Dr. Keith Yeates guests on “5 Questions with CJSM”

keith

Dr. Keith Yeates revs up the crowd at
the International Brain Injury Association meeting
in Edinburgh, Scotland

I live and work in Columbus, Ohio, United States, and I am privileged to be surrounded by many leaders in the field of sports medicine.  One such figure, who is doing great work advancing the evidence to support the diagnosis and management of sport-related concussions, is Keith Yeates, Ph.D.

Dr. Yeates and I work at the same institution, Nationwide Children’s Hospital; I have found him to be a great resource to turn to for questions regarding the sport-related concussions in kids that I manage as part of my clinical practice.  He is a prolific researcher and writer, who has been a contributor to the pages of CJSM and journals beyond.  He is a lead neuropsychologist for a multi-site study of traumatic brain injury in children and adolescents, funded by the CDC.

I just learned from a press briefing that Dr. Yeates has become a millionaire of sorts:  he has been awarded a prestigious R01 grant to continue his work in the field of traumatic brain injuries.   And so I had to try to catch up with him and have him sit for 5 questions before his various other commitments overwhelmed him!  I got lucky, and here are Dr. Yeates’ thoughts on the state of concussion research.

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CJSM asks Dr. Keith Yeates 5 questions

1) CJSM: Congratulations!!  We understand you just received a $3M R01 grant for ‘predicting outcomes in children with MTBI.”  What areas of research do you plan on pursuing with this grant?

KY: The grant will fund research to examine how well diagnostic methods commonly used for children with mild TBI can predict persistent postconcussive symptoms (PCS) and functional deficits. Various methods are recommended for the diagnostic evaluation of children with mild TBI, including assessment of presenting signs/symptoms, acute mental status examination and balance testing, neuropsychological testing, and neuroimaging. Although these methods discriminate between children with mild TBI and healthy children, we don’t know whether they predict outcomes such as persistent PCS and functional impairments among children with mild TBI. As a result, decision tools are not available to physicians and other health care providers to guide the disposition and care of children with these very common injuries. This comprehensive study of common diagnostic methods and their incremental utility in predicting outcomes should have a major impact on clinical practice, particularly in acute care settings, by helping improve prognostic determinations, develop decision tools, and focus treatment efforts. The study should also add substantively to the scientific understanding of the outcomes of mild TBI.

2) CJSM: A year ago in CJSM, you were an author who published an article: “Sport related Concussions:  a Call for Evidence and Perspective Amidst the Alarms.” What’s driving those alarms?  What’s driving the fear?

KY: Clearly the media have played a role, with all the focus recently given to sports concussions, the risk of so-called “second impact syndrome” in children, and the assertion that chronic traumatic encephalopathy (CTE) occurs among athletes as a result of concussion. Parents hearing this news are understandably concerned about it. However, the media tends to be overly alarmist, and doesn’t typically acknowledge that most concussions have no lingering impact; that catastrophic injuries in association with concussion are very, very rare; and that we do not yet know if CTE is a real entity and, if so, who is at risk for it. Children are being kept home from school in dark rooms for days at a time after concussions, when this is likely to be unhelpful at best and iatrogenic at worst. We really need better science to understand who is at risk of poor outcomes after mild TBI or concussion and what can be done to foster the best possible outcomes.

3) CJSM: You have to compose a 140 character tweet on twitter about the role of football helmets in preventing concussions.  What does the tweet say?

KY: Helmets prevent severe head trauma, but not concussions. Lots of unproven claims. Can helmets prevent concussions? More research needed! (4 characters to spare Dr. Yeates. Say, you should start microblogging). p.s. I think Dr. Kevin Walter at AAP News would agree!

4) CJSM: What do you think are the top 5 developments in the field of concussion diagnosis and management in the last decade?

KY: One important development is the increased appreciation that concussions range in severity. Not all concussions involve loss of consciousness, and the milder types, such as when an athlete says he had his “bell rung”, are now more likely to be recognized by youth, coaches, parents, and trainers. A second, related development is the creation of better on-field instruments for assessing athletes acutely, such as the various forms of the SCAT. A third important development is the recognition that the best concussion diagnosis and management involves a multidisciplinary team that relies on a range of methods, which may include symptom ratings, balance testing, neuropsychological assessment, and neuroimaging. A fourth advance worth noting is the development of consensus guidelines, such as those developed by the Zurich sports group, AAN, and AAP. Those guidelines are the best that we have available, but they also highlight the fifth important development, which is the increased recognition that we need a lot more research to generate truly evidence-based guidelines. Our current guidelines are still too reliant on expert consensus and limited data.

5) CJSM: Yes/No:  American football as we know it will be radically different in 10 years because of the issue of sport-related concussions.  (you can elaborate, but i’d love a yes or no if possible!)

KY: No, I don’t think so. I wouldn’t be surprised to see further rule changes or equipment improvements designed to reduce concussions in football. We might also see fewer youth deciding to play football in the first place; I know parents who are now unwilling to let their sons play as well. But I’d be surprised if the game was radically different.

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Thanks Dr. Yeates for taking the time to answer our questions.  We’re looking forward to the work you and your colleagues publish in the near future!  And we’re looking forward to your presence in social media:  you have a way with 140 characters!

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About sportingjim
I work at Nationwide Children's Hospital in Columbus, Ohio USA, where I am a specialist in pediatric sports medicine. My academic appointment as an Associate Professor of Pediatrics is through Ohio State University. I am a public health advocate for kids' health and safety. I am also the Emerging Media Editor for the Clinical Journal of Sport Medicine.

2 Responses to Dr. Keith Yeates guests on “5 Questions with CJSM”

  1. Vern says:

    I’m interested in Dr. Yeates’ view that no school and quiet dark room may be harmful. For the first week of the concussion, I find this to be helpful if the patient is very symptomatic. If our goal is cognitive and physical rest early on, I would think the quiet room is beneficial. Certainly school will make symptoms worse right? Perhaps he means we shouldn’t be forcing our patients into the room if they don’t need it?

    • sportingjim says:

      Don’t want to speak for him, but I think I have a similar practice. Early on for very high symptoms no school is definitely appropriate, but I think you’re right: the dark room should be not forced, and very, very short term, if at all. Far too often I see families adhering to that prescription and they’re out of their minds by the time they get to me: experiencing something like a ‘house arrest.’ My understanding of Dr. Yeates’ position, from my conversations with him, is that the full monty of cognitive rest is something similar to bed rest for folks with back pain: a commonly prescribed ‘treatment’ that will some day be discredited.

      I get my patients out doing light chores (folding laundry) and even walks outside with sunglasses as soon as I can.

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