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Davenport E.M.,Advanced Neuroscience Imaging Research ANSIR Laboratory | Davenport E.M.,Virginia Polytechnic Institute and State University | Whitlow C.T.,Advanced Neuroscience Imaging Research ANSIR Laboratory | Whitlow C.T.,Medical Center Boulevard | And 11 more authors.
Journal of Neurotrauma | Year: 2014

The aim of this study was to determine whether the cumulative effects of head impacts from a season of high school football produce magnetic resonance imaging (MRI) measureable changes in the brain in the absence of clinically diagnosed concussion. Players from a local high school football team were instrumented with the Head Impact Telemetry System (HITS™) during all practices and games. All players received pre- and postseason MRI, including diffusion tensor imaging (DTI). Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) was also conducted. Total impacts and risk-weighted cumulative exposure (RWE), including linear (RWELinear), rotational (RWERotational), and combined components (RWECP), were computed from the sensor data. Fractional, linear, planar, and spherical anisotropies (FA, CL, CP, and CS, respectively), as well as mean diffusivity (MD), were used to determine total number of abnormal white matter voxels defined as 2 standard deviations above or below the group mean. Delta (post-preseason) ImPACT scores for each individual were computed and compared to the DTI measures using Spearman's rank correlation coefficient. None of the players analyzed experienced clinical concussion (N=24). Regression analysis revealed a statistically significant linear relationship between RWECPand FA. Secondary analyses demonstrated additional statistically significant linear associations between RWE (RWECPand RWELinear) and all DTI measures. There was also a strong correlation between DTI measures and change in Verbal Memory subscore of the ImPACT. We demonstrate that a single season of football can produce brain MRI changes in the absence of clinical concussion. Similar brain MRI changes have been previously associated with mild traumatic brain injury. © Mary Ann Liebert, Inc.

Cobb B.R.,Wake forest University | Urban J.E.,Wake forest University | Urban J.E.,Medical Center Blvd | Davenport E.M.,Wake forest University | And 8 more authors.
Annals of Biomedical Engineering | Year: 2013

Head impact exposure in youth football has not been well-documented, despite children under the age of 14 accounting for 70% of all football players in the United States. The objective of this study was to quantify the head impact exposure of youth football players, age 9-12, for all practices and games over the course of single season. A total of 50 players (age = 11.0 ± 1.1 years) on three teams were equipped with helmet mounted accelerometer arrays, which monitored each impact players sustained during practices and games. During the season, 11,978 impacts were recorded for this age group. Players averaged 240 ± 147 impacts for the season with linear and rotational 95th percentile magnitudes of 43 ± 7 g and 2034 ± 361 rad/s2. Overall, practice and game sessions involved similar impact frequencies and magnitudes. One of the three teams however, had substantially fewer impacts per practice and lower 95th percentile magnitudes in practices due to a concerted effort to limit contact in practices. The same team also participated in fewer practices, further reducing the number of impacts each player experienced in practice. Head impact exposures in games showed no statistical difference. While the acceleration magnitudes among 9-12 year old players tended to be lower than those reported for older players, some recorded high magnitude impacts were similar to those seen at the high school and college level. Head impact exposure in youth football may be appreciably reduced by limiting contact in practices. Further research is required to assess whether such a reduction in head impact exposure will result in a reduction in concussion incidence. © 2013 The Author(s).

Urban J.E.,Wake forest University | Urban J.E.,Medical Center Blvd | Davenport E.M.,Wake forest University | Davenport E.M.,Medical Center Blvd | And 10 more authors.
Annals of Biomedical Engineering | Year: 2013

