Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-30 (of 48 Records) |
Query Trace: Haarbauer-Krupa J[original query] |
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Mild traumatic brain injuries and risk for affective and behavioral disorders
Delmonico RL , Tucker LY , Theodore BR , Camicia M , Filanosky C , Haarbauer-Krupa J . Pediatrics 2024 153 (2) OBJECTIVES: Recent studies document an association between mild traumatic brain injuries (mTBIs) in children and postinjury psychiatric disorders. However. these studies were subject to limitations in the design, lack of long-term follow-up, and poorly defined psychiatric outcomes. This study determines the incidence and relative risk of postinjury new affective and behavior disorders 4 years after mTBIs. METHODS: A cohort study of mTBI cases and matched comparisons within an integrated health care system. The mTBI group included patients ≤17 years of age, diagnosed with mTBI from 2000 to 2014 (N = 18 917). Comparisons included 2 unexposed patients (N = 37 834) per each mTBI-exposed patient, randomly selected and matched for age, sex, race/ethnicity, and date of medical visit (reference date to mTBI injury). Outcomes included a diagnosis of affective or behavioral disorders in the 4 years after mTBI or the reference date. RESULTS: Adjusted risks for affective disorders were significantly higher across the first 3 years after injury for the mTBI group, especially during the second year, with a 34% increase in risk. Adjusted risks for behavioral disorders were significant at years 2 and 4, with up to a 37% increase in risk. The age group with the highest risk for postinjury affective and behavioral disorders was 10- to 13-year-old patients. CONCLUSIONS: Sustaining an mTBI significantly increased the risks of having a new affective or behavioral disorder up to 4 years after injury. Initial and ongoing screening for affective and behavior disorders following an mTBI can identify persistent conditions that may pose barriers to recovery. |
Association between lifetime sexual violence and recent traumatic brain injury among adults: 2017 Connecticut Behavioral Risk Factor Surveillance System
Waltzman D , Daugherty J , Haarbauer-Krupa J , Zheng X , Jorge C , Basile KC . J Interpers Violence 2023 8862605231203962 Sexual violence (SV) is a critical public health problem that is associated with numerous negative health consequences, including immediate- and long-term physical and mental health conditions and health-risk behaviors. Some of these health-risk behaviors (e.g., substance use, unsafe driving practices, poor mental health, lower impulse control, and abnormal brain circuitry) might increase the risk for sustaining a traumatic brain injury (TBI). A TBI causes neurological or neuropsychological changes and may also lead to various symptoms that affect a person's cognition, mobility, behavior, and mental health. Determining if those who have experienced SV are at increased risk of sustaining a TBI in their lifetime is critical given the high prevalence and health impacts of SV, the potential vulnerability to TBI after SV, and the known detrimental effects of TBI. This exploratory study examined data from the 2017 Connecticut behavioral risk factor surveillance system and found that lifetime SV victimization (controlling for age and sex) was associated with increased odds of reporting a recent TBI in the past 12 months (adjusted odds ratio [AOR] = 2.1; 95% confidence interval [CI] [1.03, 4.21]). Further research is needed to better understand how SV history is related to the risk of sustaining a TBI. Healthcare professionals can support patients who experience SV by providing resources to help reduce associated physical and mental health conditions and health-risk behaviors. |
Stakeholder perspectives on navigating the pediatric concussion experience: Exploring the needs for improved communication across the care continuum
Gomez D , Glang A , Haarbauer-Krupa J , Bull R , Tucker P , Ratcliffe J , Hall A , Gioia GA , Jain S , Sathian U , Simon HK , Wright D . NeuroRehabilitation 2023 52 (4) 605-612 BACKGROUND: For children, the post-concussion return to school process is a critical step towards achieving positive health outcomes. The process requires integration between healthcare professionals, parents, and school personnel. OBJECTIVE: This research team conducted focus groups with stakeholders including parents, education personnel, school nurses, external healthcare providers (nurses) and athletic trainers to identify communication patterns between healthcare providers outside of the school setting and school personnel. METHODS: Data from focus groups were analyzed using a Thematic Analysis approach. Researchers used an inductive (bottom-up) coding process to describe semantic themes and utilized a critical realist epistemology. RESULTS: We identified four key themes within focus group data: (1) lack of effective communication between hospital and outpatient healthcare providers to school personnel; (2) parents who were strong advocates had improved communication with healthcare professionals and garnered more accommodations for their children; (3) non-school professionals and families were often confused about who the point of contact was at a given school; and (4) differing experiences for athletes vs. non-athletes. CONCLUSION: This study suggests gaps in communication between healthcare and school professionals when children return to school following a concussion. Improving communication between healthcare providers and school staff will require a multi-faceted approach. |
Using guided credible history interviews to establish special education eligibility for students with traumatic brain injury
McCart M , Unruh D , Gomez D , Anderson D , Gioia G , Davies SC , Haarbauer-Krupa J , Womack LS , Thigpen S , Brown L , Glang A . NeuroRehabilitation 2023 52 (4) 597-604 BACKGROUND: In Oregon in 2019, only 261 students were eligible for special education under the traumatic brain injury (TBI) category. Many students with TBIs are not treated by a medical provider, so the requirement for a medical statement could prevent eligible youth from receiving special education services. OBJECTIVE: This study investigated barriers to using a medical statement to establish special education eligibility for TBI, support for using a guided credible history interview (GCHI), and training needs around GCHI. RESULTS: Among participants, 84% reported difficulty obtaining a medical statement for TBI eligibility determination, and 87% favored the GCHI as an alternative, though they reported a need for training in TBI and GCHI. CONCLUSION: The results support the use of GCHI to establish special education eligibility for TBI and informed Oregon's addition of GCHI to TBI special education eligibility determination. |
