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Derivation of a Focused, Brief Concussion Physical Examination for Adolescents With Sport-Related Concussion

Leddy, John, MD*; Lesh, Kevin, MD*; Haider, Mohammad N., MD*,†; Czuczman, Natalie, MD; Baker, John G., MD*,§; Miecznikowski, Jeffrey, PhD; Willer, Barry, PhD

doi: 10.1097/JSM.0000000000000686
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Objective: To describe the derivation of a brief but pertinent physical examination (PE) for adolescents who have sustained sport-related concussion (SRC).

Design: Prospective cohort.

Setting: University concussion management clinic.

Participants: Acutely concussed (AC, n = 52, 15.5 ± 1.4 years, 4.4 ± 2 days since injury, 26.2 ± 38 days to recovery, 71% males) and healthy control (HC) adolescents (n = 30, 15.8 ± 1.4 years, 73% males).

Intervention: Acutely concussed had a PE on visit 1 and were retested at visit 2 (13.6 ± 1 day after visit 1). Acutely concussed were further characterized as normal recovery (NR, n = 41, 15.5 ± 1.5 years, recovery time 13.0 ± 7 days) and delayed recovery (DR, n = 11, 15.5 ± 1.2 years, recovery time 75.4 ± 63 days).

Main Outcome Measure: Physical examination findings, including cervical, vestibular, and oculomotor systems.

Results: Visit 1 abnormal PE signs were significantly greater in AC versus HC (2.79 ± 2.13 vs 0.07 ± 0.37, P < 0.0001) but not in NR versus DR (2.61 ± 2.2 vs 3.45 ± 1.8, P = 0.246). Visit 2 abnormal PE signs differentiated NR versus DR (0.17 ± 0.7 vs 2.45 ± 2.1, P < 0.0001).

Conclusions: A brief focused PE can help to diagnose SRC, establish recovery, and may have prognostic value.

*Department of Orthopedics and Sports Medicine, UBMD Orthopedics and Sports Medicine, SUNY at Buffalo, Buffalo, New York;

Department of Neuroscience, SUNY at Buffalo, Buffalo, New York;

SUNY at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York;

Departments of §Nuclear Medicine;

Biostatistics; and

Psychiatry, SUNY at Buffalo, Buffalo, New York.

Corresponding Author: Mohammad N. Haider, MD, University at Buffalo, The State University of New York, 160 Farber Hall, 3435 Main Street, Buffalo, NY 14214 (haider@buffalo.edu).

Research reported in this publication was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under award number 1R01NS094444. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR001412 to the University at Buffalo.

The authors report no conflicts of interest.

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The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Received April 11, 2018

Accepted September 18, 2018

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