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Lennart Riemann, Daphne C. Voormolen, Katrin Rauen, Klaus Zweckberger, Andreas Unterberg, Alexander Younsi, and the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants

(LOC) of 30 minutes, and posttraumatic amnesia (PTA) less than 24 hours after the brain impact. 2 , 3 Acute postconcussive symptoms after mTBI can be severe and might include somatic symptoms such as headaches, cognitive symptoms such as difficulty concentrating, and affective symptoms such as irritability. In a considerable fraction of patients, symptoms can chronically persist for weeks, months, or even years. 4 The prevalence of prolonged postconcussive symptoms in young patients varies depending on the diagnostic criteria used and the population studied

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R. Anna Oeur, Clara Karton, Andrew Post, Philippe Rousseau, T. Blaine Hoshizaki, Shawn Marshall, Susan E. Brien, Aynsley Smith, Michael D. Cusimano, and Michael D. Gilchrist

. 25 , 29 The combined effects of both short- and long-term outcomes of concussion contribute to the 3.8 million people affected annually by traumatic brain injury (TBI) in the US, costing an estimated $12 billion for hospitalization and treatment. 7 , 22 The severity of a concussion is typically determined by the number, severity, and duration of presenting symptoms. 3 , 36 , 37 Some patients have reported symptoms t hat resolve within 7–10 days, 23 whereas other patients suffer from persistent postconcussive symptoms (PPCS), often having symptoms lasting from

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Scott L. Zuckerman, Rachel P. Apple, Mitchell J. Odom, Young M. Lee, Gary S. Solomon, and Allen K. Sills

an athlete to play. 5 Although most postconcussive symptoms are transient, a minority of athletes suffers from long-term sequelae, lasting up to 12 months postinjury. 2 , 9 , 19 A protracted recovery, often termed postconcussion syndrome, can result in an athlete's removal from a sport or team, which may lead to reactive depression, interference with both school and extracurricular activities, and participation in potentially dangerous activities, such as drugs or alcohol. 8 , 40 Available data suggest that male and female athletes differ in terms of quantity

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Joseph H. Miller, Clarence Gill, Elizabeth N. Kuhn, Brandon G. Rocque, Joshua Y. Menendez, Jilian A. O'Neill, Bonita S. Agee, Steven T. Brown, Marshall Crowther, R. Drew Davis, Drew Ferguson, and James M. Johnston

patients with postconcussive symptoms that persisted longer than 28 days, indicating a delayed recovery outcome, and the control group comprised patients who had symptom resolution within 28 days, indicating an early recovery outcome. Symptom resolution was defined as the return of a patient to his or her preconcussion state of health with complete resolution of postconcussive symptoms. Recovery was defined as patients who were free of these symptoms both at rest and with exertion. The patient reported the time of symptom resolution at his or her last clinical follow

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Benjamin M. Krainin, Corrine N. Seehusen, Katherine L. Smulligan, Mathew J. Wingerson, Julie C. Wilson, and David R. Howell

, Meehan WP III , Freedman SB , Yeates KO , Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents . JAMA . 2016 ; 316 ( 23 ): 2504 – 2514 . 12 Thomas DG , Apps JN , Hoffmann RG , McCrea M , Hammeke T . Benefits of strict rest after acute concussion: a randomized controlled trial . Pediatrics . 2015 ; 135 ( 2 ): 213 – 223 . 13 Leddy JJ , Hinds AL , Miecznikowski J , Darling S , Matuszak J , Baker JG , Safety and

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Jennifer Strahle and Cormac O. Maher

population being studied 5 , 8 , 10 and that the prevalence of CM is higher in a population of children and young adults than in the general population or a population that includes a large number of older adults. Age differences are especially relevant when comparing to a group experiencing postconcussive symptoms since a group of patients experiencing concussion is likely to be younger than a cohort undergoing imaging for any reason. The second article that is referenced for CM prevalence is a review article that attempted to derive CM prevalence by back

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Vin Shen Ban, Julian E. Bailes, Mitchel S. Berger, Alexander R. Vaccaro, and H. Hunt Batjer

youth sport, where obtaining an accurate diagnosis in a timely fashion is critical due to the possibility of SIS. The contemporary theory is that the appropriate clinical management of sports-related TBI should accelerate return to school and return to play. Particularly challenging are athletes who have sustained multiple concussions, experienced increasing recovery times, and suffered from prolonged postconcussive symptoms. Ellis and colleagues discuss their institutional approach toward return to play and retirement considerations in youth athletes, using 3 cases

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Matthew Tormenti, Donald Krieger, Ava M. Puccio, Malcolm R. McNeil, Walter Schneider, and David O. Okonkwo

. 11 This information is useful for comparison with later evaluation to assess the effects of treatment. Neurophysiological Testing and Concussion Evidence of electrophysiological differences following concussion has been evaluated in the past. Gaetz and Weinberg 3 examined patients postconcussion with a variety of EP and ERP assessment tools. The authors found that the group of patients who reported postconcussive symptoms had a higher percentage of individuals with responses that exceeded 2.5 SDs from the mean of the norm. Using a chi-square analysis, the

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Scott L. Zuckerman, Aaron M. Yengo-Kahn, Thomas A. Buckley, Gary S. Solomon, Allen K. Sills, and Zachary Y. Kerr

emergency population . Brain Inj 13 : 173 – 189 , 1999 8 Belanger HG , Barwick FH , Kip KE , Kretzmer T , Vanderploeg RD : Postconcussive symptom complaints and potentially malleable positive predictors . Clin Neuropsychol 27 : 343 – 355 , 2013 9 Carson JD , Lawrence DW , Kraft SA , Garel A , Snow CL , Chatterjee A , : Premature return to play and return to learn after a sport-related concussion: physician's chart review . Can Fam Physician 60 : e310 – e312 – e315 , 2014 10 Conder R , Conder AA : Neuropsychological

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Eliel N. Arrey, Marcia L. Kerr, Stephen Fletcher, Charles S. Cox Jr., and David I. Sandberg

, Hoyt DB , Morris JA , : The clinical utility of computed tomograph-ic scanning and neurologic examination in the management of patients with minor head injuries . J Trauma 33 : 385 – 394 , 1992 19 Thiessen ML , Woolridge DP : Pediatric minor closed head injury . Pediatr Clin North Am 53 : 1 – 26 , v , 2006 20 Yeates KO , Kaizar E , Rusin J , Bangert B , Dietrich A , Nuss K , : Reliable change in postconcussive symptoms and its functional consequences among children with mild traumatic brain injury . Arch Pediatr Adolesc