Return to school after traumatic brain injury: Description of implementation settings
Haarbauer-Krupa J , Thigpen S , Glang A , Eagan-Johnson B , McAvoy K , Brunken C , Chininis M , Kurowski BG , Suskauer S , Crowley M , Denslow P . J Head Trauma Rehabil 2023 38 (4) 329-335 OBJECTIVE: Children who experience traumatic brain injury (TBI) of any severity may need accommodations when they return to school-the setting that manages academic achievement and learning. However, variations exist in current return to school (RTS) programs that address a child's transition to school following TBI. This article describes some of these return to school (RTS) programs and how they vary by setting. DESIGN: This article provides insights from a modified evaluability assessment that examined RTS programs and their readiness for rigorous evaluation. A secondary analysis was conducted to better describe the types and location of programs examined. RESULTS: Differences exist in program structure, access, and how care for children is monitored over time. RTS programs that serve children following TBI are located in healthcare settings, schools, and state agencies and vary in models of care due to their location and organizational structure. CONCLUSIONS: Children who experience TBI benefit from a healthcare assessment and follow-up upon RTS that includes parental involvement. Models of care for this process vary based on program location and organizational structure. Further research and program evaluation are needed to better understand effectiveness and how to optimally monitor and care for children returning to school after a concussion or TBI. |
When traumatic brain injuries in children become chronic health conditions
Kurowski BG , Haarbauer-Krupa J , Giza CC . J Head Trauma Rehabil 2022 38 (4) 348-350 THE CENTERS for disease control and prevention (CDC) Report to Congress on the Management of Traumatic Brain Injury (TBI) described the management of TBI in children as an important public health issue.1 A brain injury of any severity can occur at 1 or multiple times during childhood. As a result of TBI during childhood, changes in health, cognition, family environment, and behavior can affect learning, self-regulation, and social participation, which are critical skills to optimize functioning in adulthood.2 TBI affects children differently than it affects adults because it can impact brain development during key periods that may alter developmental trajectories over time.2 Although most children recover well physically, they can experience changes in behavior and cognition that may not be recognized immediately.2 During childhood, a history of TBI is often associated with several health conditions, including epilepsy, headache/migraine, autonomic disturbances, intellectual disability, vision problems, speech and language problems, and behavior and mental health problems.3 |
Stakeholder Perspectives on the School Experiences of Students With Traumatic Brain Injury: The Effects of COVID-19 Pandemic on Service Delivery.
Unruh D , Gomez D , Slocumb J , McCart M , Davies S , Haarbauer-Krupa J , Glang A . J Sch Health 2022 93 (5) 378-385 BACKGROUND: For students with traumatic brain injury (TBI), the COVID-19 pandemic exacerbated challenges they were already experiencing at school. METHODS: This qualitative study employed focus groups and interviews with students, parents, school, and medical personnel to explore the school experiences of students with TBI. Thematic qualitative analyses were used. RESULTS: Key themes from the analysis include (a) incidence of brain injuries decreased; (b) screen time for students with TBI exacerbated symptoms; (c) COVID protocols at school made it difficult for educators to identify and provide accommodations for students with TBI; (d) COVID protocols at school could inadvertently exacerbate mental health difficulties after a TBI; and (e) COVID-related logistics increased the time between an injury and return to school or return to play. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The results from this study suggest that professional development for teachers supporting students with TBI is needed, especially for online learning environments. Additionally, because mental/behavioral health concerns may arise for students with TBI in online learning environments, school health care providers can work with families to assess a student's mental health, making referrals to appropriate supports. CONCLUSIONS: There is a significant need for professional development and school-wide infrastructure supportive of students with TBI. |
Does binge drinking mediate the relationship between four adverse childhood experiences and adult traumatic brain injury Results from the National Longitudinal Survey of Youth 1979 Cohort
Daugherty J , Treves-Kagan S , Gottfredson NC , Miedema S , Haarbauer-Krupa J . Inj Prev 2022 29 (2) 111-115 OBJECTIVE: Adverse childhood experiences (ACEs) are associated with increased risk of sustaining a traumatic brain injury (TBI). Alcohol use may play an important role in this relationship. This study examines whether binge drinking mediates the relationship between four ACEs and TBIs sustained in adulthood. METHODS: Using the National Longitudinal Survey of Youth, 1979 cohort, we conducted longitudinal mediation analyses (n=6317). Interviews occurred annually from 1979 to 1994 and biennially until 2016. We evaluated the direct and indirect effects of individual ACEs (ie, experiencing physical violence, low parental warmth, familial alcoholism and familial mental illness; reported retrospectively) and a cumulative ACEs score on mean level of binge drinking (calculated across waves) and having a TBI in adulthood. To establish temporality, we included binge drinking that was measured at age 18 or older and before any reported TBI. RESULTS: Cumulative ACEs, familial alcoholism and physical abuse exposure were significantly associated with having a TBI through binge drinking, although this only explained a small part of the association between ACEs and TBI. Other ACEs were not significantly associated with binge drinking or TBI. CONCLUSION: The results indicate that while ACEs and adult TBI risk were significantly associated, lifetime binge drinking explains only a small part of the association. Future research could examine alternative social, biological and behavioural mechanisms along the pathway between ACEs and TBI. Determining this mechanism will allow public health practitioners to design and implement effective TBI prevention programmes for those at higher risk of injury due to ACE exposure. |
