Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines

Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines

Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, Davis-O'Reilly C, Hart EL, Bell MJ, Bratton SL, Grant GA, Kissoon N, Reuter-Rice KE, Vavilala MS, Wainwright MS. Pediatr Crit Care Med. 2019 Mar;20(3S Suppl 1):S1-S82. doi: 10.1097/PCC.0000000000001735.

Full Text is Freely Available

A multidisciplinary team has updated the guidelines for the management of pediatric severe traumatic brain injury as part of the process to update three Brain Trauma Foundation Guidelines (this one, acute care guidelines for adults, and guidelines for prehospital management of all ages [coming soon]). The guidelines cover monitoring, threshold values for measures that are monitored during an in-hospital stay, and treatment recommendations. The main document offers extensive details and the recommendations while the executive summary (freely available) offers a nice overview of the key changes.

View 186 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

Is Your State’s Concussion Law Working? Ohio’s Seems to be Effective

Initial Emergency Department Visit and Follow-Up Care for Concussions among Children with Medicaid

Tarimala A, Singichetti B, Yi H, Huang L, Doerschuk R, Tiso M, Yang J. J Pediatr. 2019 Mar;206:178-183

Full Text is Freely Available

Take Home Message: Ohio’s concussion law may have increased the rate of concussion diagnosis and follow-up care among young patients with Medicaid.

Patients need a swift diagnosis and proper care to lessen the potential long-term negative effects of a concussion. Hence, every state passed a concussion law that included 3 main core tenets: 1) immediate removal, 2) written clearance from a health care professional to return to play, and 3) concussion education. These laws have increased the recognition of a concussion; however, it is unclear if these laws impacted the needed follow-up care after a concussion diagnosis. Therefore, the authors aimed to describe the rates of initial emergency department encounters and follow-up care for concussions among children with Medicaid before and after Ohio enacted a concussion law in 2013.

To Properly Motivate Patients, We May Need to Manage Expectations

Expectations for return to preinjury sport before and after anterior cruciate ligament reconstruction.

Webster KE, and Feller JA. Am J Sports Med 2019. [Epub Ahead of Print].

https://journals.sagepub.com/doi/abs/10.1177/0363546518819454

Take Home Message: While 84% of people expected to return to preinjury levels of activity after an anterior cruciate ligament reconstruction, only 24% of them actually did within 12 months of surgery.

A patient’s expectation to return to activity after an anterior cruciate ligament reconstruction (ACLR) may predict the patient’s motivation during the rehabilitation process. While most patients expect to return to preinjury levels of activity, understanding what these expectations are and how they change after surgery is important to help clinicians develop strategies to properly manage patient expectations. Therefore, Webster and Feller completed a prospective cohort study to investigate return-to-activity expectations before and after an ACLR and decipher which factors related to a change in expectation.

Medical encounters (including injury and illness) at mass community-based endurance sports events: an international consensus statement on definitions and methods of data recording and reporting

Medical encounters (including injury and illness) at mass community-based endurance sports events: an international consensus statement on definitions and methods of data recording and reporting.

Schwellnus M, Kipps C, Roberts WO, Drezner JA, D'Hemecourt P, Troyanos C, Janse van Rensburg DC, Killops J, Borresen J, Harrast M, Adami PE, Bermon S, Bigard X, Migliorini S, Jordaan E, Borjesson M. Br J Sports Med. 2019 Feb 22. pii: bjsports-2018-100092. doi: 10.1136/bjsports-2018-100092. [Epub ahead of print]

Full Text Not Freely Available

A consensus “Medical Methods in Endurance Sport” group, which included researchers and clinicians involved in international community-based endurance sporting events met. Their goal was to agree on a set of definitions of medical incidents and complications and to standardize the methods to record and report these events at large community-based endurance sports events. Representatives of 3 major sporting federations helped prepare the manuscript for endorsement of the final consensus document. The document includes definitions for “mass community-based endurance sports event”, “medical team”, as well as “medical problems” and “medical encounters” (including severity, timing, and diagnostic categories),

View 185 other recent position statements, consensus statements, guidelines, and recommendations related to sports medicine.

A Combined Knee Injury Impairs Patient-Reported Outcomes Years Later

Patient Reported Outcomes 1 to 5 years After ACL Reconstruction: Effect of Combined Injury, and Associations with MRI-Defined Osteoarthritis Features

Patterson BE, Culvenor AG, Barton CJ, Guermazi A, Stefanick JJ, & Crossley KM.  Arthritis Care Res. 2019; Published online ahead of print February 14, 2019.  DOI:10.1002/acr.23854

https://onlinelibrary.wiley.com/doi/abs/10.1002/acr.23854?af=R

Take Home Message: Patients with an isolated anterior cruciate ligament reconstruction have better patient-reported outcomes at 1 and 5 years after surgery compared with patients who have other combined injuries. At 1 and 5 years after surgery, a patient with a patellofemoral cartilage defect or meniscal tear may be more likely to have poor patient-reported outcomes compared with their peers.

People who suffer an anterior cruciate ligament (ACL) injury often have symptoms that will gradually improve up to one year after surgical reconstruction.  However, these symptoms can persist beyond that one-year mark and cause significant limitations and comorbidities.  Persistent symptoms may be linked with concomitant injuries and other structural or degenerative changes. Therefore, the authors aimed to test this hypothesis by determining the relationship between concomitant injuries and other structural findings at 1 and 5 years post surgery to patient-reported outcomes 1 and 5 years after an ACL reconstruction.

Aerobic Exercise May Help Concussion Recovery

Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial

Leddy JJ, Haider MN, Ellis MJ, Mannix R, Darling SR, Freitas MS, Suffoletto HN, Leiter J, Cordingley DM, Willer B. JAMA Pediatr. 2019; [Epub ahead of print]

https://jamanetwork.com/journals/jamapediatrics/article-abstract/2723523

Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants.

Teel EF, Register-Mihalik JK, Appelbaum LG, Battaglini CL, Carneiro KA, Guskiewicz KM, Marshall SW, Mihalik JP. J Athl Train. 2018 Dec;53(12):1156-1165.

Full Text Freely Available

Take Home Message: Early sub-symptom threshold aerobic exercise training may help adolescent athletes recover faster after a concussion while not affecting concussion assessments in healthy athletes.

Aerobic exercise is a novel concussion rehabilitation method. This method is a large shift from the typically conservative rest that has been advocated; yet, many athletes with a concussion that are active have better outcomes than their sedentary peers (such as, faster sign and symptom recovery, quicker return to play). To help clinicians implement aerobic exercise after a patient’s concussion we need to know if aerobic exercise affects clinical tests that ascertain readiness to start a return-to-play protocol and causes better outcomes compared to standard of care without aerobic exercise. Therefore, Teel et al. and Leddy et al. randomized athletes to receive either subthreshold aerobic exercise or no aerobic activity. Teel and colleagues wanted to determine if aerobic exercise altered concussion outcomes among healthy adults. Meanwhile, Leddy and colleagues assessed if sub-symptom threshold aerobic exercise vs a stretching program improved outcomes among adolescents in the acute phase of recovery after a sports-related concussion (within 10 days of injury).

Webinar: Pushing the Laboratory Boundaries for Analyzing Running

Alexandra DeJong, a Sports Med Res contributor and PhD Student at the University of Virginia, leads our first webinar entitled "Pushing the Laboratory Boundaries for Analyzing Running".