021, nearly all used characteristics of the injury or injury history (history of severe or multiple prior concussions, prolonged symptom duration and severity of current symptoms) to assist in specialty referral. Standardized symptom scales, vestibular and balance assessments, and prognostic tools were used infrequently (ranging from 6-13% depending on the tool).

Endogenous Opioid Dynorphin Is a Potential Link Between Traumatic Brain Injury, Chronic Pain, and Substance Use Disorder

This article synthesizes information on our current understanding of TBI, highlighting potential mechanistic parallels between and across conditions that suggest a role for dynorphin in long-term sequelae after TBI. Dynorphin is an endogenous opioid neuropeptide that is significantly dysregulated after TBI. Both dynorphin and its primary receptor, the ĸ-opioid receptor (KOR), are implicated in the neuropathology of chronic pain and SUD.

Radiologic Common Data Elements Rates in Pediatric mTBI

Radiologic common data elements (rCDE) have been developed to standardize reporting of radiologic findings in research settings for mTBI. However, the clinical significance of these findings remains unclear, with some findings more likely to be related to mTBI while others are only possibly related to mTBI and others are incidental findings. In this multi-site study, 287 patients with subacute pediatric mTBI, 106 matched healthy controls, and 71 orthopedically injured patients underwent imaging approximately 1 week post-injury and were followed for 3-4 months. Each category of rCDE was examined-- probable, possible or incidental findings. Probable rCDE were found at a rate of 4-5% in the population with mTBI and were not observed in either control group, whereas possible rCDE and incidental findings were found at similar rates across all three populations, indicating that refinement of rCDE in the context of pediatric mTBI may be helpful in differentiating populations with more significant injury with mTBI.

CHOP researchers collaborated on this multi-site study with the lead authors.

High School Football and Later Life Cognition

In this study of men who graduated from Wisconsin high schools in 1957, playing high school football was not adversely associated with cognitive impairment or depression later in life.  Researchers from University of Pennsylvania's Wharton School and CHOP used data from the Wisconsin Longitudinal Study (WLS) of high school graduates in the state in 1957, which included information on high school football participation and cognitive psychological well-being assessments of participants later in life in their 50s, 60s and 70s. However, the WLS data doesn’t include history of concussion and total exposure to football before high school. In the study of 3,904 men, high school football players were compared with their nonplaying counterparts and depression and cognitive impairment were assessed in their 60s and 70s using composite cognition and depression scores.The authors report cognitive and depression outcomes later in life were similar for high school football players and those who did not play. 

Emergency Department Visits and Neuroimaging for Concussion Patients from 2006-2011

 To better understand the epidemiology of concussion and rates of head computed tomography (CT) use in head injured patients in Emergency Departments, researchers conducted a cross-sectional analysis of the Nationwide Emergency Departments Sample (NEDS) and found rates of concussion visits increased over this time period for all age groups. The rate of CT use also increased, even though the severity of injury decreased. 

Characteristics of Prolonged Recovery

This study identified pre-existing characteristics (depression, anxiety) and presenting symptoms (abnormal oculomotor, dizziness) associated with prolonged recovery from concussion in a sample of patients referred to a pediatric sports medicine clinic. 

Select Describing Pediatric and Adolescent Concussion Review Publications

In the Clinic: Concussion

 This review discusses the important role of the primary care doctor across the spectrum of concussion from injury to recovery, including prevention, diagnosis (with detailed descriptions of diagnostic tests), treatment (including graduated return to play and rehabilitation) and prognosis. Additionally, it provides a list of resources for both the provider and patient. 

The Spectrum of Mild Traumatic Brain Injury: A Review

This review discusses the varied and often conflicting diagnostic criteria for concussion, proposes an ideal diagnostic nosology for mild traumatic brain injury encouraging clinicians to adopt a probabilistic framework, describes the management of both acute and chronic concussion, and reviews the etiologies that contribute to prolonged symptoms following concussion. 

The Clinical Implications of Youth Sports Concussion Laws: A Review

 This article explores the varied specifications described in state concussion laws for children and adolescents and their affect on clinical practice, including who is qualified to provide clearance, after how long clearance can be provided, and what a medical evaluation entails. Return to play and return to learn protocols are also examined. 

Sports-Related Head Injuries in Adolescents: A Comprehensive Update

This review article summarizes the current state of the rapidly changing field of sports-related head injuries of all severities with a particular emphasis on mild TBI (mTBI) and concussion in adolescents ages 10-19 years. The definition, incidence, epidemiology, pathophysiology, diagnosis, management, long-term consequences and prevention of these injuries are discussed.