<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_353"
                     title="Helmets Linked to Reduced Head Injury Risk in Alpine Sports (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/18227?impressionId=1265819211038"
                     
      Skiers and snowboarders have a significantly lower risk of head injury if they wear helmets, a meta-analysis showed.&lt;br&gt;
&lt;br&gt;In a pooled analysis of nine studies, helmet wearers were 35% less likely to suffer a head injury than those without helmets (OR 0.65, 95% CI 0.55 to 0.79), Brent Hagel, PhD, of the University of Calgary in Alberta, and colleagues reported online in the &lt;em&gt;Canadian Medical Association Journal&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The association was significant for skiers and snowboarders alike.&lt;br&gt;
&lt;br&gt;Although there has been some concern that use of a helmet could increase the risk of neck injury because of the extra weight it adds to the head, especially with children, the studies did not confirm any danger.&lt;/p&gt;
&lt;p&gt;&quot;Based on our findings, we encourage the use of helmets among skiers and snowboarders,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;Various reports have estimated that 9% to 19% of injuries that occur on the slopes are head injuries and 1% to 4% are neck injuries.&lt;/p&gt;
&lt;p&gt;Traumatic brain injury is the leading cause of death and serious injury among skiers and snowboarders.&lt;/p&gt;
&lt;p&gt;A recent example was the training accident of U.S. Olympic hopeful snowboarder Kevin Pearce, who suffered a severe traumatic brain injury when he fell and hit his head on the edge of a half pipe on New Year&apos;s Eve. He was wearing a helmet.&lt;/p&gt;
&lt;p&gt;Although injury prevention efforts in alpine activities have focused on helmets, there were no systematic reviews of their effectiveness, the new study&apos;s authors noted.&lt;/p&gt;
&lt;p&gt;So Hagel and colleagues assembled data from 10 case-control studies, one case-control/case-crossover study, and one cohort study, totalling 9,829 participants who were wearing helmets and 36,735 who weren&apos;t. The studies evaluated head injury, neck injury, or both.&lt;/p&gt;
&lt;p&gt;In addition to protecting adults from head injury, the researchers found, helmets also appeared to protect children younger than 13 (OR 0.39, 95% CI 0.23 to 0.65).&lt;/p&gt;
&lt;p&gt;While two of four studies looking at potentially severe head trauma  --  resulting in referral to an emergency physician or hospital for treatment or evacuation by ambulance  --  found a reduced risk in those wearing helmets, the other two found no effect.&lt;/p&gt;
&lt;p&gt;There was some evidence that risk of head injury was reduced for males wearing helmets, but not for females, although sex was not found to be a significant modifier of the relationship between helmet use and injury risk (&lt;em&gt;P&lt;/em&gt;=0.09).&lt;/p&gt;
&lt;p&gt;Helmet use was not associated with risk of neck injury, even among children, which &quot;is consistent with biomechanical data showing no increase in neck loads associated with helmet use in simulated snowboarding falls,&quot; the researchers noted in the journal.&lt;/p&gt;
&lt;p&gt;The meta-analysis had some limitations, they wrote, including the moderate methodologic quality of the included studies, two different approaches for determining control groups (noninjured skiers and snowboarders versus those with injuries not involving the head or neck), the inclusion of English-language studies only, and variations in confounders, definitions of head injury, and places of and personnel involved in diagnosis.&lt;/p&gt;
&lt;p&gt;In addition, the researchers were unable to examine the results in terms of the design, quality, or fit of the helmets for cases.&lt;/p&gt;
&lt;p&gt;&quot;Methodologically rigorous research is required to determine which types of helmets provide the best protection,&quot; they wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding was received for the study.&lt;/p&gt;&lt;p&gt;Hagel holds the Alberta Children&apos;s Hospital Foundation Professorship in Child Health and Wellness, funded through the support of an anonymous donor and the Canadian National Railway Company. He also holds a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research and a New Investigator Award from the Canadian Institutes of Health Research.&lt;/p&gt;&lt;p&gt;One of his co-authors holds a doctoral studentship from the Alberta Heritage Foundation for Medical Research.&lt;/p&gt;&lt;p&gt;The authors reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_372"
