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doctor checking boy for concussion

NINDS awards $10 million for pediatric concussion research

doctor checking boy for concussion

Every year, more than 3 million Americans are diagnosed with concussions. Symptoms continue to plague 30 percent of patients three months after injury — adolescents face an even higher risk of delayed recovery.

The National Institute of Neurological Disorders and Stroke has awarded a $10-million grant to the Four Corners Youth Consortium, a group of academic medical centers studying concussions in school-aged children. Led in part by the Safe Concussion Outcome Recovery and Education (SCORE) program at Children’s National Hospital, the project is named Concussion Assessment, Research and Education for Kids, or CARE4Kids.

Researchers will use advanced brain imaging and blood tests to explore biological markers—changes in blood pressure, heart rate and pupil reactivity—that could predict which children will develop persistent symptoms after concussion. The five-year CARE4Kids study will enroll more than 1,300 children ages 11-18 nationwide.

The five-year study will be led by Gerard Gioia, Ph.D., division chief of Neuropsychology at Children’s National Hospital, Frederick Rivara, M.D., M.P.H., at Seattle Children’s Center for Child Health, Behavior and Development and University of Washington’s Medicine’s Department of Pediatrics, and Dr. Chris Giza at University of California, Los Angeles (UCLA).

“We will be gathering innovative data to help answer the critical question asked by every patient: ‘When can I expect to recover from this concussion?’” said Dr. Gioia. “We have a great team and are excited to have been selected to study this important issue.”

Christopher G. Vaughan, Psy.D., neuropsychologist, and Raquel Langdon, M.D., neurologist, both at Children’s National, will join Dr. Gioia as principal investigators of the study at this site.

Every year, more than 3 million Americans are diagnosed with concussions. Symptoms continue to plague 30 percent of patients three months after injury—adolescents face an even higher risk of delayed recovery. Chronic migraine headaches, learning and memory problems, exercise intolerance, sleep disturbances, anxiety and depressed mood are common.

“Providing individualized symptom-specific treatments for youth with a concussion has been a longstanding aim of the SCORE program,”Dr. Vaughan said. “This project will lead to a better understanding of the specific markers for which children may have a longer recovery. With this knowledge, we can start individualized treatments earlier in the process and ultimately help to reduce the number of children who experienced prolonged effects after concussion.”

The grant was announced on September 9, 2021.

In Washington, D.C., an estimated 240 children ages 11 to 18, will participate in the study.

The study will unfold in two phases. The first part will evaluate children with concussion to identify a set of biomarkers predictive of persistent post-concussion symptoms. To validate the findings, the next stage will confirm that these biomarkers accurately predict prolonged symptoms in a second group of children who have been diagnosed with concussion. The goal is to develop a practical algorithm for use in general clinical practice for doctors and other health professionals caring for pediatric patients.

Institutions currently recruiting patients for the study include Children’s National Hospital, UCLA Mattel Children’s Hospital, Seattle Children’s, the University of Washington, University of Rochester, University of Texas Southwestern Medical Center and Wake Forest School of Medicine. Indiana University, the National Institute of Nursing Research, University of Arkansas, University of Southern California and the data coordinating center at the University of Utah are also involved in the project.

Earlier research conducted by the Four Corners Youth Consortium that led to this project was funded by private donations from Stan and Patti Silver, the UCLA Steve Tisch BrainSPORT Program and the UCLA Easton Clinic for Brain Health; Children’s National Research Institute; as well as from the Satterberg Foundation to Seattle Children’s Research Institute; and an investment from the Sports Institute at UW Medicine.

doctor showing girl with concussion three fingers

Post-traumatic headache phenotype and recovery time after concussion

doctor showing girl with concussion three fingers

In a recent study published by JAMA Network Open, Gerard Gioia, Ph.D., division chief of Neuropsychology and director of Safe Concussion Outcome, Recovery and Education (SCORE) Program at Children’s National Hospital, along with other leading researchers, described the characteristics of youth with post-traumatic headache (PTH) and determine whether the PTH phenotype is associated with outcome.

Concussions and mild traumatic brain injuries (mTBI) are common among children and adolescents and constitute a major public health challenge. While symptoms from a concussion typically resolve days to weeks after injury, 10% to 30% of patients have symptoms that last longer than four weeks, and a smaller proportion have symptoms that persist for much longer.

