Neurosensory Deficits Vary as a Function of Point of Care in Pediatric Mild Traumatic Brain Injury. J Neurotrauma 2018 May 15;35(10):1178-1184
Date
01/18/2018Pubmed ID
29336197Pubmed Central ID
PMC5953216DOI
10.1089/neu.2017.5340Scopus ID
2-s2.0-85046890625 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
Neurosensory abnormalities are frequently observed following pediatric mild traumatic brain injury (pmTBI) and may underlie the expression of several common concussion symptoms and delay recovery. Importantly, active evaluation of neurosensory functioning more closely approximates real-world (e.g., physical and academic) environments that provoke symptom worsening. The current study determined whether symptom provocation (i.e., during neurosensory examination) improved classification accuracy relative to pre-examination symptom levels and whether symptoms varied as a function of point of care. Eighty-one pmTBI were recruited from the pediatric emergency department (PED; n = 40) or outpatient concussion clinic (n = 41), along with matched (age, sex, and education) healthy controls (HC; n = 40). All participants completed a brief (∼ 12 min) standardized neurosensory examination and clinical questionnaires. The magnitude of symptom provocation upon neurosensory examination was significantly higher for concussion clinic than for PED patients. Symptom provocation significantly improved diagnostic classification accuracy relative to pre-examination symptom levels, although the magnitude of improvement was modest, and was greater in the concussion clinic. In contrast, PED patients exhibited worse performance on measures of balance, vision, and oculomotor functioning than the concussion clinic patients, with no differences observed between both samples and HC. Despite modest sample sizes, current findings suggest that point of care represents a critical but highly under-studied variable that may influence outcomes following pmTBI. Studies that rely on recruitment from a single point of care may not generalize to the entire pmTBI population in terms of how neurosensory deficits affect recovery.
Author List
Mayer AR, Wertz C, Ryman SG, Storey EP, Park G, Phillips J, Dodd AB, Oglesbee S, Campbell R, Yeo RA, Wasserott B, Shaff NA, Leddy JJ, Mannix R, Arbogast KB, Meier TB, Grady MF, Master CLAuthor
Timothy B. Meier PhD Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAmbulatory Care
Ambulatory Care Facilities
Brain Concussion
Child
Emergency Medical Services
Emergency Service, Hospital
Female
Humans
Male
Neurologic Examination
Point-of-Care Systems
Post-Concussion Syndrome
