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 Surveillance

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 Study

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

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.