                     title="Low Serotonin Eyed as Mechanism for SIDS (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Neurology/GeneralNeurology/tb/18262?impressionId=1265819211038"
                     
      Low brainstem levels of serotonin and the enzyme that makes it could underlie sudden infant death syndrome (SIDS), researchers suggested.&lt;br&gt;
&lt;br&gt;In an autopsy study, SIDS cases showed 26% lower serotonin levels in two major components of the medulla&apos;s serotonin system  --  the raph&amp;#233; obscurus (&lt;em&gt;P&lt;/em&gt;=0.05) and paragigantocellularis lateralis (&lt;em&gt;P&lt;/em&gt;=0.04)  --  compared with age-adjusted controls who died from known causes.&lt;br&gt;
&lt;br&gt;These brainstem circuits control breathing, blood pressure, and heart rate during sleep, Hannah C. Kinney, MD, of Children&apos;s Hospital Boston, and colleagues reported in the Feb. 3 issue of the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;A baby with an abnormality in control of these systems might not be able to respond to a life-threatening challenge like asphyxia by rousing from sleep or turning its head the researchers explained.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;SIDS occurs in the &quot;critical first year of life, when homeostatic systems are still maturing,&quot; they noted.&lt;/p&gt;
&lt;p&gt;Mary McClain, RN, MS, of Boston University Medical Center, who counsels families that have lost a baby to SIDS, commented that these findings help establish the biological basis for urging parents to place their babies on their backs to sleep.&lt;/p&gt;
&lt;p&gt;The researchers obtained tissue samples from autopsies of 41 children who died from SIDS, seven who died acutely from known causes (including a car accident, drowning, pneumonia, and unsuspected congenital heart disease), and five who died in the hospital with chronic conditions causing hypoxia-ischemia.&lt;/p&gt;
&lt;p&gt;SIDS cases had mean serotonin levels of 31.4 pmol/mg of protein in the paragigantocellularis lateralis, compared with 40.0 pmol/mg among the controls who died acutely (&lt;em&gt;P&lt;/em&gt;=0.04).&lt;/p&gt;
&lt;p&gt;Levels averaged 55.4 versus 75.5 pmol/mg of protein, respectively, in the raph&amp;#233; obscurus (&lt;em&gt;P&lt;/em&gt;=0.05).&lt;/p&gt;
&lt;p&gt;These abnormalities in the medulla did not appear to involve the catecholamine system. Catecholamine levels were similar between SIDS cases and controls.&lt;/p&gt;
&lt;p&gt;Nor was there evidence for excessive degradation of dopamine or neurotransmitter turnover in SIDS cases, supporting the idea that the key abnormality is reduced synthesis of serotonin, the researchers said.&lt;/p&gt;
&lt;p&gt;Another marker of serotonin function  --  tryptophan hydroxylase (TPH2), the key enzyme involved in synthesis of serotonin  --  also supported this conclusion, with 22% lower levels in the raph&amp;#233; obscurus in SIDS than in controls (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;Serotonin receptor binding was 29% to 55% lower in three medullary nuclei that receive serotonin projections, notable for a decrease in binding with older age in SIDS cases, but not controls, the researchers noted.&lt;/p&gt;
&lt;p&gt;Given similar findings in three previous investigations, this &quot;may reflect a progressive decrease with age in those infants with the &apos;SIDS abnormality,&apos;&quot; they wrote. Or it&apos;s possible that those with a &quot;stronger abnormality take longer to outgrow the risk period for SIDS and continue to die at older ages,&quot; Kinney&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;Likewise, serotonin receptor binding in infants who died from SIDS was significantly lower in those without known risk factors for SIDS, such as &lt;a href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/17365&quot; mce_href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/17365&quot; target=&quot;_blank&quot;&gt;sleeping face down&lt;/a&gt;, &quot;suggesting that additional risk factors are necessary to precipitate death when the medullary serotonin system is less compromised,&quot; they added.&lt;/p&gt;