Implementation of active injury management (AIM) in youth with acute concussion: A randomized controlled trial
Thomas D , Erpenbach H , Hickey RW , Waltzman D , Haarbauer-Krupa J , Nelson LD , Patterson CG , McCrea M , Collins M , Kontos AP . Contemp Clin Trials 2022 123 106965 BACKGROUND: Nearly 2 million youth seek acute medical care following concussion in the U.S. each year. Current standard of care recommends rest for the first 48 h after a concussion. However, research suggests that prolonged rest may lengthen recovery time especially for patients with certain risk profiles. Research indicates that physical activity and behavioral management interventions (sleep, stress management) may enhance recovery. To date, there is limited empirical evidence to inform acute (<72 h) concussion recommendations for physical activity and behavioral management in adolescents. OBJECTIVE: To determine the effectiveness of physical activity and behavioral management for acute concussion in adolescents and young adults, and to evaluate the role of patient characteristics on treatment response. METHODS: This multicenter prospective randomized controlled trial will determine which combination of physical activity and behavioral management is most effective for patients 11-24 years old who present to the emergency department or concussion clinic within 72 h of injury. Participants are randomized into: 1) rest, 2) physical activity, 3) mobile health application (mHealth) behavioral management, or 4) physical activity and mHealth app conditions. Assessments at enrollment, 3-5 days, 14 days, 1 month, and 2 months include: concussion symptoms, balance, vestibular-ocular and cognitive assessments, quality of life, and recovery time. Somatic symptoms and other risk factors are evaluated at enrollment. Compliance with treatment and symptoms are assessed daily using actigraph and daily self-report. The primary study outcome is symptoms at 14 days. CONCLUSION: Prescribed physical activity and behavioral management may improve outcomes in youth following acute concussion. |
Traumatic brain injury in older adults-a public health perspective
Waltzman D , Haarbauer-Krupa J , Womack LS . JAMA Neurol 2022 79 (5) 437-438 Traumatic brain injuries (TBIs) are a leading cause of morbidity and mortality in the US.1 In recent years, these injuries have received greater attention as a public health concern due to increased awareness of sport- and military-related TBIs.2 However, older adults have been reported to have higher rates of TBI than any other age group.1 In 2017, adults aged 65 years or older accounted for 38.4% of all TBI-related deaths and 43.9% of all TBI-related hospitalizations in the US.1 In addition, older adults who experience a TBI are more likely to have higher morbidity and mortality, slower recovery, and worse outcomes than younger adults.2 |
Prevalence of suspected concussions among K-12 students in Utah: Findings from Utah's Student Injury Reporting System
Waltzman D , Daugherty J , Sarmiento K , Haarbauer-Krupa J , Campbell H , Ferrell D . J Sch Health 2021 92 (3) 241-251 BACKGROUND: To inform prevention strategies, this study provides incidence, factors, and actions taken when a suspected concussion occurred in K-12 schools in Utah. METHODS: Data were collected using Utah's Student Injury Reporting System (SIRS) from the academic years 2011-2012 to 2018-2019. SIRS is a unique online system that tracks injuries that occur in the school setting among K-12 students in Utah. Descriptive statistics were computed to characterize students with a suspected concussion. Chi-square (χ(2) ) analysis looking at characteristics by school level was also conducted. RESULTS: Over 63,000 K-12 students in Utah sustained an injury at school during the study period. Suspected concussions comprised 10% of all injuries. The prevalence of concussions was highest among males (60.6%) and elementary school students (42.6%) and most often occurred outdoors (57.6%) or on a playground/playfield (33.9%), and in sports- and recreation-related activities (75.1%) (specifically contact sports, 24.0%). Most students with a suspected concussion were absent 1 day or less from school (71.4%) but about 68% were seen by a medical professional. Further, there were differences by school level. Females and students playing contact sports had a higher percentage of suspected concussions as school level increased, whereas males and concussions sustained during school hours had a lower percentage of suspected concussions as school level increased. CONCLUSIONS: SIRS enables schools in Utah to identify groups at risk for concussion, as well as activities most commonly associated with these injuries, within the school environment. Using this information, schools may implement targeted prevention strategies to protect students. |
Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking among parents of children aged 5-10years
Haarbauer-Krupa JK , Register-Mihalik JK , Nedimyer AK , Chandran A , Kay MC , Gildner P , Kerr ZY . J Safety Res 2021 78 203-209 BACKGROUND: Understanding parents' concussion-related knowledge and attitudes will contribute to the development of strategies that aim to improve concussion prevention and sport safety for elementary school children. This study investigated the association between parent- and child-related factors and concussion symptom knowledge and care-seeking attitudes among parents of elementary school children (aged 5-10 years). METHODS: Four hundred parents of elementary school children completed an online questionnaire capturing parental and child characteristics; concussion symptom knowledge (25 items, range = 0-50; higher = better knowledge); and concussion care-seeking attitudes (five 7-point scale items, range = 5-35; higher = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher score levels. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) excluding 1.00 were deemed statistically significant. RESULTS: Select parent and child characteristics were associated with higher score levels for both outcomes. For example, odds of better knowledge level in parents were higher with increased age (10-year increase aOR = 1.59; 95% CI = 1.10-2.28), among females (aOR = 3.90; 95% CI = 2.27-6.70), and among white/non-Hispanics (aOR = 1.79; 95%CI = 1.07-2.99). Odds of more positive concussion care-seeking attitude levels were higher among parents with a college degree (aOR = 1.98; 95%CI = 1.09-3.60). Child sports participation was not associated with higher score levels for either outcome. CONCLUSIONS: Certain elementary school parent characteristics were associated with parents' concussion symptom knowledge and care-seeking attitudes. While the findings suggest providing parents with culturally and demographically relevant concussion education might be helpful, they also emphasize the importance of ensuring education/prevention regardless of their children's sports participation. Practical Applications: Pediatric healthcare providers and elementary schools offer an optimal community-centered location to reach parents with this information within various communities. |
