Advancing Concussion Assessment in Children (A-CAP)
The objective of A-CAP is to improve ability to diagnose pediatric concussion and make prognostic predictions about outcomes. A-CAP is a multi-site, prospective cohort study that is assessing a broad pool of neurobiological and psychosocial markers, including some not yet studied in any large-scale study (e.g., genes; psychological resilience; multi-model magnetic resonance imaging), and assess outcomes over 6 months post-injury. Recruitment for the study occurs when children present to the Emergency Department at five sites across Canada: Alberta Children’s Hospital (Calgary), Children’s Hospital of Eastern Ontario (Ottawa), Ste-Justine Hospital (Montreal), Stollery Children’s Hospital (Edmonton), and BC Children’s Hospital (Vancouver). All sites are members of the Pediatric Emergency Research Canada (PERC) network. Injury information is collected in the emergency department. A range of neurobiological and psychosocial markers, potential confounders, and outcomes (i.e., post-concussive symptoms, functional disability, quality of life) are assessed at follow-up visits within 10 days post-injury and at 3 and 6 months post-injury. Weekly symptoms ratings also are obtained remotely via smartphones or the Internet. The study will have a large sample (700 mTBI, 300 mild orthopaedic injuries) to enable the analysis of complex interactions among diagnostic and prognostic markers. We hypothesize that this strategy will (1) identify mTBI with excellent sensitivity and specificity (i.e., differentiate it from orthopaedic injury) and (2) predict longitudinal outcomes of mTBI.
Co-Investigators: William Craig, Quynh Doan, Miriam Beauchamp, Roger Zemek, Nishard Abdeen, Karen Barlow, Christian Beaulieu, Bruce Bjornson, Brian Brooks, Sylvain Deschenes, Carolyn Emery, Stephen Freedman, Jocelyn Gravel, Bradley Goodyear, Kristina Kowalski, Ryan Lamont, Catherine Lebel, Angelo Mikrogianakis, Kelly Mrklas, Kathryn Schneider, Lianne Tomfohr
Participating Centers: University of Calgary/Alberta Children’s Hospital (Calgary, AB), University of Ottawa/Children’s Hospital of Eastern Ontatrio (CHEO) (Ottawa, ON), University of Montreal/Ste-Justine Hopsital (Montreal, QB), University of Alberta/ Stollery Children’s Hospital (Edmonton, AB), University of British Columbia/BC Children’s Hospital (Vancouver, BC)
Funding: Canadian Institutes of Health Research (CIHR)
Mild Injury Outcomes Study (MIOS)
A critical decision confronting health care providers is how to predict in the acute setting which children will suffer persistent postconcussive symptoms (PCS) and functional impairments after mild traumatic brain injury (TBI). Various methods are recommended for the diagnostic evaluation of children with mild TBI, but no previous study has systematically compared the prognostic significance of these methods. The overall goal of MIOS is to examine the utility of diagnostic methods commonly used in clinical settings in the prediction of persistent PCS and functional impairments. Participants include 8- to 15-year-old children with mild TBI (n = 200) or mild orthopedic injuries (n = 100), recruited in the Emergency Departments (ED) at two large children’s hospitals. Acute signs and symptoms of concussion, as well as mental status and balance, are assessed using standardized methods at the time of recruitment. All children complete computerized neuropsychological testing and magnetic resonance imaging (MRI) within 7 days of injury. PCS are assessed remotely on a weekly basis using electronic devices during the first 6 months post injury. Functional impairments are assessed in person acutely and 3 and 6 months post injury. The proposed research is innovative because no previous study has compared the predictive utility of these commonly-used methods for assessing pediatric mild TBI. The specific aims are (1) to examine the prediction of PCS and functional impairments following mild TBI and (2) to determine the incremental predictive utility of each of four assessment methods. A comprehensive study of these diagnostic methods and their incremental utility in predicting outcomes will have a major impact on clinical practice, particularly in acute care settings, by helping improve prognostic determinations, develop decision tools, and focus treatment efforts.
Co-Investigators: H. Gerry Taylor, Barbara Bangert, Ann Bacevice, Leslie Mihalov, Daniel Cohen, Nicholas Zumberge, Naomi Hunsaker, Erin Bigler
Participating Centers: The Research Institute at Nationwide Children’s Hospital (Columbus, OH), Case Western Reserve University/Rainbow Babies and Children’s Hospital (Cleveland, OH); Brigham Young University, Provo, UT, USA
Funding: National Institutes of Health (NIH)
Implementation of the MNCY Clinical Pathway for Acute Care of Pediatric Concussion: Uptake, Outcomes, and Health Care Impacts
Multiple evidence-based clinical practice guidelines (CPGs) exist to manage the care of concussion in children, but these guidelines have not been implemented consistently in clinical settings. This reflects the failure to translate CPGs into specific clinical pathways (CPs) implemented with active, planned interventions. In Alberta, CPs do not currently guide the care of children with concussions presenting to acute care settings. The Maternal Newborn Child Youth (MNCY) Strategic Clinical Network of Alberta Health Services (AHS), established a working group to develop best-practice, evidence-based CPGs for the management of concussion. These CPGs were translated into specific CPs for pediatric acute care settings. The goal of the project is to conduct an expanded evaluation of the implementation of the CP for acute care of pediatric concussion across four acute care sites in Calgary and Edmonton. The three objectives of the project are: (1) Design an evidence-based, knowledge-user informed, and theory driven approach to implementation of the MNCY CP for acute care of pediatric concussion; (2) Evaluate the impact of the implementation on patient-centered outcomes using a stepped wedge cluster randomised trial; (3) Determine whether implementation of the MNCY CP is associated with changes in health care utilization and associated costs. Implementation is complete and the project is currently in the analysis phase.
Co-Investigators: Karen Barlow, Bruce Wright, Brenda Clark, Alf Conradi, Angelo Mikrogianakis, Kathryn Schneider, Roger Zemek
Participating Centers: University of Calgary, Alberta Children’s Hospital, South Health Campus, University of Alberta, Stollery Children’s Hospital, Grey Nuns Hospital, Northeast Community Health Centre
Funding: Brain Canada and AHS Health Outcomes Improvement Fund (HOIF)