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

Can you do a brief but comprehensive examination of a concussed patient in your clinic?

Well, can you?

If your exam is brief, can it be comprehensive? If it’s comprehensive, will you be able to get through all of the patients on your schedule?

These are some practical questions that most of us in the world of sports medicine struggle with.

I’m looking at my clinic schedule tomorrow, and I have 15 minutes for most patients; for new concussed patients I’m ‘given’ 30 minutes.

Most of us know these clinic slots are a Procrustean bed – there really is little chance we can fit the patient and their needs, as well as our obligation to diagnose and manage the injury, in these time frames.

M. Nadir Haider, M.D.

Good news, then – authors from the University of Buffalo Concussion Management Clinic have just produced a Practical Management article that promises to make your approach much more efficient when you next see a clinic patient with a sports related concussion (SRC).

The first and corresponding author of this manuscript, M Nadir Haider, M.D., is our guest on the newest CJSM blog post. Dr. Haider is affiliated with the Jacobs School of Medicine, State University of New York (SUNY), Buffalo where he is an Assistant Professor of Orthopedics and Sports Medicine and the Assistant Director of Research at the University Concussion Management Clinic. Many of the readers of CJSM and listeners of the podcast will be familiar with the voluminous research that comes out of the SUNY, Buffalo center.  This work has been transformative in the area of SRCs.

Listen in on our conversation, where Dr. Haider walks us through the evidence-based exam, and then go to the September 2020 CJSM where you will find the Practical Management article itself, currently free of charge.

As always you can find the podcast on our journal website, or you may go to iTunes to listen in and subscribe as well.

Any way you read, listen or engage with CJSM, we are happy you are part of our sports medicine community.

Exercise as a prescription to address post-concussion syndrome: The CJSM Blog Journal Club

Sports like American football are taking place in the midst of COVID19 — concussions are sure to follow

Our September 2020 edition has just published, and this edition is a particularly compelling one, full of original research.  You have to check it out.

As ever our Jr. Associate Editor Jason Zaremski M.D. has just posted his newest submission to the CJSM journal club.

While COVID19 is wreaking havoc with sports schedules around the globe, there are enough high schools and youth sports programs active that concussions will continue to remain a challenge for clinicians to treat.  And post-concussion syndrome is one particularly challenging aspect to this injury.  Dr. Zaremski walks us through original research looking at an ‘exercise prescription’ to treat post-concussion syndrome.

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Jason Zaremski MD

Gauvin-Lepage J, Friedman D, Grilli L, Sufrategui M, De Matteo C, Iverson, GL, Gagnon I. Effectiveness of an Exercise-Based Active Rehabilitation Intervention for Youth Who Are Slow to Recover After Concussion, Clinical Journal of Sport Medicine: September 2020 – Volume 30 – Issue 5 – p 423-432 doi: 10.1097/JSM.0000000000000634

Introduction:  With the change of seasons, many of our readers return to covering pediatric and adolescent sport. In the Northern Hemisphere, summer vacation is over, and academics and school sports are commencing. Fall is the start of the gridiron football season and there is often a surge of concussed youth who need effective, evidence-based management.

This month the CJSM Journal Club has chosen to highlight original research on the effectiveness of exercise-based rehabilitation in 8-17 year youth who have sustained a concussion. In this age group, return to school is even more important than return to sport, and the lingering difficulties in intellectual ability, vestibular system function, memory, and/or attention can be particularly debilitating.  The authors in this new study report that between 20% and 30% of all concussed youth will endorse post-concussive symptoms (PCS) 1 month after injury. Further research into treatments and modalities aimed at reducing the frequency with which children and adolescents experience PCS is paramount.

Purpose: The authors state two aims:

1) To determine the impact of providing participants (aged 8 to 17 years) who are slow to recover after a concussion with an active rehabilitation intervention (ARI) compared to receiving standard care alone, at 2 and 6 weeks after the initiation of the ARI.

2) To investigate functional recovery 6 weeks after initiation of the ARI.

Setting: Tertiary care pediatric trauma center and associated community health care providers. Read more of this post

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