PTH is defined as significantly worsened head pain attributed to a blow or force to the head. Although adolescents have a higher risk for sustaining concussions and developing persistent symptoms than younger children or adults, there is little data regarding PTH recovery and treatment in youth.

Dr. Gioia founded the multicenter Four Corners Youth Consortium to fill the gap in our understanding of youth concussion and recovery. This study is the first analysis of PTH phenotype and prognosis in this cohort of concussed youth.

The researchers analyzed headache-related symptoms from a validated questionnaire developed by Dr. Gioia and his Children’s National concussion research team. The primary outcomes were time to recovery and concussion-attributable headache three months after injury while the secondary outcome was headache six months after injury. Recovery was defined as resolution of symptoms related to a concussion.

Future large studies validating the classification of posttraumatic headache phenotypes in youth and studying outcomes are essential. PTH phenotyping will improve prognostication of concussion recovery and will enhance the treatment for PTH with more appropriate and targeted therapies to treat and prevent persistent and disabling headaches in youth with a concussion.

Teenage boy sleeping

Longer concussion recovery in children connected to poor sleep

Teenage boy sleeping

A new research study suggests that adolescents who get a good night’s sleep after a sports-related concussion might be linked to a shorter recovery time.

Research presented at the American Academy of Pediatrics Conference in Orlando, Fla., concluded that young athletes who slept well after a concussion were more likely to recover within two weeks, while those that didn’t receive a good night’s rest increased their likelihood to endure symptoms for 30 days or more.

The design and method was observational, where sleep factors and recovery are examined in association with each other. While the design does not allow a strong causal relationship to be established, it does not report control of other possible mediating variables, its sample size and strength of the findings are strongly suggestive, and provide a rationale for further study of sleep as a critical factor in recovery.

According to Gerard Gioia, Ph.D., chief of the Division of Pediatric Neuropsychology at Children’s National Health System, clinicians should ensure that sleep is properly assessed post-concussion and appropriate sleep hygiene strategies should be provided to the patient and family.

The average age of the 356 participants in the study was 14. Researchers conducting the study had the participants complete a questionnaire called the Pittsburgh Sleep Quality Index. Based on the answers reported, the teens were grouped into two categories: 261 good sleepers and 95 poor sleepers.

“The study highlights the importance of sleep, a critical factor in the recovery from a concussion,” says Dr. Gioia, “These findings are highly consistent with our own clinical experience in treating children and adolescents with concussions in that poor sleep are a significant limiting factor in recovery.”

During the follow-up visits three months later, both groups of patients had improved, however the good sleepers continued to have significantly better symptoms and sleep scores.

little girl with concussion at doctors

Predicting kids’ outcomes after concussion

little girl with concussion at doctors

A concussion symptom measurement tool, developed by investigators at Children’s National Health System, allows other researchers to collect valuable evidence about the natural progression of symptoms and recovery for children. The tool, Post-Concussion Symptom Inventory (PCSI), was a key tool in the recent large-scale multi-center prospective study of recovery trajectory for children, which was published online in JAMA Pediatrics Sept. 4, 2018.

That study included 2,716 children between the ages of 5 and 17, and identified major trends in symptom improvement post concussion, such as:

  • Children younger than 12 experience primary symptom improvement in the first two weeks
  • Pre-adolescents, male adolescents and teens experience primary symptom improvement in the first four weeks and
  • Female adolescents take longer to perceive primary symptom improvements than children, pre-adolescents and male counterparts.

“We’ve known for many years that different people experience concussion recovery very differently. This study is the first to provide significant evidence of what we should expect to see in terms of symptom improvement for children and teens,” says Gerard Gioia, Ph.D., chief of the Division of Neuropsychology at Children’s National and director of its Safe Concussion Outcome Recovery and Education Program, who co-authored the study and whose team developed the PCSI measurement tool. “Ultimately, these findings are an important step in predicting outcomes after a concussion and developing treatment plans that get kids back to school and sports safely, when they are ready.”

Dr. Gioia and his team also recently received a Centers for Disease Control and Prevention (CDC) grant to develop a new smartphone application, Online Treatment Recovery Assistant for Concussion in Kids (OnTRACK), that applies several concussion tools developed at Children’s National, including the same one applied in the JAMA Pediatrics study, to track individual symptoms over time.

The OnTRACK app will report concussion symptoms on a regular basis (daily or weekly) and map their trajectory, so doctors can see when recovery is proceeding along the expected pathway. Alternatively, clinicians will receive an alert when a child’s recovery misses targets and warrants further investigation and possible referral to a specialist.

Shireen Atabaki

Innovative care using health IT lands Children’s National a 2017 HIMSS Enterprise Davies Award

Shireen Atabaki

A new diagnostic tool led by Shireen Atabaki, M.D., M.P.H., helps prescribers determine if CT scans are necessary for children with head injuries through a checklist protocol.

Opportunities to improve the lives of children are increasingly found at the intersection of health and technology, a sweet spot for enhancing care in today’s connected world. A team of experts at Children’s National Health System launched several initiatives using health information technology to improve care delivery, earning the institution the prestigious 2017 HIMSS Enterprise Davies Award. Recognizing outstanding achievements of organizations that have utilized health IT to significantly improve patient outcomes while also achieving a return on investment, Children’s National received the award based on three case studies in particular:

  • Decreasing use of CAT scans by 44 percent – A new diagnostic tool led by Shireen Atabaki, M.D., M.P.H., emergency medicine specialist, incorporated into the electronic health record helps prescribers determine if CT scans are necessary for children with head injuries through a checklist protocol. The new tool reduced the rate of CT scan utilization by 44 percent – decreasing unnecessary radiation exposure for children and resulting in first-year cost savings of more than $875,000.
  • Innovative unit-based quality boards – These electronic boards provide health care teams and families with real-time quality and safety information. By having patient information readily available in one location, the boards improved medication reconciliation by 13 percent, decreased the time to patient consent by 49 percent, and reduced duration of urinary catheters by 11 percent.
  • Improved clinician documentation – To improve outcomes and reduce costs,

Children’s National transitioned from dictation/transcription-driven notes to electronic/voice recognition notes in ambulatory specialty clinics. This allowed for the immediate availability of notes to all care providers and a significant reduction in transcription costs.

These initiatives demonstrate the life-changing quality and safety efforts under way at Children’s National that put patient safety first. Brian Jacobs, M.D., vice president, chief medical information officer and chief information officer, accepted the award on behalf of Children’s National at the HIMSS Awards gala at the Wynn in Las Vegas in March.

Electronic medical record on tablet

Children’s National submissions make hackathon finals

Electronic medical record on tablet

This April, the Clinical and Translational Science Institute at Children’s National (CTSI-CN) and The George Washington University (GW) will hold their 2nd Annual Medical and Health App Development Workshop. Of the 10 application (app) ideas selected for further development at the hackathon workshop, five were submitted by clinicians and researchers from Children’s National.

The purpose of the half-day hackathon is to develop the requirements and prototype user interface for 10 medical software applications that were selected from ideas submitted late in 2017. While idea submissions were not restricted, the sponsors suggested that they lead to useful medical software applications.

The following five app ideas from Children’s National were selected for the workshop:

  • A patient/parent decision tool that could use a series of questions to determine if the patient should go to the Emergency Department or to their primary care provider; submitted by Sephora Morrison, M.D., and Ankoor Shah, M.D., M.P.H.
  • The Online Treatment Recovery Assistance for Concussion in Kids (OnTRACK) smartphone application could guide children/adolescents and their families in the treatment of their concussion in concert with their health care provider; submitted by Gerard Gioia, Ph.D.
  • A genetic counseling app that would provide a reputable, easily accessible bank of counseling videos for a variety of topics, from genetic testing to rare disorders; submitted by Debra Regier, M.D.
  • An app that would allow the Children’s National Childhood and Adolescent Diabetes Program team to communicate securely and efficiently with diabetes patients; submitted by Cynthia Medford, R.N., and Kannan Kasturi, M.D.
  • An app that would provide specific evidence-based guidance for medical providers considering PrEP (pre-exposure prophylaxis) for HIV prevention; submitted by Kyzwana Caves, M.D.

Kevin Cleary, Ph.D., technical director of the Bioengineering Initiative at Children’s National Health System, and Sean Cleary, Ph.D., M.P.H., associate professor in epidemiology and biostatistics at GW, created the hackathon to provide an interactive learning experience for people interested in developing medical and health software applications.

The workshop, which will be held on April 13, 2018, will start with short talks from experts on human factors engineering and the regulatory environment for medical and health apps. Attendees will then divide into small groups to brainstorm requirements and user interfaces for the 10 app ideas. After each group presents their concepts to all the participants, the judges will pick the winning app/group. The idea originator will receive up to $10,000 of voucher funding for their prototype development.