&lt;p&gt;Although repetitive apnea and agonal &lt;a href=&quot;http://www.medpagetoday.com/Pulmonology/SleepDisorders/2817&quot; mce_href=&quot;http://www.medpagetoday.com/Pulmonology/SleepDisorders/2817&quot; target=&quot;_blank&quot;&gt;impaired gasping&lt;/a&gt; before death have been reported in some SIDS cases, chronic impaired oxygenation in the hospitalized children in the study produced a very different serotonin pattern than that seen in SIDS.&lt;/p&gt;
&lt;p&gt;Children who died with chronic hypoxia conditions had 55% higher serotonin levels in the raph&amp;#233; obscurus (&lt;em&gt;P&lt;/em&gt;=0.02) and 126% higher levels in the paragigantocellularis lateralis (&lt;em&gt;P&lt;/em&gt;=0.002) than the SIDS cases.&lt;/p&gt;
&lt;p&gt;They also had 640% higher dopamine levels in the raph&amp;#233; obscurus than the SIDS cases (&lt;em&gt;P&lt;/em&gt;=0.006).&lt;/p&gt;
&lt;p&gt;This suggested &quot;that the primary mechanisms underlying serotonin abnormalities in SIDS are not mediated by chronic hypoxia-ischemia,&quot; Kinney&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that their neurotransmitter measurements may have been off somewhat due to prolonged postmortem intervals.&lt;/p&gt;
&lt;p&gt;They also warned that the study was limited by inability to perform these measurements at the synapse in postmortem tissues and by the small sample of controls.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the First Candle/SIDS Alliance, CJ Martin Overseas Fellowship (National Health and Medical Research Council of Australia), CJ Murphy Foundation for Solving the Puzzle of SIDS, CJ Foundation for SIDS, National Institute of Child Health and Development, and the Developmental Disabilities Research Center at Children&apos;s Hospital Boston.&lt;/p&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;p&gt;McClain provided no information on conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_358"
                     title="Poststroke Antidepressant Boosts Mental Agility (CME/CE)"
                     score="0.007"
                     href="http://www.medpagetoday.com/Cardiology/Strokes/tb/18240?impressionId=1265819211038"
                     
      &lt;p&gt;Antidepressants in the first months after a stroke may aid cognitive recovery for patients without depression, according to a randomized trial analysis.&lt;/p&gt;
&lt;p&gt;Global cognitive function scores improved significantly more with escitalopram (Lexapro) than with problem-solving therapy or placebo (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01), according to Ricardo E. Jorge, MD, of the University of Iowa in Iowa City, and colleagues.&lt;/p&gt;
&lt;p&gt;Memory scores rose significantly higher with the antidepressant as well (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01), with both effects independent of those on depression, they reported in the February &lt;em&gt;Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Adjunctive restorative therapies administered during the first few months after stroke, the period with the greatest degree of spontaneous recovery, reduce the number of stroke patients with significant disability,&quot; the researchers concluded.&lt;/p&gt;
&lt;p&gt;The &lt;a href=&quot;http://www.medpagetoday.com/Cardiology/Strokes/9621&quot; mce_href=&quot;http://www.medpagetoday.com/Cardiology/Strokes/9621&quot; target=&quot;_blank&quot;&gt;primary analysis&lt;/a&gt; of the trial, reported in the &lt;em&gt;Journal of the American Medical Association on&lt;/em&gt; May 28, 2008, showed that prophylactic escitalopram treatment would prevent poststroke depression in one patient for every 7.2 treated &lt;em&gt;(P&lt;/em&gt;&amp;lt;0.001 compared with placebo). That article ultimately raised a controversy over an undisclosed conflict of interest.&lt;/p&gt;
&lt;p&gt;Escitalopram is a selective serotonin reuptake inhibitor (SSRI). Since serotonin plays a role in neuroplastic changes in the developing brain as well as in depression, Jorge&apos;s group analyzed whether there might be such an effect after a stroke.&lt;/p&gt;
&lt;p&gt;The study randomized patients to double-blind treatment with escitalopram (10 mg/d under age 65 or 5 mg/day age 65 and older) or placebo or unblinded problem-solving therapy (12 sessions of going through steps to arrive at a course of action for a patient-selected problem).&lt;/p&gt;
&lt;p&gt;The intent-to-treat analysis included 129 patients treated starting within the first three months after their mild to moderate severity stroke and who did not meet criteria for major or minor depression.&lt;/p&gt;
