CJSM May 2021 Journal Club — Blood Biomarkers in Pediatric Concussions

The May 2021 CJSM issue has just published, and as always it is full of articles you will want to read.

As I gaze at the table of contents, a non-random sampling of eye catching articles includes

CJSM Junior Associate Editor Jason Zaremski, MD breaks it all down for us.

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Clinical Journal of Sports Medicine

Online Journal Club May 2021

CJSM Junior Associate Editor Jason Zaremski, MD

Jason L Zaremski, MD, CAQSM, FACSM, FAAPMR

Anzalone AJ, et al. Blood Biomarkers of Sports-Related Concussion in Pediatric Athletes.

Introduction:  There has been a substantial amount of interest in the diagnosis, evaluation, and management sports related concussions (SRC) in the past decade. An emerging area of interest has been the study of biomarkers as a more objective measure of head trauma. Two blood biomarkers — Neurofilament light polypeptide (Nf-L), primarily found in axons, and Tau, a microtubule-associated protein necessary for axonal transport — have been studied at advanced level of sport (collegiate, professional, and Olympic athletes).

The authors of this new study evaluated these blood biomarkers in pediatric athletes.  The main outcome measures they looked at were correlations between self-reported symptom measures biomarker concentration levels.

Purpose/Specific Aims: The authors examined patterns of blood biomarker concentrations (tau and Nf-L) in pediatric athletes seen in clinic in the days following a SRC and at a six-month follow up.  A comparator group of non-injured controls were assessed as well.  Correlations between biomarker concentrations and self-reported symptom scores were assessed. Read more of this post

CJSM Blog Journal Club — Preinjury & Postinjury Factors Predicting Recovery in Sports-related Concussions

The new year is upon us, and the first issue of the 2021 Clinical Journal of Sports Medicine has published.

There is much to commend in the issue.  It is always difficult to pick one manuscript among many to highlight in the CJSM Blog Journal club (that’s a good ‘problem’ to have).  

This month, our Jr. Associate Editor Jason L Zaremski, MD has decided to evaluate an original research article looking at pre- and post-injury risk factors that affect clinical recovery time in sport-related concussions.

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Jr. Associate Editor Jason L Zaremski MD

Jason L Zaremski, MD

Introduction:  As we finish up a fall sport season that has been like no other and begin 2021 with renewed spirit, the editors of CJSM and the CJSM blog journal club would like to take a moment to thank all of the health care professionals working tirelessly to keep all of our athletes, patients, support staff, and family members safe. We are proud of how the sports medicine community has conducted itself during this pandemic, and we are hopeful that vaccination will allow us to put this pandemic in the rear view mirror in the not-too-distant future.

To kick off 2021 we would like to review a wonderful manuscript from a team headed by Margot Putukian, M.D., past-president of the AMSSM, which analyzes preinjury and post-injury factors that predict sports-related concussion and clinical recovery time.

Purpose/Specific Aims:

1) The authors evaluated a possible relationship between preinjury risk factors (RFs) and resultant occurrence of concussion.

2) They also sought to examine whether preinjury RFs or post-injury assessments predicted clinical recovery in collegiate athletes

  • defined as days until symptom-free (DUSF) and days until full return to play (DUFRTP)

Read more of this post

CJSM and concussions — in the news

As 2020 rolls on and COVID dominates, quite rightly, much of the conversation in sports medicine, important research continues on topics of concern that have been present a lot longer than the novel SARS-CoV-2 virus.

CJSM prides itself on publishing a large number of primary research articles, which often get considerable media buzz. I wanted to share with you today two recent CJSM publications that have caught the attention of the lay press and are likely to have a significant and transformative impact on sports medicine practice.  The two research articles both address a long-standing concern of sports medicine — concussion in sport.

The first such article was published in our March 2020 edition: Distribution of Head Acceleration Events Varies by Position and Play Type in North American Football, a study whose team of authors primarily comes from Purdue University in the United States.  This pilot study contributes to the literature of risk mitigation in contact sport — how might we lower the incidence of concussion in a sport like North American football?  The findings were interesting enough to command the attention of Forbes magazine.

John Miller of the Buffalo Bills demonstrating a ‘2-point’ or ‘up’ stance. Photo Erik Drost, Wikimedia

This study evaluated the number of head acceleration events (HAEs) based on position, play type, and starting stance.  The most significant outcomes were reported for offensive linemen.  Offensive linemen in North American football have typically begun plays in a ‘down’, or what is known as a 3- or 4- point stance, as opposed to an ‘up’ or a 2-point stance. The position taken at the start of the play is sometimes dictated by what type of play, run vs. pass, may be run. Read more of this post

Concussions take time — CJSM Blog Post Journal Club

Our Jr. Assoc. Editor Jason Zaremski MD looking for some help from a friend with the newest CJSM Blog Post Journal Club

Our March 2020 issue has just published, and right out of the gate one of the studies that has received the most buzz is one from a team of researchers in New Zealand demonstrating that less than 50% of concussed individuals recover within two weeks of a sports-related concussion.

Jason Zaremski, MD, CJSM’s Jr. Assoc. Editor, explores this new study today in our most recent CJSM Blog post Journal Club.  It is a two year prospective study with some revealing findings. We’re sure you will enjoy the blog post and the study itself!

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Jason Zaremski MD

Kara S, et al. Less Than Half of Patients Recover Within 2 Weeks of Injury After a Sports-Related Mild Traumatic Brain Injury: A 2-Year Prospective Study. Clin J Sport Med 2020;30:96–101. doi.org/10.1097/JSM.0000000000000811.

Introduction:  Sports related concussion (SRC) is a common and significant concern, challenging not only sports medicine practitioners, but also athletes, coaches, family members, and all sports performance team members. While diagnostic skills and research in this area have dramatically improved in the past 10 years, our patients still have several questions, including: How long until I can go back and play? Some data has suggested the majority of SRC patients recover in approximately a 2-4 week recovery time frame. According to the consensus statement in concussion in sport (5th iteration) held in Berlin, Germany, in October 2016—“the expected duration of symptoms in children with SRC is up to 4 weeks.” (McCrory, et al. BJSM 2017).  Kara and colleagues  have looked into the validity of this stated time frame.

Purpose: To describe clinical recovery time and factors that could impact recovery after a sports-related mild traumatic brain injury (SR-mTBI, aka “concussion”).

Methods/Design:  This is a prospective cohort study with level IV evidence. Read more of this post

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