Featured Research

from universities, journals, and other organizations

Comprehensive concussion literature analysis lays foundation for evidence-based guidelines

Date:
July 10, 2014
Source:
Congress of Neurological Surgeons
Summary:
There has been heightened public concussion awareness in the last few years related to professional sports, in particular, the NFL. The most underreported, under diagnosed and underestimated head injury is concussion, with the number of cases ranging in the millions every year. The term “concussion” is not well defined in clinical or research contexts, contributing to confusion among patients, families, and health providers.

There has been heightened public concussion awareness in the last few years related to professional sports, in particular, the NFL. Former Secretary of State Hillary Clinton recently shared details about the symptoms she experienced, and blood clot that was detected, after sustaining a concussion in December 2012. The most underreported, under diagnosed and underestimated head injury is concussion, which is also called mild traumatic brain injury (TBI). Concussion accounts for 90% of TBIs and the number of cases range in the millions every year. Up to 20% of patients diagnosed with concussion do not recover. Yet the term "concussion" is not well defined in clinical or research contexts, contributing to confusion among patients, families, and many health providers.

Related Articles


Despite the plethora of peer-reviewed research, there is presently no evidence-based definition for concussion that is uniformly applied in clinical and research settings. Current imaging and biomarkers research show promise, but fall short of providing evidence to support the use of a physiologic marker to identify concussion.

"The goal of this extensive analysis was to identify the most prevalent signs, symptoms, and deficits, and their associations, following a force to the head, in athletic, hospital, and military populations," said Jamshid Ghajar, MD, PhD, president of the Brain Trauma Foundation, and director of the Stanford Concussion and Brain Trauma Center. "We compiled data from the strongest scientific research, which provides an evidence-based foundation for diagnostic and prognostic criteria, and eventually treatment guidelines," added lead study author Nancy Carney, PhD, of Oregon Health & Science University, who is director of research for the Brain Trauma Foundation.

Concussion Guidelines Step 1: Systematic Review of Prevalent Indicators is a special supplement of Neurosurgery, official journal of the Congress of Neurological Surgeons. It is authored by Nancy Carney, PhD; Jamshid Ghajar, MD, PhD; Andy Jagoda, MD; Steven Bedrick, PhD; Cynthia Davis-O'Reilly, BSc; Hugo du Coudray, PhD; Dallas Hack, MD; Nora Helfand; Amy Huddleston, MPA; Tracie Nettleton, MS; and Silvana Riggio, MD.

From 5437 abstracts, 1362 full-text publications were reviewed, of which 231 studies were included in the final library. Only 26 of these met stringent criteria required to be used for this analysis. Because of the lack of sufficient objective data from strong studies, concussion remains undefined. There was sufficient reliable information to compile the following:

The most prevalent indicators of concussion, observed in alert individuals (Glascow Coma Scale of 13 to 15) after a force to the head are:

·Observed and documented disorientation or confusion immediately after the event

·Impaired balance within 1 day after injury

·Slower reaction time within 2 days after injury

·Impaired verbal learning and memory within 2 days after injury

Key Findings -- Among the studies included in the review:

·Loss of Consciousness (LOC) ranged from 1% to 14.3%

·Posttraumatic amnesia (PTA) ranged from 2% to 29.7%

·Retrograde amnesia ranged from 7.4% to 53.3%

·Disorientation/confusion ranged from 18% to 44.7%

·The prevalence of balance deficits ranged from 23.8% to 36.5% within 24 hours of injury and decreased to 19.2% to 24% by day 2.

·The prevalence of slowed reaction time ranged from 41.7% to 71.4% within 24 hours of injury.

·Findings indicated that in the majority of cases, cognitive deficits resolved within one week.

Influence of Prior Concussions

There has been a good deal in the news about athletes who incur multiple concussions, and the permanent brain damage that may occur due to repeated hits to the head. This review identified two well-designed and executed studies that appear to provide evidence for greater vulnerability in individuals with multiple concussions:

·In one study, individuals with a history of previous concussions had lower baseline scores than those without previous concussions on tests of cognitive function.

·In another study, odds of sustaining a 14-point drop in a memory test within 5 days of injury were 7 to 8 times greater for athletes who sustained prior concussions.

"It is important to understand that the findings in this report are limited by the nature and quality of the available scientific studies. Clearly more research is needed in order to derive a comprehensive and evidence-based picture of concussion," Dr. Carney said.

"Most of the studies used to compile the evidence in this report about what are true indicators of concussion were conducted among athletes," Dr. Ghajar stated. "We know very little about hospital and military populations. We hope our report will inspire a new generation of strong studies designed to fill the gaps in information we discovered and identified. The forthcoming report in our series will focus on evidence-based diagnostic criteria for concussion."


Story Source:

The above story is based on materials provided by Congress of Neurological Surgeons. Note: Materials may be edited for content and length.


Journal References:

  1. Nancy Carney, Jamshid Ghajar, Andy Jagoda, Steven Bedrick, Cynthia Davis-OʼReilly, Hugo du Coudray, Dallas Hack, Nora Helfand, Amy Huddleston, Tracie Nettleton, Silvana Riggio. Executive Summary of Concussion Guidelines Step 1. Neurosurgery, 2014; 75: S1 DOI: 10.1227/NEU.0000000000000434
  2. Nancy Carney, Jamshid Ghajar, Andy Jagoda, Steven Bedrick, Cynthia Davis-OʼReilly, Hugo du Coudray, Dallas Hack, Nora Helfand, Amy Huddleston, Tracie Nettleton, Silvana Riggio. Concussion Guidelines Step 1. Neurosurgery, 2014; 75: S3 DOI: 10.1227/NEU.0000000000000433

Cite This Page:

Congress of Neurological Surgeons. "Comprehensive concussion literature analysis lays foundation for evidence-based guidelines." ScienceDaily. ScienceDaily, 10 July 2014. <www.sciencedaily.com/releases/2014/07/140710094342.htm>.
Congress of Neurological Surgeons. (2014, July 10). Comprehensive concussion literature analysis lays foundation for evidence-based guidelines. ScienceDaily. Retrieved October 25, 2014 from www.sciencedaily.com/releases/2014/07/140710094342.htm
Congress of Neurological Surgeons. "Comprehensive concussion literature analysis lays foundation for evidence-based guidelines." ScienceDaily. www.sciencedaily.com/releases/2014/07/140710094342.htm (accessed October 25, 2014).

Share This



More Mind & Brain News

Saturday, October 25, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Academic Scandal Shocks UNC

Academic Scandal Shocks UNC

AP (Oct. 23, 2014) — A scandal involving bogus classes and inflated grades at the University of North Carolina was bigger than previously reported, a new investigation found. (Oct. 23) Video provided by AP
Powered by NewsLook.com
Working Mother Getaway: Beaches Turks & Caicos

Working Mother Getaway: Beaches Turks & Caicos

Working Mother (Oct. 22, 2014) — Feast your eyes on this gorgeous family-friendly resort. Video provided by Working Mother
Powered by NewsLook.com
What Your Favorite Color Says About You

What Your Favorite Color Says About You

Buzz60 (Oct. 22, 2014) — We all have one color we love to wear, and believe it or not, your color preference may reveal some of your character traits. In celebration of National Color Day, Krystin Goodwin (@kyrstingoodwin) highlights what your favorite colors may say about you. Video provided by Buzz60
Powered by NewsLook.com
First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

First-Of-Its-Kind Treatment Gives Man Ability To Walk Again

Newsy (Oct. 21, 2014) — A medical team has for the first time given a man the ability to walk again after transplanting cells from his brain onto his severed spinal cord. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins