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Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging

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Abstract

Purpose

Approximately 90% of concussions are transient, with symptoms resolving within 10–14 days. However, a minority of patients remain symptomatic several months post-injury, a condition known as post-concussion syndrome (PCS). The treatment of these patients can be challenging. The goal of our study was to assess the utility and cost-effectiveness of neurologic imaging two or more weeks post-injury in a cohort of youth with PCS.

Methods

We conducted a retrospective study of 52 pediatric patients with persistent post-concussion symptoms after 3 months. We collected demographics and neuroimaging results obtained greater than 2 weeks post-concussion. Neuroimaging ordered in the first 2 weeks post-concussion was excluded, except to determine the rate of re-imaging. Descriptive statistics and corresponding cost data were collected.

Results

Of 52 patients with PCS, 23/52 (44 %) had neuroimaging at least 2 weeks after the initial injury, for a total of 32 diagnostic studies. In summary, 1/19 MRIs (5.3 %), 1/8 CTs (13 %), and 0/5 x-rays (0 %) yielded significant positive findings, none of which altered clinical management. Chronic phase neuroimaging estimated costs from these 52 pediatric patients totaled $129,025. We estimate the cost to identify a single positive finding was $21,000 for head CT and $104,500 for brain MRI.

Conclusions

In this cohort of pediatric PCS patients, brain imaging in the chronic phase (defined as more than 2 weeks after concussion) was pursued in almost half the study sample, had low diagnostic yield, and had poor cost-effectiveness. Based on these results, outpatient management of pediatric patients with long-term post-concussive symptoms should rarely include repeat neuroimaging beyond the acute phase.

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References

  1. Choe MC et al (2012) A pediatric perspective on concussion pathophysiology. Curr Opin Pediatr 24(6):689–695. doi:10.1097/MOP.0b013e32835a1a44

    Article  PubMed  Google Scholar 

  2. McCrea M et al (2013) Incidence, clinical course, and predictors of prolonged recovery time following sport-related concussion in high school and college athletes. J Int Neuropsychol Soc 19(1):22–33

    Article  PubMed  Google Scholar 

  3. Meehan WP 3rd, d'Hemecourt P, Comstock RD (2010) High school concussions in the 2008–2009 academic year: mechanism, symptoms, and management. Am J Sports Med 38(12):2405–9

    Article  PubMed Central  PubMed  Google Scholar 

  4. Makdissi M et al (2013) The difficult concussion patient: what is the best approach to investigation and management of persistent (>10 days) postconcussive symptoms? Br J Sports Med 47(5):308–13

    Article  PubMed  Google Scholar 

  5. Lau BC, Collins MW, Lovell MR (2012) Cutoff scores in neurocognitive testing and symptom clusters that predict protracted recovery from concussions in high school athletes. Neurosurgery 70(2):371–9, discussion 379

    Article  PubMed  Google Scholar 

  6. Ruff RM, Camenzuli L, Mueller J (1996) Miserable minority: emotional risk factors that influence the outcome of a mild traumatic brain injury. Brain Inj 10(8):551–65

    Article  CAS  PubMed  Google Scholar 

  7. American Psychiatric, A., A. American Psychiatric, and D.-I. Task Force on (2000) Diagnostic and statistical manual of mental disorders : DSM-IV-TR. American Psychiatric Association, Washington, DC

    Google Scholar 

  8. Pulsipher DT et al (2011) A critical review of neuroimaging applications in sports concussion. Curr Sports Med Rep 10(1):14–20

    Article  PubMed  Google Scholar 

  9. Davis GA et al (2009) Contributions of neuroimaging, balance testing, electrophysiology and blood markers to the assessment of sport-related concussion. Br J Sports Med 43(Suppl 1):i36–45