&lt;p&gt;Overall, global cognitive functioning was significantly changed between groups as measured on the Repeatable Battery for the Assessment of Neuropsychological Status (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;After controlling for change in depression score and type of stroke, escitalopram was associated with the best cognitive recovery, an adjusted mean change of 9.9 points compared with 1.9 for problem-solving therapy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01) and 4.0 for placebo (&lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;Similarly, for delayed memory scores on the same test battery, escitalopram came out on top (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;After adjustment for depression score change and stroke mechanism, the antidepressant was associated with an 11.2 point improvement in delayed memory, compared with a change of -0.7 with problem-solving therapy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) and 3.9 with placebo (&lt;em&gt;P&lt;/em&gt;=0.02).&lt;/p&gt;
&lt;p&gt;On test of immediate memory, escitalopram again yielded the best recovery.&lt;/p&gt;
&lt;p&gt;The researchers found mean improvement of 13.4 points with the antidepressant compared with 2.0 with problem-solving therapy (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001) and 7.2 with placebo (&lt;em&gt;P&lt;/em&gt;=0.04), after adjustment for time between stroke and treatment, depression score change, and stroke type.&lt;/p&gt;
&lt;p&gt;These mental benefits appeared to have an impact on functional status as well.&lt;/p&gt;
&lt;p&gt;Cognitive domain scores on the Functional Independence Measure were better for escitalopram-treated patients than those who didn&apos;t get the drug (&lt;em&gt;P&lt;/em&gt;=0.05), as were memory domain scores on the same measure (&lt;em&gt;P&lt;/em&gt;=0.03).&lt;/p&gt;
&lt;p&gt;At baseline, the global cognitive functioning and delayed and immediate memory scores were nonsignificantly lower in the antidepressant group than in the other two groups, which could have biased the results.&lt;/p&gt;
&lt;p&gt;However, the treatment effects appeared to be real, Jorge explained in an interview.&lt;/p&gt;
&lt;p&gt;In an unpublished regression analysis, the baseline scores were not a significant covariate. &quot;If [the results were] related only to the difference in baseline, this would be significant but it wasn&apos;t,&quot; he told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Moreover, with an initially lower score it might have been expected that the escitalopram-treated group would have had a lower score at the end of the study than the other groups, added co-author Robert G. Robinson, MD, also of the University of Iowa.&lt;/p&gt;
&lt;p&gt;But that wasn&apos;t the case, he said in an interview. With regard to delayed memory, for example, &quot;the escitalopram-treated group went from the most impaired to the best performing.&quot;&lt;/p&gt;
&lt;p&gt;The researchers didn&apos;t compare end scores for the escitalopram, problem solving therapy, and placebo groups, but they were: &lt;ul&gt; &lt;li&gt;For global cognitive functioning 89.8, 89.1, and 91.0 points, respectively&lt;/li&gt; &lt;li&gt;For delayed memory, 96.6, 89.1, and 94.2, respectively&lt;/li&gt; &lt;li&gt;For immediate memory, 95.1, 94.9, and 98.5, respectively&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The treatment showed no effect on other individual cognitive measurements, including those for attention, language, and IQ. Nor were there significant differences in changes in occupational or living conditions.&lt;/p&gt;
&lt;p&gt;Although SSRIs such as escitalopram have been associated with hospitalization for GI bleeding and falls in prior studies, these complications did not occur in Jorge&apos;s study.&lt;/p&gt;
&lt;p&gt;&quot;Long-term administration of SSRIs appears to be an effective and safe treatment option to improve cognitive outcomes among patients with cerebrovascular disease,&quot; they concluded in the &lt;em&gt;Archives&lt;/em&gt; paper.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the study was limited by lack of CT or MRI scans and the younger age of escitalopram-treated patients, compared with other groups. That may have been a source of bias, although age did not appear to be a significant factor in the trial results.&lt;/p&gt;