Sports-related concussion is the most common athletic head injury with football having the highest rate among high school athletes. Traditionally, research on the biomechanics of football-related head impact has been focused at the collegiate level. Less research has been performed at the high school level, despite the incidence of concussion among high school football players. The objective of this study is to twofold: to quantify the head impact exposure in high school football, and to develop a cumulative impact analysis method. Head impact exposure was measured by instrumenting the helmets of 40 high school football players with helmet mounted accelerometer arrays to measure linear and rotational acceleration. A total of 16,502 head impacts were collected over the course of the season. Biomechanical data were analyzed by team and by player. The median impact for each player ranged from 15.2 to 27.0 g with an average value of 21.7 (±2.4) g. The 95th percentile impact for each player ranged from 38.8 to 72.9 g with an average value of 56.4 (±10.5) g. Next, an impact exposure metric utilizing concussion injury risk curves was created to quantify cumulative exposure for each participating player over the course of the season. Impacts were weighted according to the associated risk due to linear acceleration and rotational acceleration alone, as well as the combined probability (CP) of injury associated with both. These risks were summed over the course of a season to generate risk weighted cumulative exposure. The impact frequency was found to be greater during games compared to practices with an average number of impacts per session of 15.5 and 9.4, respectively. However, the median cumulative risk weighted exposure based on combined probability was found to be greater for practices vs. games. These data will provide a metric that may be used to better understand the cumulative effects of repetitive head impacts, injury mechanisms, and head impact exposure of athletes in football. © 2013 Biomedical Engineering Society.

Loftis K.L.,Wake forest University | Pranikoff T.,Wake forest University | Pranikoff T.,Childress Institute for Pediatric Trauma | Anthony E.Y.,Wake forest University | And 4 more authors.
48th Annual Rocky Mountain Bioengineering Symposium and 48th International ISA Biomedical Sciences Instrumentation Symposium 2011 | Year: 2011

Pediatric occupants are vulnerable in motor vehicle crashes (MVCs), and alternative restraints have been developed for their protection. T his study sought to characterize injuries in MVCs for pediatric occupants and to identify scenarios that m ay benefit from enhanced vehicle safety. Using the NASS-CDS database (2000-2008), pediatri c occupants (< 19 yr old) were characterized by their age and injuries to look at national averag es in MVCs. There were over 14 million pediatric injuries and non-injured occupants in weighted NASS-CDS (out of over 70 million total). Of these pediatric cases, 60% sustained injuries, which was comparable to the percentage of all occupants injured (65%). Six percent of NASS-CDS pediatric occupants had AIS 2+ injuries, which is the injury inclusion criteria for CIREN pediatric cases. CIREN was used to investigate pediatric occupants and injuries resulting from incorrect positioning and restrain ts according to NHTSA sugge stions. Results indicated that m any injured pediatric occupants were not properly restrained, with over 100 in the fr ont row of the vehicle under 13 years of age. There were also over 200 CIREN pediatric occupants under 4′ 9″ that were not seated in a child safety seat (CSS). The most frequently injured body region was the face, followed by the head and lower extremity. Eighty-six percent of head injuries and 82% of spinal injuries were AIS 2+. This study supports prior findings that demonstrate a need for enhanced public awareness for proper CSS use to reduce pediatric injuries in the future.

Doud A.N.,Childress Institute for Pediatric Trauma | Lawrence K.,Weill Cornell | Zeller K.A.,Childress Institute for Pediatric Trauma
Journal of Pediatric Surgery | Year: 2015

Background Parental, familial, and demographic risk factors for nonaccidental trauma (NAT) have been well-studied, but neonatal factors, such as comorbidities and prematurity have not. We assess the correlation of these factors with NAT. Methods A total of 234 cases of NAT and 287 cases of accidental trauma (AT) among children < 1 year were identified in a trauma registry. Known risk factors for NAT, gestational age, and neonatal comorbidities were abstracted from medical records. Chi-square analysis and logistic regression evaluated the association of prematurity and comorbidities with NAT compared to AT with and without controlling for confounders. Results Children treated for NAT were younger than those treated for AT and were more likely to have younger parents with substance abuse issues. Prematurity, major comorbidities, and minor comorbidities were more common in those treated after NAT than after AT (24.8% vs 12.7%, p = 0.0004; 25.6% vs 7.2%, p < 0.0001, and 42.6% vs 29.3%, p = 0.0014, respectively). After model adjustments for other risk factors, major comorbidity remained a significant risk factor for NAT compared to AT, with an adjusted odds ratio of 4.37 (p < 0.0001). Conclusions Among other risk factors, neonatal factors predict a child's risk for abuse. We have an opportunity for targeted preventive interventions among this at-risk population. © 2015 Elsevier Inc. All rights reserved.

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