Concussion, Mild
Conditions
Brief summary
The purpose of this study is to identify changes in salivary micro ribonucleic acid (miRNA) levels that are predictive of symptom duration and character following mild traumatic brain injury (mTBI) in children.
Detailed description
The objective of this multi-center study is to refine and validate a saliva RNA assessment for youth concussion, yielding a non-invasive test that predicts duration and character of symptoms, and helps guide clinical decisions. To accomplish this goal, the study will enroll 750 youth with mTBI. Saliva RNA levels and symptoms will be assessed at enrollment, 7 days, and 30 days post-injury. Aim 1 will assess the ability of saliva RNA to predict PPCS 30 days after mTBI (defined by reliable change index, or persistence of ≥2 symptoms on day 30, compared with pre-injury state on the Post-Concussion Symptom Inventory; PCSI). RNA accuracy will be compared to a validated clinical prediction tool (5p tool). Aim 2 will assess the ability of saliva RNA levels to identify recovered participants on day 30. RNA accuracy will be compared to change in composite score on a standardized reaction time test (from enrollment to day 30). Completion of these aims will yield an objective biologic test that can be used for prognosis at the time of mTBI, and to aid clinical decisions regarding return-to-learn or return-to-play.
Interventions
None listed
Sponsors
Milton S. Hershey Medical Center
National Institutes of Health (NIH)
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
5 Years to 24 Years
Healthy volunteers
No
Inclusion criteria
* Presence of mTBI: defined by criteria from the Berlin Consensus Statement and WHO. Assessment for mTBI status be performed by a licensed clinician per the 2018 CDC guidelines. * Age at enrollment: 5-24 years of age (inclusive).
Exclusion criteria
* \>7d after initial mTBI * Glasgow Coma Scale score of 13 or less * Previous moderate-to-severe TBI requiring overnight hospitalization * Unresolved symptoms from previous concussion, or any concussion within the last 3 months * Abbreviated Injury Scale (AIS) score \> 3 (to reduce confounding from poly-trauma) * Psychiatric illness requiring previous hospitalization; * Neurological condition (e.g. epilepsy, hydrocephalus) or abnormality on neuroimaging (if performed) * Intellectual disability that prevents ability to provide informed assent * Pregnancy * Active substance use/dependence * Previous neurosurgery * Non-fluency in English * Upper respiratory infection * Periodontal infection * Injury to the oropharynx * Previously enrolled in the same study * Inability to complete follow-up assessments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Presence or absence of persistent post-concussive symptoms (PPCS) 30 days after injury | 30 days after injury | PPCS will be defined by reliable change index on day 30, compared with pre-injury state, which will be determined from pre-injury symptoms reported at enrollment using the Post-Concussion Symptom Scale (PCSS). PCSS is a self reported survey that focus on symptoms in the cognitive, emotional, sleep, and physical domains. This form is called the "Sport Concussion Assessment Tool- 5th Edition" and symptoms are scored from 0 to 6 with 0 being no symptom and 6 being severe. A high score is indicative of a subject experiencing the worst they have experienced this symptom. |
| Presence or absence of concussion recovery 30 days after injury | 30 days after injury | Defined as a score of 0 (no difference) on item 22 of the Post-Concussion Symptom Inventory (PCSI); "To what degree do you feel 'differently' than before your injury?" This patient-oriented outcome measure relies on the individual's experience of symptoms to define recovery.PCSI is a self reported survey that focus on symptoms in the cognitive, emotional, sleep, and physical domains. This form is called the "Sport Concussion Assessment Tool- 5th Edition" and symptoms are scored from 0 to 6 with 0 being no symptom and 6 being severe. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Concussion symptom burden and severity | Within 48 hours of injury, 7 days post-injury, and 30 days post-injury | measured as ranked scores by the PCSI at enrollment, PCSI is a self reported survey that focus on symptoms in the cognitive, emotional, sleep, and physical domains. This form is called the "Sport Concussion Assessment Tool- 5th Edition" and symptoms are scored from 0 to 6 with 0 being no symptom and 6 being severe. Symptom burden will be number of symptoms experiencing and severity will be how sever those symptoms are on the 0-6 scale |
| Orientation, immediate memory, concentration, and delayed recall performance | Within 48 hours of injury | measured as ranked scores by the Standardized Assessment of Concussion (SAC) at enrollment, this test scores cognition using orientation (ex. what is todays date), immediate memory (repeating a list of 10 words), concentration (repeating a list of 3-6 numbers backwards and the months of the year backwards), and delayed recall (recalling the list of 10 words from earlier). Subject receives points for each correct answer with lower scores meaning the concussion has affect the subject more |
| Balance performance | Within 48 hours of injury | measured by the Balance Error Scoring System (BESS) at enrollment, which includes scoring balance on foam and firm surfaces in three different stances for 20 seconds with eyes closed. One point is give per error. An error is credited to the subject when any of the following occur: moving the hands off of the iliac crests, opening the eyes, step stumble or fall, abduction or flexion of the hip beyond 30, lifting the forefoot or heel off of the testing surface, remaining out of the proper testing position for greater than 5 seconds. The maximum total number of errors for any single condition is 10 with 3 conditions (double leg, single leg and tandem stances) each on each foam and firm surfaces the total maximum BESS score is 60 and the lowest score one can achieve is 0. With 0 being the best and 60 being the worst. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORSteve Hicks, MD, PhD
Penn State University, College of Medicine
Outcome results
None listed