The association between school district-based policies related to concussions and concussions among high school students
Miller GF , Sarmiento K , Haarbauer-Krupa J , Everett Jones S . J Sch Health 2021 92 (2) 140-147 BACKGROUND: Little is known about the effectiveness of school district concussion policies on reducing the concussion prevalence among students. METHODS: Data from the 2016 School Health Policies and Practices Study and 2017 Youth Risk Behavior Survey for 10 school districts were linked. The outcome variable was having a sports- or physical activity-related concussion during the 12 months before of the survey. Exposure variables were 2 district policies, including district-funded professional development and prioritizing return to the classroom before returning to athletics. Logistic regression models estimated the odds of a concussion among students in districts with one, both, or neither policy (referent). RESULTS: In districts with district-funded professional development, the odds of students self-reporting ≥2 sports- or physical activity-related concussions were 1.4 times higher than in districts with neither policy. In districts with a policy prioritizing a return to the classroom before returning to athletics, the odds of students self-reporting ≥2 concussions were significantly lower (OR = 0.6) than in districts with neither policy. CONCLUSION: School district concussion policies may have positive effects by identifying and reducing multiple concussions among students. |
Effect of parental education and household poverty on recovery after traumatic brain injury in school-aged children
Zonfrillo MR , Haarbauer-Krupa J , Wang J , Durbin D , Jaffe KM , Temkin N , Bell M , Tulsky DS , Bertisch H , Yeates KO , Rivara FP . Brain Inj 2021 35 (11) 1-11 OBJECTIVE: While prior studies have found parental socioeconomic status (SES) affects the outcomes of pediatric traumatic brain injury (TBI), the longitudinal trajectory of this effect is not well understood. METHODS: This prospective cohort study included children 8-18 years of age admitted to six sites with a complicated mild (n = 123) or moderate-severe TBI (n = 47). We used caregiver education and household poverty level as predictors, and multiple quality of life and health behavior domains as outcomes. Differences at 6, 12, and 24 months from baseline ratings of pre-injury functioning were compared by SES. We examined the association between measures of SES and domains of functioning over the 24 months post-injury in children with a complicated mild or moderate- severe TBI, and determined how this association varied over time. RESULTS: Parental education was associated with recovery among children with complicated mild TBI; outcomes at 6, 12, and 24 months were substantially poorer than at baseline for children with the least educated parents. After moderate-severe TBI, children in households with lower incomes had poorer outcomes compared to baseline across time. IMPLICATIONS: Parental education and household income were associated with recovery trajectories for children with TBI of varying severity. |
Epidemiology of Chronic Effects of Traumatic Brain Injury.
Haarbauer-Krupa J , Pugh MJ , Prager EM , Harmon N , Wolfe J , Yaffe KC . J Neurotrauma 2021 38 (23) 3235-3247 Although many patients diagnosed with traumatic brain injury (TBI), particularly mild TBI, recover from their symptoms within a few weeks, a small but meaningful subset experience symptoms that persist for months or years after injury and significantly impact quality of life for the individual and their family. The factors associated with an increased likelihood of negative TBI outcomes include not only characteristics of the injury and injury mechanism, but also the individual's age, pre-injury status, comorbid conditions, environment, and propensity for resilience. In this article, as part of the Brain Trauma Blueprint: TBI State of the Science framework, we examine the epidemiology of long-term outcomes of TBI, including incidence, prevalence, and risk factors. We identify the need for increased longitudinal, global, standardized, and validated assessments on incidence, recovery, and treatments, as well as standardized assessments of the influence of genetics, race, ethnicity, gender, and environment on TBI outcomes. By identifying how epidemiological factors contribute to TBI outcomes in different groups of people and potentially impact differential disease progression, we can guide investigators and clinicians towards more precise patient diagnosis along with tailored management and improve clinical trial designs, data evaluation and patient selection criteria. |
Healthcare Providers' Self-Reported Pediatric Mild Traumatic Brain Injury Diagnosis, Prognosis, and Management Practices: Findings From the 2019 DocStyles Survey
Sarmiento K , Daugherty J , Haarbauer-Krupa J . J Head Trauma Rehabil 2021 36 (4) 282-292 OBJECTIVE: To assess adherence to 5 key recommendations in the Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury, this article presents results from the 2019 DocStyles survey. STUDY DESIGN: Cross-sectional, web-based survey of 653 healthcare providers. RESULTS: Most healthcare providers reported adhering to the recommendations regarding the use of computed tomography and providing education and reassurance to patients and their families. However, less than half reported routinely examining their patients with mild traumatic brain injury (mTBI) using age-appropriate, validated symptom scales, assessing for risk factors for prolonged recovery, and advising patients to return to noncontact, light aerobic activities within 2 to 3 days. Self-reported mTBI diagnosis, prognosis, and management practices varied by specialty. Only 3.8% of healthcare providers answered all 7 questions in a way that is most consistent with the 5 recommendations examined from the Centers for Disease Control and Prevention Pediatric mTBI Guideline. CONCLUSION: This study highlights several important information gaps regarding pediatric mTBI diagnosis and management. Further efforts to improve adoption of guideline recommendations may be beneficial to ensure optimal outcomes for children following an mTBI. |
Sports- and physical activity-related concussion and risk for youth violence
