Page 76 - NNS 2014 Program & Abstract Book

A5-04
THE INCIDENCE OF TRAUMATIC BRAIN INJURY IN THE
COUNTY OF KAINUU, FINLAND: THE KAINUU TBI CO-
HORT
Kemppainen, S.1, Pitka¨nen, A.2, Tenovuo, O.4, Sillanpa¨a¨, M.3
1NordLab, Kajaani, Finland
2University of Eastern Finland, Kuopio, Finland
3University of Turku, Turku, Finland
4Turku University Hospital and University of Turku, Turku, Finland
Aim of the study is to provide up-to-date retrospective information on
the incidence rate, demography and etiology, and evaluate the state of
clinical practice in adults ( >16 yrs) with traumatic brain injury (TBI).
All patients with an ICD-10 diagnostic code indicating TBI or a
high probability of TBI were collected from the medical files of
Kainuu Central Hospital during 2004–12 (population 85000). De-
mographic features, etiology, and clinical findings for the diagnosis of
TBI were reviewed.
We identified 2300 potential TBI patients of which the first 460 were
reviewed. Of them, 23 patients were excluded because of TBI before
year 2004, 70 patients were 16 or less by age, and further 49 patients
were living outside the region of Kainuu. Of the remaining 318 patients,
96 were diagnosed non-TBI and 59 uncertain TBI. The remaining 163
had definite TBI (59% males, 41% females) and make up the final study
sample. The annual incidence of TBI was 107/100000 inhabitants,
calculated, on the basis of the sample, from potential TBI patients in the
study population. Falls were the leading cause of TBI. Seven percent of
163 patients were admitted to the intensive care unit, 58% to an in-
patient ward, and the remaining 35% to an out-patient ward. Three
percent of the patients were unconscious at admission to hospital, 9%
had lowered level of consciousness, and the remaining 88% were fully
conscious. Disorientation, headache, and nausea were symptoms of
40% of patients, and evidence of unconsciousness or amnesia was found
in 35% of patients. Acute CT scan was acquired of 48% of patients; one
third had acute TBI related findings.
The observed incidence of TBI was relatively low compared to
previous epidemiologic studies suggesting that many TBIs remain
undiagnosed.
Key words
cohort, epidemiology, incidence, retrospective, traumatic brain injury
A5-05
OBSERVED DIFFERENCES BETWEEN ATHLETES WITH
AND WITHOUT ADD AT BASELINE AND ACUTE POST-
CONCUSSION ASSESSMENT
Pardini, J.E.1, Sandel, N.2 , Saad, A.3, Johnson, E.W.4, Lovell, M.R.1
1University of Pittsburgh Medical Center; Department of Neurologi-
cal Surgery, Pittsburgh, PA, USA
2Widener University, Chester, PA, United States
3Chatham University, Pittsburgh, PA, United States
4University of Pittsburgh Medical Center; Sports Medicine Concus-
sion Program; Department of Orthopedic Surgery, Pittsburgh, PA,
United States
Sport-related concussion has been increasingly studied as its impor-
tance as a public health concern has grown. Computerized neu-
ropsychological testing is an important component in concussion
management. In this study, we examined baseline and acute post-
injury performance of concussed athletes who reported a history of
Attention Deficit Disorder (ADD), in comparison to a matched sample
who did not report the diagnosis.
Subject data was acquired from a larger de-identified database.
Included were athletes aged 14–18 who had completed baseline and
post-injury computerized neuropsychological testing. A group of
athletes who reported a history of ADD were acquired (n1 = 970), then
an age-matched comparison group was extracted (n2 = 970). Outcome
measures included the Verbal Memory, Visual Memory, Visual Motor
Speed, and Reaction Time composites from the ImPACT test, from
the baseline and acute post-injury (< 7 days) assessments.
1940 subjects were included in the analysis, 75% were male, and
mean age was 15.65. MANOVA revealed significant differences
across all composites when comparing baseline (F = 26.06; p < .001)
and post-injury (F = 72.03, p < .001) scores, with the ADD group
performing worse. Both groups saw expected declines from baseline
for all composites (p < 0.05) following injury. The interaction between
time and ADD diagnosis was also significant (F = 3.29, p < .05).
The findings underscore the importance of having a valid baseline
for all athletes prior to participation in a contact sport. Additionally,
given observed differences in group performances for athletes with
ADD, as well as the notion that this population may demonstrate
greater variability in baseline performance, it is essential to obtain
baseline testing for these and other special populations. Both groups
showed expected declines in performance following concussion.
Key words
ADD, computerized testing, concussion
B1-01
EVALUATION OF THE MILITARY FUNCTIONAL ASSESS-
MENT PROGRAM: ASSESSMENT OF THE CONSTRUCT
VALIDITY USING ARCHIVED CLINICAL DATA
Kelley, A.M.1 , Ranes, B.2, Estrada, A.1, Grandizio, C.M.1
1U.S. Army Aeromedical Research Laboratory, Fort Rucker, USA
2Oak Ridge Institute of Science and Education, Belcamp, MD, USA
There are several important factors to consider when making a deci-
sion to return a Soldier to duty after a traumatic brain injury (TBI). If
returned prematurely, there is an increased risk for not only second
impact syndrome during the acute phase of the injury, but also per-
manent changes from repetitive concussions. Thus, there is a critical
need for a set of return-to-duty (RTD) assessment criteria that en-
compasses the spectrum of injury and disease experienced by U.S.
Soldiers, particularly TBI. Fort Campbell National Intrepid Center of
Excellence-Intrepid Satellite III has developed and begun im-
plementing the Military Functional Assessment Program (MFAP),
which uses face-valid military tasks paired with clinical assessments
to help determine a Soldier’s readiness for active duty.
The objective of this study was to provide evidence-based standards
that may eventually serve as criteria for operational competence and
performance of a Soldier after injury. Specifically, the relationships
between clinical assessments and the MFAP’s novel military-specific
tasks were evaluated. Exploratory analyses (including non-parametric
tests and Spearman’s rank correlations) were conducted on an archived
database of 79 patients with TBI who participated in the MFAP.
Several of the military operational assessment tasks correlated
significantly with clinical measures of vestibular function, psycho-
logical well-being, and cognitive function. Soldiers who passed the
MFAP differed significantly from Soldiers who did not pass the
MFAP on clinical function, self-reported occupational performance,
psychological well-being, and Military Acute Concussion Evalua-
tion (MACE) scores.
A-44