GORDON Presentation - Mount Sinai School of Medicine

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Concussion Update
Wayne A. Gordon, Ph.D., ABPP
Jack Nash Professor & Vice Chair
Department of Rehabilitation Medicine
[email protected]
1
Goals
• Define concussion.
• Review symptoms of concussion.
• Review prevalence of concussion in
children.
2
What is concussion?
3
• Concussion is a brain injury and is
defined as a complex physiological
process affecting the brain.
(Consensus statement on concussion in sport: 4th
International Conference on Sport held in Zurich,
November, 2012. McCory, P. et al. British Journal of
Sports Medicine, 2013)
4
• TBI is an alteration in brain function
caused by an external force.
(Menon, et al. Arch. Phys. Med. Rehabil., 2010)
5
• Symptoms of a concussion may appear
immediately or emerge over time.
• Learning or behavioral difficulties may not
emerge until school becomes more
demanding.
6
What do we know about the prevalence of
concussion in children?
•
3 month follow up of 406 children seen in the ED
-
At 3 months post-injury 29% had post-concussion
syndrome.
-
•
7.4 days of school missed (+/-) 13.9 days.
Most common symptom reported was headache
followed by fatigue, frustration, dizziness,
concentration and memory difficulties.
(Butler et al. JAMA, Neurology, 2013)
7
• 20% of Ontario students in grades 7-12 sustained a
TBI (LOC > 5 minutes) at some point in their life.
• 5.6% sustained a TBI last year.
(Ilie, et al JAMA, 2013)
8
Screening of 134 kids at 12-19 in 3 NYC
schools
•
9% high probability of TBI.
•
80% of the 9% had neuropsychological evidence of
TBI.
(Cantor, Gordon, Ashman, JHTR, 2006)
9
•
Screening of 692 1-5 graders in Nebraska 7.66%
positive screen.
•
25% of positive screens kids receiving Special Ed.
(Hux, et al. Brain Injury, 2013)
10
• A recent longitudinal cohort study found that 17%
of children tracked from birth experience a TBI
requiring medical attention by the age of 15.
• Of these 29% had a second injury.
• 23% of those with two had three.
• 33% of those with three had four or more.
(McKinlay, et. al, 2008)
11
Nearly 500,000 children under the age of 15
visit ERs each year reporting a TBI and an
additional 35,000 are hospitalized.
(Faul, et. al, CDC, 2010)
12
• CDC estimates that about 3,000,000
children under the age of 19 sustain a
concussion each year.
• While most recover about 20% do not.
(Alexander, 1995)
13
• Numbers are an undercount because they
do not include kids who did not seek medical
attention.
• Those injured when there was no adult
present.
• Or the responsible adult may be reluctant to
disclose/report the injury.
(Langlois et. al, CDC, 2004)
14
Mount Sinai
Play Safe Program
Departments of Rehabilitation Medicine,
Pediatrics, Emergency Medicine, Neurology,
Neurosurgery, Orthopedic Surgery
Mount Sinai Medical Center
15
Our Team
▶
Emergency Medicine
▶
Neurology
▶
Neuropsychology
▶
Neurosurgery
▶
Orthopedic Surgery
▶
Pediatrics
▶
Rehabilitation Medicine
16
The Mount Sinai Play Safe Program
provides
• Multidisciplinary care to injured athletes.
• Technical assistance & education to
families and school personnel.
(800) 283-8481
17
Thank you.
18
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