Lowry R , Haarbauer-Krupa J , Breiding MJ , Simon TR . Am J Prev Med 2021 60 (3) 352-359 INTRODUCTION: Sports and physical activities are an important cause of traumatic brain injury among adolescents. Childhood traumatic brain injury has been associated with cognitive impairment, emotional problems, and impaired behavior control, and these neuropsychological changes may place these youth at increased risk for engagement in violence-related behaviors. METHODS: Data from the 2017 National Youth Risk Behavior Survey (N=14,765), a nationally representative survey of U.S. high school students, were analyzed in 2019 to examine the associations between sports- and physical activity-related concussion and violence-related behaviors occurring in the community and at school. Multivariable logistic regression models were used to calculate sex-stratified, adjusted (for race/ethnicity, grade, athlete status, impaired cognitive functioning, feeling sad/hopeless, and current substance use) prevalence ratios. Prevalence ratios were considered statistically significant if p<0.05. RESULTS: Male students (17.1%) were more likely than female students (13.0%) to experience a sports- and physical activity-related concussion during the 12 months preceding the survey. Compared with students who did not have a concussion, those who experienced ≥1 sports- and physical activity-related concussion were more likely to be in a physical fight (male students, adjusted prevalence ratio=1.45; female students, adjusted prevalence ratio=1.55), carry a weapon (male students, adjusted prevalence ratio=1.24; female students, adjusted prevalence ratio=1.79), and fight at school (male students, adjusted prevalence ratio=1.40; female students, adjusted prevalence ratio=1.77). In addition, male students were more likely to carry a gun (adjusted prevalence ratio=1.62) and carry a weapon at school (adjusted prevalence ratio=1.73). CONCLUSIONS: Although the direction of these associations is unknown, return-to-school programs may benefit from inclusion of assessment and counseling around issues of psychological and social functioning, conflict resolution, and coordination with violence prevention programs. |
Comparing prevalence estimates of concussion/head injury in U.S. children and adolescents in national surveys
Haarbauer-Krupa J , Lebrun-Harris LA , Black LI , Veliz P , Daugherty J , Desrocher R , Schulenberg J , Pilkey D , Breiding M . Ann Epidemiol 2020 54 11-20 BACKGROUND AND OBJECTIVES: Reports on pediatric lifetime concussions/head injuries (LCHI) from national surveys have offered estimates on prevalence that range from 2.5% to 18% in the general population. The purpose of this study is to examine national surveys to compare methodologies and limitations pertaining to LCHI data collection. METHODS: Three nationally representative surveys that measure LCHI in children, including the National Survey of Children's Health (NSCH), the National Health Interview Survey (NHIS), and the Monitoring the Future (MTF) Survey were examined. Children were grouped by ages 3-17 years and adolescents ages 13-17 years, stratified by selected demographic characteristics. Participants in the surveys included parents (NSCH, NHIS) and adolescents (MTF Survey). The primary outcome measure is an estimate of LCHI in children. RESULTS: Estimates of prevalence of LCHI ranged from 3.6% to 7.0% for children ages 3-17 years and from 6.5% to 18.3% for adolescents 13-17 years. Survey modality, question wording, and respondent may contribute to differing estimates. Prevalence showed consistent variation by age, sex, and race/ethnicity across surveys. Associations were inconsistent between LCHI and insurance status, parental education, and household primary language. CONCLUSIONS: Although there are methodological differences in capturing pediatric LCHI across surveys, the prevalence estimates and correlational associations generated can offer awareness about the burden of these injuries and insights to research and clinical care. |
Factors associated with concussion symptom knowledge and attitudes towards concussion care-seeking in a national survey of parents of middle school children in the U.S
Kerr ZY , Nedimyer AK , Kay MC , Chandran A , Gildner P , Byrd KH , Haarbauer-Krupa JK , Register-Mihalik JK . J Sport Health Sci 2020 10 (2) 113-121 OBJECTIVE: Developing appropriate concussion prevention and management paradigms in middle school (MS) settings requires understanding parents' general levels of concussion-related knowledge and attitudes. This study examined factors associated with concussion symptom knowledge and care-seeking attitudes among parents of MS children (aged ∼10-15 years). METHODS: A panel of 1224 randomly selected US residents, aged ≥18 years and identifying as parents of MS children, completed an online questionnaire capturing parental and child characteristics. The parents' concussion symptom knowledge was measured using 25 questions, with possible answers being "yes", "maybe", and "no". Correct answers earned 2 points, "maybe" answers earned 1 point, and incorrect answers earned 0 points (range = 0-50; higher scores = better knowledge). Concussion care-seeking attitudes were also collected using five 7-point scale items (range = 5-35; higher scores = more positive attitudes). Multivariable ordinal logistic regression models identified predictors of higher scores. Models met proportional odds assumptions. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) (excluding 1.00) were deemed statistically significant. RESULTS: Median scores were 39 (interquartile range (IQR) = 32-44) for symptom knowledge and 32 (IQR = 28-35) for care-seeking attitude. In multivariable models, odds of better symptom knowledge were higher in women vs. men (aOR = 2.28; 95%CI: 1.71-3.05), white/non-Hispanics vs. other racial or ethnic groups (aOR = 1.88; 95%CI: 1.42-2.49), higher parental age (10-year-increase aOR = 1.47; 95%CI: 1.26-1.71) and greater competitiveness (10%-scale-increase aOR = 1.24; 95%CI: 1.13-1.36). Odds of more positive care-seeking attitudes were higher in white/non-Hispanics versus other racial or ethnic groups (aOR = 1.45; 95%CI: 1.06-1.99), and higher parental age (10-year-increase aOR = 1.24; 95%CI: 1.05-1.47). CONCLUSION: Characteristics of middle school children's parents (e.g., sex, race or ethnicity, age) are associated with their concussion symptom knowledge and care-seeking attitudes. Parents' variations in concussion knowledge and attitudes warrant tailored concussion education and prevention. |
State-level numbers and rates of traumatic brain injury-related emergency department visits, hospitalizations, and deaths by age, 2014
