Page 92 - NNS 2014 Program & Abstract Book

recruit participants over 3 years, with a second center coming on-
line in years 4 and 5.
Target population: Children aged 13 to 18 years with mTBI who
remain symptomatic at 30 days post-injury.
The mechanisms of action of melatonin relevant to mTBI and
PCS in youth will be presented, together with results of a case-
series of children with PCS treated with melatonin. The PLAY-
GAME trial, which began enrolment in November 2013 will be
presented.
Key words
melatonin, mild traumatic brain injury, neuroprotection, post con-
cussion syndrome
B4-03
EFFECT OF A COMMUNITY EDUCATION PROGRAM ON
PEDIATRICIAN’S MANAGEMENT OF CONCUSSIONS
Hall, L.B.1, Reisner, A.1, Jain, S.1 , Chern, J.J.1, Weselman, B.2, Hogan,
E.2, Speake, K.1, Johnson, E.1 , Hatcher, B.1, Polikandriotis, J.A.1, Clark,
G.3, Marshall, D.4, Waldner, D.1, Licata, R.M.5, Burns, T.G.1
1Children’s Healthcare of Atlanta, Atlanta, USA
2Kids Health First, Atlanta, USA
3North Fulton Pediatrics, Roswell, USA
4Children’s Orthopaedics of Atlanta, Atlanta, USA
5Pediatric Associates, Marietta, USA
Although pediatricians frequently manage concussions, they often
feel ill-equipped to execute treatment, possibly due to inadequate
training, lack of universally accepted guidelines, and misconcep-
tions regarding concussion management. Here, we implemented
community-wide, comprehensive education on concussion manage-
ment and aimed to evaluate its impact on practice and attitudes in
concussion management.
A comprehensive evidence-based educational curriculum on
concussion management was established through a concussion
program at a tertiary teaching hospital. In June, 2012, web-based
education and lectures were provided on definitions, symptoms,
emergency/specialist referral, and CT scanning. Pre-program
surveys were distributed to 614 pediatricians in May, 2012, and
post-surveys were distributed 18 months later (Oct, 2013) to 619
pediatricians. We analyzed overall knowledge, comfort level in
managing concussions, ability to manage various head injury sce-
narios, and understanding of management options. Data were an-
alyzed using Chi-square tests.
Overall, 204/614 and 157/619 pediatricians responded to the pre-
and post-surveys, respectively. Pre- to post-survey, pediatricians re-
porting ‘comfortable’ or ‘very comfortable’ managing concussions
increased from 71.6% to 84.1% (146/204 to 132/157; p < 0.01). Use of
guidelines to manage concussions increased from 59.3% to 91.0%
(121/204 to 142/156; p < 0.001). Pediatricians advising gradual return
to play after a concussion increased from 39.7% to 64.7% (81/204 to
101/156; p < 0.001).
Implementing a concussion education program for pediatricians
improved self-reported practice and attitudes on managing children
with concussions, including comfort level and use of guidelines and
evidence-based strategies. This has implications on reducing unnec-
essary short-term interventions and optimizing longer-term outcomes
via safer return to play.
Key words
community education, concussion, mild traumatic brain injury, pedi-
atrician
B4-04
MATRIX METALLOPROTEINASES AS THERAPEUTIC
TARGETS FOR THE INJURED PEDIATRIC BRAIN
Trivedi, A.1, Semple, B.D.1, Gimlin, K.1 , Gooyit, M.2, Peng, Z.2,
Hesek, D.2 , Lee, M.2, Pi, H.2, Schroeder, V.A.2, Suckow, M.A.2, Chang,
M.2, Noble-Haeusslein, L.J.1
1Department of Neurosurgery, UCSF, San Francisco, USA
2Department of Chemistry, Biochemistry, and Biological Sciences,
University of Notre Dame, Notre Dame, USA
Matrix-metalloproteinase (MMP)-9 and - 2, are destructive proteo-
lytic enzymes and key mediators of damage in adult traumatic brain
injury (TBI). Their involvement in the injured pediatric brain has to be
determined. In the pediatric brain, we found upregulation of pro-
MMP-9 and pro-MMP-2 by gelatin zymography within the first 48
hours post-injury. To determine the contribution of these gelatinases
to long-term recovery, male mice subjected to TBI at postnatal day 21
were treated acutely with p-OH-SB-3CT, a potent gelatinase inhibitor,
or vehicle and evaluated at adulthood. Both groups showed similar
long-term functional impairments (hyperactivity, deficits in learning
and spatial memory, and sociability), neuronal and tissue loss. In light
of these findings, we examined indices of cell death in the acutely
injured brain. Immunofluorescence displayed equivalent levels of
TUNEL and caspase-3 in both groups. Such findings prompted a more
extensive profiling of actively expressed MMPs in the acutely injured
brain. A newly developed assay to identify and quantify active MMPs
and related proteins revealed no active forms of MMP-9 and - 2
but rather active MMP-19 and a disintegrin and metalloproteinase
domain-containing protein (ADAM)-9 and ADAM-10, with ADAM-10
significantly increased after TBI and unaffected by treatment. These
results demonstrate a unique profile of MMPs and ADAMs in the
acutely injured immature brain, a finding that contrasts the dominant
role of MMP-2 and - 9 in the injured adult brain. Such findings
underscore the concept that the developing brain shows acute injury-
related responses that are unique from those of the injured adult brain.
Thus, understanding the processes of long-term structural and func-
tional recovery after pediatric TBI is contingent upon a broader pro-
filing of the acute injury-response to precisely delineate those
pathogenic targets that are determinants of long-term recovery.
Funding:NINDS-R01NS050159
Key words
cognitive behavior, developing brain, gelatinases, MMP, traumatic
brain injury
B4-05
EMOTION PROCESSING FOLLOWING PEDIATRIC TRAU-
MATIC BRAIN INJURY
Johnson, C.P., Prasad, M.P., Waugh, J.K., Ewing-Cobbs, L.
Children’s Learning Institute, University of Texas Health Science
Center, Houston, TX
Children with traumatic brain injury (TBI) often have difficulty in the
domains of behavioral control and social skills, including difficulty
identifying the emotional state and intentions of other people. We
investigated whether children with TBI also have difficulty ascer-
taining emotional state from facial cues, which may also prompt errors
in attribution of intention in others.
Participants included 57 children between the ages of 8 and 16
years of age split into three groups: traumatic brain injury (n = 23),
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