&lt;p&gt;In this analysis, the researchers emphasized that the trial was not financially supported in any way by any drug company  --  a declaration hinting at the controversy that brewed last year over failure of one of the authors of the original &lt;em&gt;JAMA&lt;/em&gt; article to &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/13391&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/13391&quot; target=&quot;_blank&quot;&gt;properly disclose ties&lt;/a&gt; to Forest Pharmaceuticals, which makes escitalopram.&lt;/p&gt;
&lt;p&gt;Another scientist who discovered that omission published the information in a competing journal, inducing &lt;em&gt;JAMA&lt;/em&gt; to issue a gag rule on reporting of undisclosed conflicts of interest. That policy encourages those who discover such conflicts to report them to &lt;em&gt;JAMA&apos;s&lt;/em&gt; editors but prohibits them from disclosing the conflicts publicly pending an investigation by the journal.&lt;/p&gt;
&lt;p&gt;In the current analysis, the disclosure statement indicated that co-author Robertson, had received honoraria and speakers&apos; bureau fees from Forest, with the caveat that &quot;none of the design, analysis, or expenses (including the cost of medications) of this study were supported by monies, materials, or any intellectual input from Forest Laboratories.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported solely by a grant from the National Institute of Mental Health.&lt;/p&gt;&lt;p&gt;Jorge reported having received travel awards to participate in national meetings from the former Hamilton Pharmaceutical Company and Avanir Pharmaceutical Company.&lt;/p&gt;&lt;p&gt;Co-authors reported financial conflicts of interest with Merck, NMT Medical, Eli Lilly, Centocor, Sanofi-Bristol-Meyers-Squibb, Boerhringer-Ingelheim, Schering-Plough, AstraZeneca, and GlaxoSmithKline, the former Hamilton Pharmaceutical Company, Avanir Pharmaceutical Company, Lubeck, Forest Laboratories, and Pfizer.&lt;/p&gt;&lt;p&gt;No pharmaceutical company donated medications for or had any financial interest in the study.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_168"
                     title="Concussion Label Can be Confusing (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/18000?impressionId=1265819211038"
                     
      Whether a clinician calls a mild traumatic brain injury a concussion or not appears to influence how serious the injury is considered to be, researchers found.&lt;br&gt;
&lt;br&gt;Among children admitted for a traumatic brain injury, those who were told they had a concussion were discharged significantly earlier (OR 1.49, 95% CI 1.15 to 1.94) and returned to school sooner (OR 2.42, 95% CI 1.56 to 3.73) than those who were not given the label, Carol DeMatteo, MSc, of McMaster University in Hamilton, Ontario, and colleagues reported in the February issue of &lt;em&gt;Pediatrics&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;The trends remained significant even after adjusting for the severity of the head injury and the presence of other injuries.&lt;/p&gt;
&lt;p&gt;&quot;We suggest that the [concussion] label itself conveys a message and also directs outcomes,&quot; the researchers wrote. &quot;If we want to encourage full reporting with subsequent adequate management and convalescence, perhaps we should use the term &apos;mild traumatic brain injury.&apos;&quot;


 &lt;p&gt;Disagreeing was Kenneth Perrine, PhD, a neuropsychologist at Hackensack University Medical Center in New Jersey.
    &lt;p&gt;&quot;Granted, concussion is by definition a mild brain injury, but it&apos;s so transient that I think it would be a disservice both to the public and for research to continue to confuse mild traumatic brain injury with concussion,&quot; said Perrine, who was not involved in the study.
    &lt;p&gt;He said a true concussion is characterized by feeling like one is in a fog, fatigue, sensitivity to light and sound, headache, blurred vision or other visual disturbances, and feeling off balance.
    &lt;p&gt;A mild traumatic brain injury, on the other hand, has longer-lasting effects and is not usually accompanied by concussion symptoms. Retrograde amnesia, post-traumatic amnesia, and more severe memory loss would occur, he said.
    &lt;p&gt;&quot;They are two distinct entities both from what we call it and from a prognostic standpoint,&quot; said Perrine, who is also consulting neuropsychologist for the New York Jets.