Sarmiento K , Thomas K , Daugherty J , Haarbauer-Krupa J , Waltzman D . J Head Trauma Rehabil 2020 35 (6) E469-E480 OBJECTIVE: To provide state-level traumatic brain injury (TBI)-related emergency department (ED) visit, hospitalization, and death estimates by age group for 2014. SETTING AND PARTICIPANTS: Centers for Disease Control and Prevention's Core Violence and Injury Prevention Program and State Injury Indicators-participating states. DESIGN: Cross-sectional. MAIN MEASURES: Number and population-based incidence rates of TBI-related ED visits, hospitalizations, and deaths by age group-children and young adults (0-24 years), adults (25-64 years), and older adults (≥65 years)-in 36 states. RESULTS: South Dakota had the lowest rates of TBI-related ED visits for all age groups-children and young adults: 566.2 (95% CI: 539.2-593.3) per 100 000; adults: 269.2 (95% CI: 253.0-285.4) per 100 000; and older adults: 324.3 (95% CI: 293.4-355.2) per 100 000. Rhode Island had the lowest rate of TBI-related hospitalizations for children and young adults-25.9 (95% CI: 20.7-32.0) per 100 000. The lowest rate of TBI-related hospitalizations among adults and older adults was in Virginia-39.6 (95% CI: 37.7-41.4) per 100 000-and Ohio-129.3 (95% CI: 124.0-134.6) per 100 000-respectively. Maryland had the lowest rate of TBI-related deaths for children and young adults-3.1 (95% CI: 2.3-3.9) per 100 000. Rhode Island had the lowest rate of TBI-related deaths for adults-7.2 (95% CI: 5.2-9.8) per 100 000-and New Jersey had the lowest rate of TBI-related deaths for older adults-29.4 (95% CI: 26.5-32.4) per 100 000. CONCLUSION: This analysis demonstrated that there are variations in TBI-related ED visits, hospitalizations, and deaths by age. State public health professionals may use these findings to develop state-based strategies to address TBI. |
State-level numbers and rates of traumatic brain injury-related emergency department visits, hospitalizations, and deaths by sex, 2014
Waltzman D , Haarbauer-Krupa J , Daugherty J , Thomas K , Sarmiento K . J Head Trauma Rehabil 2020 35 (6) E481-E489 OBJECTIVE: To provide state-level traumatic brain injury (TBI)-related emergency department (ED) visit, hospitalization, and death estimates by sex for 2014. SETTING AND PARTICIPANTS: Centers for Disease Control and Prevention's Core Violence and Injury Prevention Program and State Injury Indicators-participating states. DESIGN: Cross-sectional. MAIN MEASURES: Number and rate of TBI-related ED visits, hospitalizations, and deaths (indicators) by sex in over 25 states. RESULTS: Across all states that supplied data, males had higher rates of TBI-related ED visits, hospitalizations, and deaths than females. However, for some indicators, high rates for both sexes and low rates for both sexes appeared clustered in a specific region of the United States. There was also within-state variability in TBI rates by indicator and sex. For example, within-state variability between sexes ranged from as low as 2.8% for ED visits and as high as 335% for deaths. CONCLUSION: TBI-related ED visits, hospitalizations, and deaths varied by state and by sex, and evidence was found for within-state variability in TBI rates by indicator and sex in 2014. Differences in TBI indicators by sex may have important implications for public health professionals implementing TBI prevention and care strategies at the state level. |
Informing data-driven strategies to prevent traumatic brain injury at the state and local level
Daugherty J , Thomas K , Waltzman D , Sarmiento K , Haarbauer-Krupa J . J Head Trauma Rehabil 2020 35 (6) E458-E460 CAUSED BY a blunt external force to the head or body or a penetrating head injury, traumatic brain injuries (TBIs) are classified by healthcare providers as mild, moderate, or severe.1 Depending on the severity of the injury, individuals who sustain a TBI may experience a wide range of functional short- or long-term changes affecting thinking (eg, memory and reasoning), sensation (ie, sight and balance), language (eg, communication and understanding), and/or emotion (eg, depression, personality changes, social inappropriateness).2 Recently, the Centers for Disease Control and Prevention (CDC) released a report on the number and rate of TBI-related emergency department (ED) visits, hospitalizations, and deaths in the United States.3 This report found that there were approximately 2.53 million TBI-related ED visits, 288 000 hospitalizations, and 56 800 deaths in 2014.3 The number of TBI-related ED visits, hospitalizations, and deaths increased by 53% from 2006 (n = 1.88 million) to 2014 (n = 2.88 million), almost entirely due to an increase in TBI-related ED visits.3 Still, this is thought be an underestimate of the true public health burden of this injury.4 |
Characteristics of diagnosed concussions in children aged 0 to 4 years presenting to a large pediatric healthcare network
Podolak OE , Chaudhary S , Haarbauer-Krupa J , Metzger KB , Curry AE , Kessler RS , Pfeiffer MR , Breiding MJ , Master CL , Arbogast KB . Pediatr Emerg Care 2020 37 (12) e1652-e1657 OBJECTIVE: The aim of the study was to comprehensively describe the natural history of concussion in early childhood between 0 and 4 years. METHODS: Retrospective cohort study of 329 patients aged 0 to 4 years, with an International Classification of Diseases, Ninth Revision, concussion diagnosis in the Children's Hospital of Philadelphia healthcare network from October 1, 2013, to September 30, 2015. Clinical data were abstracted from the Children's Hospital of Philadelphia electronic health record, which captured all clinical care visits and injury characteristics. RESULTS: Nearly 9 (86.6%) of 10 patients sought care in the emergency department or urgent care setting, most commonly on the day of injury (56.2%) and as a result of a fall (64.4%). More than two-thirds (64.4%) of patients or their parent/caregiver reported somatic symptoms (ie, vomiting or headache), whereas close to half (49.2%) reported sleep issues. One of 5 patients identified emotional symptoms (21.9%) or visio-vestibular dysfunction (20.4%). Many patients also experienced symptoms not included in standard assessment tools including personality changes (34.0%) and change in appetite (12.8%). CONCLUSIONS: These results provide insight into the clinical characteristics of concussion in early childhood up to 4 years of age. Because assessment in this group relies heavily on parent/caregiver symptom reporting, rather than patient self-report, these results will aid clinicians with the challenge of diagnosing concussions in this population. These findings highlight the need to develop additional tools to adequately and systematically assess common signs and symptoms of concussion in early childhood that may not be included in standard assessment scales routinely used in older adolescents and adults. |
