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J Neurotrauma. 2018 May 15;35(10):1178-1184. doi: 10.1089/neu.2017.5340. Epub 2018 Mar 20.

Neurosensory Deficits Vary as a Function of Point of Care in Pediatric Mild Traumatic Brain Injury.

Author information

1
1 The Mind Research Network/Lovelace Biomedical and Environmental Research Institute , Pete & Nancy Domenici Hall, Albuquerque, New Mexico.
2
2 Neurology Department, University of New Mexico School of Medicine , Albuquerque, New Mexico.
3
3 Psychiatry Department, University of New Mexico School of Medicine , Albuquerque, New Mexico.
4
4 Psychology Department, University of New Mexico , Albuquerque, New Mexico.
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5 Division of Orthopedic Surgery, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
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6 Emergency Medicine, University of New Mexico Hospital , Albuquerque, New Mexico.
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7 Department of Orthopaedics, University at Buffalo , Buffalo, New York.
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8 Division of Emergency Medicine, Boston Children's Hospital , Boston, Massachusetts.
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9 Center for Injury Research and Prevention, The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania.
10
10 Department of Neurosurgery, Medical College of Wisconsin , Milwaukee, Wisconsin.
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11 Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin , Milwaukee, Wisconsin.

Abstract

Neurosensory abnormalities are frequently observed following pediatric mild traumatic brain injury (pmTBI) and may underlie the expression of several common concussion symptoms and delay recovery. Importantly, active evaluation of neurosensory functioning more closely approximates real-world (e.g., physical and academic) environments that provoke symptom worsening. The current study determined whether symptom provocation (i.e., during neurosensory examination) improved classification accuracy relative to pre-examination symptom levels and whether symptoms varied as a function of point of care. Eighty-one pmTBI were recruited from the pediatric emergency department (PED; n = 40) or outpatient concussion clinic (n = 41), along with matched (age, sex, and education) healthy controls (HC; n = 40). All participants completed a brief (∼ 12 min) standardized neurosensory examination and clinical questionnaires. The magnitude of symptom provocation upon neurosensory examination was significantly higher for concussion clinic than for PED patients. Symptom provocation significantly improved diagnostic classification accuracy relative to pre-examination symptom levels, although the magnitude of improvement was modest, and was greater in the concussion clinic. In contrast, PED patients exhibited worse performance on measures of balance, vision, and oculomotor functioning than the concussion clinic patients, with no differences observed between both samples and HC. Despite modest sample sizes, current findings suggest that point of care represents a critical but highly under-studied variable that may influence outcomes following pmTBI. Studies that rely on recruitment from a single point of care may not generalize to the entire pmTBI population in terms of how neurosensory deficits affect recovery.

KEYWORDS:

neurosensory; ocular motor; pmTBI; recovery; vestibular; vision

PMID:
29336197
PMCID:
PMC5953216
[Available on 2019-05-15]
DOI:
10.1089/neu.2017.5340

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