    Article  PubMed  Google Scholar 

  10. Kuppermann N et al (2009) Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 374(9696):1160–70

    Article  PubMed  Google Scholar 

  11. Osmond MH et al (2010) CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ 182(4):341–8

    Article  PubMed Central  PubMed  Google Scholar 

  12. Morgan C, et al. Predictors of post-concussion syndrome (PCS) after sports-related concussion in young athletes: a matched case–control study. Journal of Neurosurgery: Pediatrics, In Press

  13. Babcock L et al (2013) Inability of S100B to predict postconcussion syndrome in children who present to the emergency department with mild traumatic brain injury: a brief report. Pediatr Emerg Care 29(4):458–61

    Article  PubMed Central  PubMed  Google Scholar 

  14. Babcock L et al (2013) Predicting postconcussion syndrome after mild traumatic brain injury in children and adolescents who present to the emergency department. JAMA Pediatr 167(2):156–61

    Article  PubMed Central  PubMed  Google Scholar 

  15. Heitger MH, Jones RD, Anderson TJ (2008) A new approach to predicting postconcussion syndrome after mild traumatic brain injury based upon eye movement function. Conf Proc IEEE Eng Med Biol Soc 2008:3570–3

    PubMed  Google Scholar 

  16. Ma M et al (2008) Serum cleaved tau does not predict postconcussion syndrome after mild traumatic brain injury. Am J Emerg Med 26(7):763–8

    Article  PubMed Central  PubMed  Google Scholar 

  17. Preiss-Farzanegan SJ et al (2009) The relationship between gender and postconcussion symptoms after sport-related mild traumatic brain injury. PM R 1(3):245–53

    Article  PubMed  Google Scholar 

  18. American Psychiatric, A., A. American Psychiatric, and D.S.M.T. Force (2013) Diagnostic and statistical manual of mental disorders : DSM-5., Available from: http://dsm.psychiatryonline.org/book.aspx?bookid=556

  19. Losey-Flores K et al (2014) Free hernia surgery for the underserved is possible in the United States. Hernia 18(2):305–310

    Article  CAS  PubMed  Google Scholar 

  20. Millhiser WP, Veral EA, Valenti BC (2012) Assessing appointment systems’ operational performance with policy targets. IIE Transactions on Healthcare Systems Engineering 2(4):274–289

    Article  Google Scholar 

  21. Riley D (2014) The art of a pediatric exam. Nurse Pract 39(6):50–4

    Article  PubMed  Google Scholar 

  22. Sannino G, De Falco I, De Pietro G (2013) Automatic extraction of effective rule sets for Obstructive Sleep Apnea detection for a real-time mobile monitoring system. in Information Reuse and Integration (IRI), 2013 I.E. 14th International Conference on

    Google Scholar 

  23. Shetty V et al (2013) The “Shetty test” in ankle injuries: validation of a novel test to rule out ankle fractures. European Journal of Orthopaedic Surgery & Traumatology 23(7):831–833

    Article  Google Scholar 

  24. Trinh L, Ikeda DM, Miyake KK, Trinh J, Lee KK, Dave H, Hanafusa K, Lipson J (2015) Patient awareness of breast density and interest in supplemental screening tests: comparison of an academic facility and a county hospital. J Am Coll Radiol 12(3):249–255

  25. Zamosky L. Cutting Medical Costs, in Healthcare, Insurance, and You. 2013, Apress. p. 75–88

  26. Baker JG et al (2012) Return to full functioning after graded exercise assessment and progressive exercise treatment of postconcussion syndrome. Rehabil Res Pract 2012:705309

    PubMed Central  PubMed  Google Scholar 

  27. Leddy JJ et al (2011) Reliability of a graded exercise test for assessing recovery from concussion. Clin J Sport Med 21(2):89–94

    Article  PubMed  Google Scholar 

  28. Solomon GS, Sills AK (2013) Pharmacologic treatment of sport-related concussion: a review. J Surg Orthop Adv 22(3):193–7

    Article  PubMed  Google Scholar 

  29. Reddy CC et al (2013) Efficacy of amantadine treatment on symptoms and neurocognitive performance among adolescents following sports-related concussion. J Head Trauma Rehabil 28(4):260–5