Characteristics of concussion in elementary school-aged children: Implications for clinical management
Master CL , Curry AE , Pfeiffer MR , Metzger KB , Kessler RS , Haarbauer-Krupa J , DePadilla L , Greenspan A , Breiding MJ , Arbogast KB . J Pediatr 2020 223 128-135 OBJECTIVE: To comprehensively characterize the clinical presentation and course of care for concussion among 5- to 11-year-old children, identifying preinjury and injury factors potentially influencing clinical outcomes. STUDY DESIGN: A single-institution retrospective cohort study using electronic health record data from children ages 5- to 11 years with a concussion from July 1, 2014, through June 30, 2015. Electronic health record data were abstracted for a 20% random sample of 292 patients. RESULTS: Three-fourths of patients (74.3%) presenting for concussion care had a standardized visiovestibular assessment performed. Almost all of those who eventually sought specialty care (92.9%) also had such an assessment, and only 42.9% patients initially seen in the emergency department or urgent care were examined in this manner. Of those assessed, 62.7% (n = 136) demonstrated deficits, with children ages 9-11 years more frequently exhibiting deficits than their younger counterparts (67.9% vs 53.2%; P = .03). Almost all patients (95.9%) reported at least 1 somatic symptom (eg, headache, dizziness), and one-half to two-thirds reported problems with sleep (54.1%) and visiovestibular symptoms (66.1%). Only 11.6% of children were referred for rehabilitation therapies and less than one-half of concussed patients (43.8%) were provided with a letter recommending school accommodations. CONCLUSIONS: Somatic symptoms, sleep problems, and visiovestibular deficits are common in elementary school-aged children with concussion, but specific visiovestibular clinical assessments are often not performed, particularly in the emergency department setting. Recommendations for school accommodations are often not provided at the time of concussion diagnosis. Incorporating a standardized visiovestibular assessment into practice could facilitate early targeted school accommodations and thereby improve return to learning for elementary school-aged children with concussion. |
Mortality secondary to unintentional poisoning after inpatient rehabilitation among individuals with moderate to severe traumatic brain injury
Hammond F , Ketchum J , Dams-O'Connor K , Corrigan JD , Miller AC , Haarbauer-Krupa J , Faul M , Trexler LE , Harrison-Felix CL . J Neurotrauma 2020 37 (23) 2507-2516 Studies have shown reduced life expectancy following moderate-severe traumatic brain injury (TBI) with death due to unintentional poisoning (UP) 11x higher following TBI than in the general population. The characteristics of those who die of unintentional poisoning are compared to those who die of other causes (OC) in a retrospective cohort who received inpatient rehabilitation following traumatic brain injury (TBI) and enrolled in the TBI Model Systems National Database between 1989 and 2017 (n = 15,835 cases with 2,238 deaths recorded). Seventy-eight cases (3.5%) of deaths were due to UP, 76% were due to OC, and 20.5% died of unknown cause. Among the UP deaths, 90% involved drugs (of these 67% involved narcotic drugs and 14% psychostimulants) and 8% involved alcohol. Age- adjusted risk for UP death was associated with: White/Non-Hispanic race/ethnicity, living alone, non-institutionalization, pre- and post-injury illicit drug use and alcohol/drug problem use, any alcohol use at last follow up, better Functional Independence Measure TM (FIM) scores, history of arrest, moderate disability (vs severe disability or good recovery), less supervision needed, and greater anxiety. Adults who receive inpatient rehabilitation for TBI who die due to UP are distinguishable from those who die of OC. Factors such as pre-injury substance use in the context of functional independence may be regarded as targets for prevention and/or intervention to reduce substance use and substance-related mortality among survivors of moderate-severe TBI. The current findings may have implications for medical care, surveillance, prevention, and health promotion. |
Use of sport-related concussion information sources among parents of United States middle school children
Kerr ZY , Chandran A , Nedimyer AK , Rothschild AE , Kay MC , Gildner P , Byrd KH , Haarbauer-Krupa JK , Register-Mihalik JK . J Sport Health Sci 2020 11 (6) 716-724 OBJECTIVE: Parents may use various information sources to obtain information about sport-related concussions (SRC). This study examined SRC-related information sources used by parents of United States middle school (MS) children (aged approximately 10-15 years). METHODS: A panel of 1083 randomly selected U.S. residents, aged >/=18 years and identifying as parents of MS children, completed an online questionnaire capturing parental and child characteristics, and utilization and perceived trustworthiness of various sources of SRC-related information. Multivariable logistic regression models identified factors associated with utilizing each source. Adjusted odds ratios (OR) with 95% confidence intervals (CIs) excluding 1.00 were deemed significant. RESULTS: Doctors/healthcare providers (49.9%) and other healthcare-related resources (e.g., Centers for Disease Control and Prevention, WebMD) (37.8%) were common SRC-related information sources; 64.0% of parents utilized at least one of these sources. Both sources were considered "very" or "extremely" trustworthy for SRC-related information among parents using these sources (doctors/healthcare providers: 89.8%; other healthcare-related resources: 70.9%). A 10-year increase in parental age was associated with higher odds of utilizing doctors/healthcare providers (adjusted odd ratio (ORadjusted)=1.09, 95%CI: 1.02-1.16) and other healthcare-related resources (ORadjusted=1.11, 95%CI: 1.03-1.19). The odds of utilizing doctors/healthcare providers (ORadjusted=0.58, 95%CI: 0.40-0.84) and other healthcare-related resources (ORadjusted=0.64, 95%CI: 0.44-0.93) were lower among parents whose MS children had concussion histories versus the parents of children who did not have concussion histories. CONCLUSIONS: One-third of parents did not report using doctors/healthcare providers or other healthcare-related resources for SRC-related information. Factors associated with under-utilization of these sources may be targets for future intervention. Continuing education for healthcare providers and educational opportunities for parents should highlight accurate and up-to-date SRC-related information. |
Concussion and academic impairment among U.S. high school students