    &lt;p&gt;But, although the term concussion is used widely in clinical records and has garnered much attention in recent years because of head injuries to athletes at all levels of sports, an accepted definition does not exist, according to DeMatteo and her colleagues.&lt;/p&gt;


&lt;p&gt;&quot;Clinicians may use the concussion label because it is less alarming to parents than the term &quot;mild brain injury,&quot; with the intent of implying that the injury is transient with no signi&amp;#64257;cant long-term health consequences,&quot; they said.&lt;/p&gt;

&lt;p&gt;Commenting on the study, Wendy Wright, MD, a neurologist at Emory University in Atlanta, said in an e-mail, &quot;This study puts a spotlight on the issue that concussion is not always taken as seriously as it should be, partly because concussion encompasses a spectrum of disease.&quot;&lt;/p&gt;
&lt;p&gt;She said parents, coaches, teammates, and the individual with the concussion may not believe the injury is serious because symptoms are transient.&lt;/p&gt;
&lt;p&gt;That perception appears to be held by both clinicians and parents alike. DeMatteo and colleagues noted in the journal that during recruitment of the current study, both groups were heard saying, &quot;He doesn&apos;t have a head injury, he has a concussion.&quot;&lt;/p&gt;
&lt;p&gt;However, Wright said, &quot;it must be noted that concussion means brain injury.&quot;&lt;/p&gt;


&lt;p&gt;To explore how the term is used clinically, DeMatteo and colleagues analyzed the records of 434 children admitted to McMaster Children&apos;s Hospital with a diagnosis of acquired brain injury.&lt;/p&gt;
&lt;p&gt;Of those determined to have a traumatic brain injury, 72.7% had a mild injury according to the Glasgow Coma Scale. Nearly one-third (32.4%) were said to have a concussion.&lt;/p&gt;
&lt;p&gt;The concussion label was more likely to be given to children with a mild injury (&lt;em&gt;P&lt;/em&gt;=0.03), but the association was weak, according to the researchers, and nearly one-quarter (24%) of children with moderate or severe scores were also said to have a concussion.&lt;/p&gt;
&lt;p&gt;&quot;This leads one to question the use of the term as being reflective of mild injury and again supports the existence of confusion about what a concussion really is and how the term should best be used in the care of children,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;&quot;Our findings, both in the return-to-school data and the phenomenon we experienced during recruitment, suggest that if a child is given a diagnosis of concussion, then the family is less likely to consider it as a brain injury,&quot; the researchers said.&lt;/p&gt;
&lt;p&gt;They acknowledged some limitations of the study, including the fact that data from medical charts may have had missing information and a lack of control over the validity of measurements and that their use of only a single center might influence the results.&lt;/p&gt;
&lt;p&gt;Further, they wrote, some measures, such as CT frequency, might be inflated because only children who were admitted to the hospital were included in the study. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was funded by a research grant from the Ontario Neurotrauma Foundation. The &lt;em&gt;CanChild&lt;/em&gt;&lt;em&gt;&lt;/em&gt; Center for Childhood Disability Research is supported by the Ontario Ministry of Health and Long-Term Care.&lt;/p&gt;&lt;p&gt;The authors reported that they had no relevant financial disclosures to make.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2903"
                     title="Rules Can Guide Use of CT After Head Trauma (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Neurology/HeadTrauma/tb/15975?impressionId=1265819211038"
                     
      &lt;p&gt;More than one-fifth of children who receive CT scans following head trauma don&apos;t need them, researchers found.&lt;/p&gt;
&lt;p&gt;Applying simple, validated rules showed that 20.1% of children 2 and older and 24.1% of those younger than 2 who received CT scans had a low risk of serious brain injury, Nathan Kuppermann, MD, MPH, of the University of California Davis, and colleagues reported online in &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;For these children, the risk of developing cancer because of radiation exposure outweighs the risk of clinically important traumatic brain injuries, including those resulting in death, neurosurgery, intubation for longer than 24 hours, or hospital admission for at least two nights, they said.&lt;/p&gt;
&lt;p&gt;Previous studies have suggested that CT scans were being overused for pediatric head trauma, but they were subject to various limitations, including small sample size and lack of validation or independent assessment in children younger than 2, according to the researchers.&lt;/p&gt;