    Article  PubMed  Google Scholar 

  30. Packard RC (2000) Treatment of chronic daily posttraumatic headache with divalproex sodium. Headache 40(9):736–9

    Article  CAS  PubMed  Google Scholar 

  31. Peterlin BL et al (2008) Post-traumatic stress disorder in episodic and chronic migraine. Headache 48(4):517–22

    Article  PubMed  Google Scholar 

  32. Weiss HD, Stern BJ, Goldberg J (1991) Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma. Headache 31(7):451–6

    Article  CAS  PubMed  Google Scholar 

  33. Gonzalez PG, Walker MT (2011) Imaging modalities in mild traumatic brain injury and sports concussion. PM&R 3(10, Supplement 2):S413–S424

    Article  Google Scholar 

  34. Forbes JA et al (2013) Subdural hemorrhage in two high-school football players: post-injury helmet testing. Pediatr Neurosurg 49(1):43–9

    Article  PubMed  Google Scholar 

  35. Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32(4):228–1, discussion 242–4

    Article  PubMed  Google Scholar 

  36. Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357(22):2277–84

    Article  CAS  PubMed  Google Scholar 

  37. Parizel PM et al (2005) New developments in the neuroradiological diagnosis of craniocerebral trauma. Eur Radiol 15(3):569–81

    Article  CAS  PubMed  Google Scholar 

  38. Schrader H et al (2009) Magnetic resonance imaging after most common form of concussion. BMC Med Imaging 9:11

    Article  PubMed Central  PubMed  Google Scholar 

  39. McCrory P et al (2009) Consensus statement on concussion in sport—the 3rd International Conference on concussion in sport held in Zurich, November 2008. J Sci Med Sport 12(3):340–51

    Article  CAS  PubMed  Google Scholar 

  40. Yuh EL, Hawryluk GW, Manley GT (2014) Imaging concussion: a review. Neurosurgery 75(Suppl 4):S50–63

    Article  PubMed  Google Scholar 

  41. Zuckerman SL (2012) Structural brain injury in sports-related concussion. Neurosurg Focus 33(6):E6, 1–12

    Article  PubMed  Google Scholar 

  42. Sener RN (1997) Arachnoid cysts associated with post-traumatic and spontaneous rupture into the subdural space. Comput Med Imaging Graph 21(6):341–4

    Article  CAS  PubMed  Google Scholar 

  43. Parsch CS et al (1997) Arachnoid cysts associated with subdural hematomas and hygromas: analysis of 16 cases, long-term follow-up, and review of the literature. Neurosurgery 40(3):483–90

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University School of Medicine, Medical Center North T-4224, 37212, Nashville, TN, USA

    Clinton D. Morgan, Scott L. Zuckerman, Allen K. Sills & Gary S. Solomon

  2. Division of Pediatric Neurology, Vanderbilt University School of Medicine, Nashville, TN, USA

    Lauren E. King & Susan E. Beaird

Authors
  1. Clinton D. Morgan
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  2. Scott L. Zuckerman
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  3. Lauren E. King
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  4. Susan E. Beaird
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  5. Allen K. Sills
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  6. Gary S. Solomon
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Corresponding author

Correspondence to Scott L. Zuckerman.

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Conflict of interest

Support for this study came from an unrestricted educational grant from Rawlings. Dr. Solomon is a consultant for ImPACT, Nashville Predators, and Tennessee Titans. Otherwise, the study authors have no conflicts of interest or financial interests to report.

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Morgan, C.D., Zuckerman, S.L., King, L.E. et al. Post-concussion syndrome (PCS) in a youth population: defining the diagnostic value and cost-utility of brain imaging. Childs Nerv Syst 31, 2305–2309 (2015). https://doi.org/10.1007/s00381-015-2916-y

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  • DOI: https://doi.org/10.1007/s00381-015-2916-y

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