Lowry R , Haarbauer-Krupa JK , Breiding MJ , Thigpen S , Rasberry CN , Lee SM . Am J Prev Med 2019 57 (6) 733-740 Introduction: Sports and physical activities are a frequent cause of traumatic brain injury, primarily concussions, among adolescents. These concussions may adversely affect students’ ability to learn and impair academic achievement in educational settings. Methods: The 2017 Youth Risk Behavior Survey, conducted among a nationally representative sample of 14,765 U.S. high school students, was analyzed in 2018 to examine associations between self-reported sports- and physical activity-related concussions and symptoms of cognitive impairment (difficulty concentrating, remembering, or making decisions) and self-reported academic grades (mostly A's=4.0, mostly B's=3.0, mostly C's=2.0, mostly D's=1.0, mostly F's=0.0). Adjusted prevalence ratio and the difference in self-reported estimated grade point average were adjusted for sex, race/ethnicity, grade, and athlete status (participation on sports teams) and considered statistically significant if p<0.05. Results: Male students were more likely than female students (17.1% vs 13.0%), and athletes were more likely than nonathletes (21.4% vs 7.6%) to have a self-reported sports- and physical activity-related concussion in the 12 months preceding the survey. Students with a reported sports- and physical activity-related concussion were more likely than students without one to report symptoms of cognitive impairment regardless of whether they were male (adjusted prevalence ratio=1.49), female (adjusted prevalence ratio=1.37), athletes (adjusted prevalence ratio=1.45), or nonathletes (adjusted prevalence ratio=1.42). Self-reported grade point averagedecreased significantly from 3.14 among students who reported no concussions (referent), to 3.04 among students who reported a single concussion, and 2.81 among students who reported >/= 2 concussions. Conclusions: School-based programs are needed to monitor students’ academic performance and provide educational support and resources to promote academic success following a concussion. |
What schools need to know about the Centers for Disease Control and Prevention's Guideline on Diagnosis/Management of Mild Traumatic Brain Injury in Children - a commentary
McAvoy K , Haarbauer-Krupa J . J Sch Health 2019 89 (12) 941-944 Traumatic brain injury (TBI) in children is a growing public health concern. In 2013, there were an estimated 641,935 TBI-related emergency department (ED) visits, 17,930 TBI-related hospitalizations, and 1,484 TBI-related deaths among children aged 0 to 14 years (Taylor et al., 2017). A recent research study on parent-reported TBI estimates that 1.8 million children in the United States have experienced TBI in their lifetime (Haarbauer-Krupa et al, 2018). Additionally, it is estimated that for children who seek care in an ED for a TBI, 70-90% of these are classified as mild (Cassidy et al., 2004; Faul et al., 2010). Recent research examining the point of entry for care in a large children’s healthcare network reported that children with mild TBI (mTBI) are more likely to be seen in their pediatrician’s office and not included in ED visit counts, broadening the diversity of locations where children receive medical care after TBI (Arbogast et al, 2016). In addition, some children may not be seen for a medical assessment at the time of injury. Children with mTBI are more likely to recover faster than children with more severe injuries (CDC, 2018). Current research suggests that 70% of children with mTBI will recover within 28 days post-injury (Zemek et al., 2016). | |
Strengthening the evidence base: Recommendations for future research identified through the development of CDC's Pediatric Mild TBI Guideline
Suskauer SJ , Yeates KO , Sarmiento K , Benzel EC , Breiding MJ , Broomand C , Haarbauer-Krupa J , Turner M , Weissman B , Lumba-Brown A . J Head Trauma Rehabil 2019 34 (4) 215-223 OBJECTIVE: The recently published Centers for Disease Control and Prevention evidence-based guideline on pediatric mild traumatic brain injury (mTBI) was developed following an extensive review of the scientific literature. Through this review, experts identified limitations in existing pediatric mTBI research related to study setting and generalizability, mechanism of injury and age of cohorts studied, choice of control groups, confounding, measurement issues, reporting of results, and specific study design considerations. This report summarizes those limitations and provides a framework for optimizing the future quality of research conduct and reporting. RESULTS: Specific recommendations are provided related to diagnostic accuracy, population screening, prognostic accuracy, and therapeutic interventions. CONCLUSION: Incorporation of the recommended approaches will increase the yield of eligible research for inclusion in future systematic reviews and guidelines for pediatric mTBI. |
Fall-related traumatic brain injury in children ages 04 years
Haarbauer-Krupa J , Haileyesus T , Gilchrist J , Mack KA , Law CS , Joseph A . J Safety Res 2019 70 127-133 Introduction: Falls are the leading cause of traumatic brain injury (TBI) for children in the 0–4 year age group. There is limited literature pertaining to fall-related TBIs in children age 4 and under and the circumstances surrounding these TBIs. This study provides a national estimate and describes actions and products associated with fall-related TBI in this age group. Method: Data analyzed were from the 2001–2013 National Electronic Injury Surveillance System–All Injury Program (NEISS–AIP), a nationally representative sample of emergency departments (ED). Case narratives were coded for actions associated with the fall, and product codes were abstracted to determine fall location and product type. All estimates were weighted. Results: An estimated 139,001 children younger than 5 years were treated annually in EDs for nonfatal, unintentional fall-related TBI injuries (total = 1,807,019 during 2001–2013). Overall, child actions (e.g., running) accounted for the greatest proportion of injuries and actions by others (e.g., carrying) was highest for children younger than 1 year. The majority of falls occurred in the home, and involved surfaces, fixtures, furniture, and baby products. Conclusions: Fall-related TBI in young children represents a significant public health burden. The majority of children seen for TBI assessment in EDs were released to home. Prevention efforts that target parent supervision practices and the home environment are indicated. Practical applications: Professionals in contact with parents of young children can remind them to establish a safe home and be attentive to the environment when carrying young children to prevent falls. |
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