Concussion最新文献

{"title":"Will eye tracking change the way we diagnose and classify concussion and structural brain injury?","authors":"Uzma Samadani","doi":"10.2217/cnc.15.2","DOIUrl":"https://doi.org/10.2217/cnc.15.2","url":null,"abstract":"Lee Schwamm’s recent editorial in the New England Journal of Medicine lamented the failure of the PROTECT III and SYNAPSE clinical trials after recruitment of more than 2000 brain injured patients, despite their being ‘exceptionally well designed and conducted’ [1]. Both of these trials selected and stratified patients on the basis of Glasgow Coma Scale (GCS) score and assessed outcome with extended Glasgow Outcome Scale Scores and secondary measures. Schwamm cited the lack of biomarkers for brain injury as one of the many causes of failure, and noted that “the investigators appropriately call for a comprehensive review of the TBI translational research strategy,” particularly in light of the fact that these represent only the most recent of a long string of failed clinical trials for the treatment of brain injury [1]. Even before the failure of these most recent trials, recognition of the brain’s complexity and propensity for astonishing heterogeneity of injury has spurred a 22 country, 80 center effort in Europe. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury trial is a prospective longitudinal observational study with one of its goals listed as improving ‘characterization and classification of TBI’ [2,3]. At a fundamental level, the mild/moderate/severe paradigm for brain injury most frequently based on GCS, loss of consciousness and post-traumatic amnesia has utility for triage and rapid communication during the acute phase of injury, but it is neither sufficiently sensitive to assess cognitive and neuropsychiatric deficits of TBI nor predictive of outcome [3]. Recently, I cared for a 44-year-old woman who had bumped her head at home, without any loss of consciousness or other symptoms whatsoever. She did not seek medical care. Two weeks later she had a headache and took aspirin. She developed a mild expressive aphasia and reported to her local ED, where a head CT revealed a subdural hemorrhage. This woman had a GCS that never slipped from 15. She never met the criteria for mild, moderate or severe TBI, yet could potentially have died without neurosurgical intervention and would likely have residual deficit requiring therapy. Dogmatically, physicians will admit to the hospital or observe in the ED, any acute brain injury we can see on a CT scan, with the idea that these patients are at the highest risk for requiring surgical intervention. Equally dogmatically, we dismiss any patient without a visible structural brain injury on CT. And therein lies the problem. This subconscious allowance that the CT scan defines acute brain injury belittles the cryptic nature of concussive injury. The idea that something should be called ‘mild’ TBI, when it can potentially lead to a spiral of disabling and potentially lifelong symptoms, needs to be discarded. “...eye tracking might ultimately be used to classify – or even define concussion – and limit its scope to traumatic neurologic injury not apparent on CT scanning","PeriodicalId":37006,"journal":{"name":"Concussion","volume":"1 1","pages":"CNC2"},"PeriodicalIF":0.0,"publicationDate":"2015-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc.15.2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36475918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensitivity and specificity of an eye movement tracking-based biomarker for concussion.","authors":"Uzma Samadani,&nbsp;Meng Li,&nbsp;Meng Qian,&nbsp;Eugene Laska,&nbsp;Robert Ritlop,&nbsp;Radek Kolecki,&nbsp;Marleen Reyes,&nbsp;Lindsey Altomare,&nbsp;Je Yeong Sone,&nbsp;Aylin Adem,&nbsp;Paul Huang,&nbsp;Douglas Kondziolka,&nbsp;Stephen Wall,&nbsp;Spiros Frangos,&nbsp;Charles Marmar","doi":"10.2217/cnc.15.3","DOIUrl":"https://doi.org/10.2217/cnc.15.3","url":null,"abstract":"<p><strong>Object: </strong>The purpose of the current study is to determine the sensitivity and specificity of an eye tracking method as a classifier for identifying concussion.</p><p><strong>Methods: </strong>Brain injured and control subjects prospectively underwent both eye tracking and Sport Concussion Assessment Tool 3. The results of eye tracking biomarker based classifier models were then validated against a dataset of individuals not used in building a model. The area under the curve (AUC) of receiver operating characteristics was examined.</p><p><strong>Results: </strong>An optimal classifier based on best subset had an AUC of 0.878, and a cross-validated AUC of 0.852 in CT- subjects and an AUC of 0.831 in a validation dataset. The optimal misclassification rate in an external dataset (n = 254) was 13%.</p><p><strong>Conclusion: </strong>If one defines concussion based on history, examination, radiographic and Sport Concussion Assessment Tool 3 criteria, it is possible to generate an eye tracking based biomarker that enables detection of concussion with reasonably high sensitivity and specificity.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":"1 1","pages":"CNC3"},"PeriodicalIF":0.0,"publicationDate":"2015-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc.15.3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36479809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability of the modified Balance Error Scoring System at baseline using objective and subjective balance measures.","authors":"Amaal J Starling,&nbsp;Danielle F Leong,&nbsp;Jamie M Bogle,&nbsp;Bert B Vargas","doi":"10.2217/cnc.15.5","DOIUrl":"https://doi.org/10.2217/cnc.15.5","url":null,"abstract":"<p><strong>Aim: </strong>To investigate preseason modified Balance Error Scoring System (mBESS) performance in a collegiate football cohort; to compare scores to an objective mobile balance measurement tool.</p><p><strong>Materials & methods: </strong>Eighty-two athletes completed simultaneous balance testing using mBESS and the King-Devick Balance Test, an objective balance measurement tool. Errors on mBESS and objective measurements in the double-leg, single-leg (SS) and tandem stances were compared.</p><p><strong>Results: </strong>Mean mBESS error score was 7.23 ± 4.65. The SS accounted for 74% of errors and 21% of athletes demonstrated the maximum error score. There was no significant correlation between mBESS score and objective balance score.</p><p><strong>Conclusion: </strong>The high variability and large number of errors in the SS raises concerns over the utility of the SS in identifying suspected concussion.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":"1 1","pages":"CNC5"},"PeriodicalIF":0.0,"publicationDate":"2015-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc.15.5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36479811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Returning the student to school after concussion: what do clinicians need to know?","authors":"Sean C Rose,&nbsp;Kelly A McNally,&nbsp;Geoffrey L Heyer","doi":"10.2217/cnc.15.4","DOIUrl":"https://doi.org/10.2217/cnc.15.4","url":null,"abstract":"<p><p>Participation in school is vital to a child's academic and social development. Following concussion, returning the student to school can pose several challenges for families, healthcare providers and school personnel. The complex constellation of postconcussion symptoms can impair learning and can make the school environment intolerable. Research evidence to guide the return to school process is lacking, but protocols have been proposed that outline a gradual reintroduction to school with academic accommodations tailored to the student's specific symptoms. Key medical and school personnel must understand their respective roles to optimize the process. This review of the current literature examines the available data and expert recommendations that can support a student's successful return to school following concussion.</p>","PeriodicalId":37006,"journal":{"name":"Concussion","volume":"1 1","pages":"CNC4"},"PeriodicalIF":0.0,"publicationDate":"2015-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2217/cnc.15.4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36479810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}