&lt;p&gt;So, using a derivation cohort of 33,785 children, Kuppermann and colleagues developed rules for classifying children as low risk. These children would not need CT scans.&lt;/p&gt;
&lt;p&gt;Older children are considered low-risk if they have normal mental status, no loss of consciousness, no vomiting, no signs of basilar skull fracture, and no severe headache, and did not sustain their injury in a serious accident.&lt;/p&gt;
&lt;p&gt;Because children younger than 2 are generally unable to communicate their symptoms, are more sensitive to the effects of radiation, and have different mechanisms of injury, the researchers said, they needed slightly different rules.&lt;/p&gt;
&lt;p&gt;Those who had normal mental status, no scalp swelling except frontal, no loss of consciousness more than five seconds, and no palpable skull fracture, and were acting normally according to the parents and sustained their injury in a non-severe way were classified as low risk.&lt;/p&gt;
&lt;p&gt;&quot;Application of these rules could limit CT use, protecting children from unnecessary radiation risks,&quot; Kuppermann and colleagues wrote.&lt;/p&gt;
&lt;p&gt;The rules are not, however, meant to replace the judgment of an individual clinician, they said, but rather, &quot;these rules provide the necessary data to assist clinicians and families in CT decision making after head trauma.&quot;&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, Patricia Parkin, MD, and Jonathan Maguire, MD, of the Hospital for Sick Children in Toronto, wrote that &quot;these researchers have not only addressed an important clinical question, but have also provided a powerful example of the science behind clinical decision making.&quot;&lt;/p&gt;
&lt;p&gt;The study included 42,412 children with signs of minor head trauma treated at 25 hospitals, sought to address some of those shortcomings. The data came from the the Pediatric Emergency Care Applied Research Network (PECARN).&lt;/p&gt;
&lt;p&gt;Overall, 35.3% of the children received CT scans. Serious brain injuries were diagnosed in only 376 (0.9%) and only 60 (0.1%) required neurosurgery.&lt;/p&gt;
&lt;p&gt;When the researchers&apos; rules were applied to a validation cohort of 8,627 children, they accurately predicted 100% of those under 2 who did not require CT scans and were not diagnosed with serious brain injuries. Sensitivity was 100%.&lt;/p&gt;
&lt;p&gt;The rules for older children correctly predicted 99.5% who did not require CT scans; the sensitivity was 96.8%.&lt;/p&gt;
&lt;p&gt;The researchers noted that not all children who do not fall into the low-risk group necessarily need to have CT scans. The use of imaging in these children should be based on physician experience, severity and number of symptoms, and other factors, such as parental preference, they said.&lt;/p&gt;
&lt;p&gt;They noted some limitations of the study, including the inability to obtain CT scans from all patients, the low rate of CT use compared with the national average, and the lack of information on long-term neurocognitive outcomes.&lt;/p&gt;
&lt;p&gt;Parkin and Maguire, the editorialists, raised two other issues.&lt;/p&gt;
&lt;p&gt;Although the sensitivities of the rules were high, they said, they were not perfect. The lower confidence limits were 93% in both age groups in the derivation cohort and 86% for the younger age group and 89% for the older age group in the validation cohort.&lt;/p&gt;
&lt;p&gt;&quot;Predicting clinically important traumatic brain injury in children might be sufficiently complex that it might be difficult for a rule with six predictors to achieve perfect sensitivity,&quot; they said. &quot;Yet rules with a greater number of predictors might be impractical.&quot;&lt;/p&gt;
&lt;p&gt;Also, if the rules were strictly implemented in a clinical setting, the predicted rate of CT use would actually be higher than found in the study, they said.&lt;/p&gt;
&lt;p&gt;&quot;To address these issues, Kuppermann and colleagues remind us that the rules are meant to inform clinical decision making, not to replace it,&quot; they said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;PECARN is supported by cooperative agreements from the Emergency Medical Services for Children program of the Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human Services. The study was also supported by a grant from the Maternal and Child Health Bureau Research Program.&lt;/p&gt;&lt;p&gt;Both the study authors and the editorialists reported that they have no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
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