Association of concussion with high school academic standing: sex, school grade and race as stratifiers.

INTRODUCTION: The purpose was to examine the association between concussion history and academic standing among high school students, and whether the association varies by sex, school grade and race/ethnicity. METHODS: Data from the 2019 Youth Risk Behaviour Survey were used for our cross-sectional study. Exposure was self-reported history of concussions in the past 12 months. Outcome was self-reported academic standing in the past 12 months. Poisson regression was used to analyse the exposure-outcome association, and whether there were differences by our stratifying variables. RESULTS: Having a history of concussion in the past 12 months was significantly associated with a higher risk of poor academic standing during the same period, and the association varied by race/ethnicity. DISCUSSION: Youth with a history of concussion may be at risk for poorer academic standing, indicating to the importance of prevention. Future studies are needed to examine the interaction of race/ethnicity on the presented association.

Microscale pedestrian environment surrounding pedestrian injury sites in Washington state, 2015-2020.

OBJECTIVE: While microscale pedestrian environment features such as sidewalks and crosswalks can affect pedestrian safety, it is challenging to assess microscale environment associated risk across locations or at scale. Addressing these challenges requires an efficient auditing protocol that can be used to assess frequencies of microscale environment features. For this reason, we developed an eight-item pedestrian environment virtual audit protocol and conducted a descriptive epidemiologic study of pedestrian injury in Washington State, USA. METHODS: We used data from police reports at pedestrian-automotive collision sites where the pedestrian was seriously injured or died. At each collision site, high school students participating in an online summer internship program virtually audited Google Street View imagery to assess the presence of microscale pedestrian environment features such as crosswalks and streetlighting. We assessed inter-rater reliability using Cohen's kappa and explored prevalence of eight microscale environment features in relation to injury severity and municipal boundaries. RESULTS: There were 2248 motor vehicle crashes eliciting police response and resulting in death or serious injury of a pedestrian in Washington State between January 1, 2015 and May 8, 2020. Of the crashes resulting in serious injury or death, 498 (22%) resulted in fatalities and 1840 (82%) occurred within municipal boundaries. Cohen's kappa scores for the eight pedestrian features that were audited ranged from 0.52 to 0.86. Audit results confirmed that features such as sidewalks and crosswalks were more common at collision sites within city limits. CONCLUSIONS: High school student volunteers with minimal training can reliably audit microscale pedestrian environments using limited resources.

Concussion symptoms and temporary accommodations using a student-centered return to learn care plan.

BACKGROUND: Many students return to school after concussion with symptoms but without formal support. OBJECTIVE: To examine concussion symptoms and temporary academic accommodations during school use of a four-week student-centered return to learn (RTL) care plan. METHODS: Five public high schools used the RTL care plan and contributed student-level data after student report of concussion. Data on concussion symptoms, temporary academic accommodations corresponding to reported symptoms, and accommodations provided during RTL care plan use were examined. RESULTS: Of 115 students, 55%used the RTL care plan for three (34%) or four (21%) weeks. Compared to students whose symptoms resolve within the first two weeks, students who used the RTL care plan for three or four weeks reported more unique symptoms (P = 0.038), higher total severity score (P = 0.005), and higher average severity per symptom (P = 0.007) at week one. Overall, 1,127 weekly accommodations were provided. While least reported, emotional symptoms received corresponding accommodations most often (127/155 reports: 82%of occurrences). CONCLUSIONS: Use of an RTL care plan can facilitate the RTL of students with a concussion and may aid in the identification of students who are in need of longer-term support.

Functional improvement in hand strength and dexterity after surgical treatment of cervical spondylotic myelopathy: a prospective quantitative study.

OBJECTIVE: Cervical spondylotic myelopathy (CSM) is the primary cause of adult spinal cord dysfunction. Diminished hand strength and reduced dexterity associated with CSM contribute to disability. Here, the authors investigated the impact of CSM severity on hand function using quantitative testing and evaluated the response to surgical intervention. METHODS: Thirty-three patients undergoing surgical treatment of CSM were prospectively enrolled in the study. An occupational therapist conducted 3 functional hand tests: 1) palmar dynamometry to measure grip strength, 2) hydraulic pinch gauge test to measure pinch strength, and 3) 9-hole peg test (9-HPT) to evaluate upper extremity dexterity. Tests were performed preoperatively and 6-8 weeks postoperatively. Test results were expressed as 1) a percentile relative to age- and sex-stratified norms and 2) achievement of a minimum clinically important (MCI) difference. Patients were stratified into groups (mild, moderate, and severe myelopathy) based on their modified Japanese Orthopaedic Association (mJOA) score. The severity of stenosis on preoperative MRI was graded by three independent physicians using the Kang classification. RESULTS: The primary presenting symptoms were neck pain (33%), numbness (21%), imbalance (12%), and upper extremity weakness (12%). Among the 33 patients, 61% (20) underwent anterior approach decompression, with a mean (SD) of 2.9 (1.5) levels treated. At baseline, patients with moderate and low mJOA scores (indicating more severe myelopathy) had lower preoperative pinch (p < 0.001) and grip (p = 0.01) strength than those with high mJOA scores/mild myelopathy. Postoperative improvement was observed in all hand function domains except pinch strength in the nondominant hand, with MCI differences at 6 weeks ranging from 33% of patients in dominant-hand strength tests to 73% of patients in nondominant-hand dexterity tests. Patients with moderate baseline mJOA scores were more likely to have MCI improvement in dominant grip strength (58.3%) than those with low mJOA scores/severe myelopathy (30%) and high mJOA scores/mild myelopathy (9%, p = 0.04). Dexterity in the dominant hand as measured by the 9-HPT ranged from < 1 in patients with cord signal change to 15.9 in patients with subarachnoid effacement only (p = 0.03). CONCLUSIONS: Patients with CSM achieved significant improvement in strength and dexterity postoperatively. Baseline strength measures correlated best with the preoperative mJOA score; baseline dexterity correlated best with the severity of stenosis on MRI. The majority of patients experienced MCI improvements in dexterity. Baseline pinch strength correlated with postoperative mJOA MCI improvement, and patients with moderate baseline mJOA scores were the most likely to have improvement in dominant grip strength postoperatively.