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Chapter 3 - Traumatic Brain Injury: The Acute Management and Prevention Programmes

Published online by Cambridge University Press:  10 August 2021

By
Colette Griffin
Edited by
Marco Mula
Marco Mula
Affiliation:
St George's Hospital Medical School, University of London
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Summary

The ideal management of patients with an acute TBI allows accurate and timely diagnosis of complex problems which occur immediately and less acutely post TBI.

Major Trauma Networks were developed in order to get the right patient to the right place at the right time.

Pre-hospital TBI care has greatly improved over the past few decades. This care emphasizes rapid, safe extrication of the trauma victim, stabilization of the spine, aggressive resuscitation to prevent hypotension, immediate airway management and rapid, safe transport to an appropriate trauma centre.

Most TBIs are preventable, and demographics are changing. Whilst TBI from high velocity injuries in young males still occur, the burgeoning elderly population with TBIs from falls from standing are increasing considerably.

Sport related TBIs have received significant media coverage in recent years, in part due to an increased body of scientific literature and growing concern surrounding their long term effects.

With the development and application of advanced mild TBI assessment tools, there is a rising tide of data that is driving changes in clinical practices and the management of patients with mild TBI.

Keywords

PreventionEpidemiologyMajor Trauma NetworksNeurorehabilitation
Type
Chapter
Information
Post-traumatic Epilepsy , pp. 47 - 62
Publisher: Cambridge University Press
Print publication year: 2021

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References

Hawley, C, Sakr, M, Scapinello, S, et al. Traumatic brain injuries in older adults—6 years of data for one UK trauma centre: retrospective analysis of prospectively collected data. Emerg Med J 2017;34:509–16.Google Scholar
Maas, AIR, Menon, DK, Adelson, PD, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care and research. Lancet Neurol 2017;16:987–1048.Google Scholar
Saatman, KE, Duhaime, AC, Bullock, R, et al. Classification of traumatic brain injury for targeted therapies. J Neurotrauma 2008;25:719–38.Google Scholar
Andelic, N, Bautz-Holter, E, Ronning, P, et al. Does an early onset and continuous chain of rehabilitation improve the long term functional outcome of patients with severe traumatic brain injury? J Neurotrauma 2012;29 (1):66–74.Google Scholar
Rubenstein, R, Chang, B, Davies, , et al. A novel, ultrasensitive assay for tau: potential for assessing traumatic brain injury in tissues and biofluids. J Neurotrauma 2015;32:342–52.Google Scholar
Shahim, P, Tegner, Y, Wilson, DHD, et al. Blood biomarkers for brain injury in concussed professional ice hockey players. JAMA Neurol 2014;71:684–92.Google Scholar
Mitra, B, Rau, TF, Surendran, N, et al. Plasma micro-RNA biomarkers for diagnosis and prognosis after traumatic brain injury: a pilot study. J Clin Neurosci 2017;38:37–42.Google Scholar
Posti, JP, Dickens, AM, Orešič, M, et al. Metabolomics profiling as a diagnostic tool in severe traumatic brain injury. Front Neurol 2017;8:398.CrossRefGoogle ScholarPubMed
Martínez-Morillo, E, Childs, C, García, BP, et al. Neurofilament medium polypeptide (NFM) protein concentration is increased in CSF and serum samples from patients with brain injury. Clin Chem Lab Med 2015;53:1575–84.Google Scholar
Engberg, AW, Teasdale, TW. Psychosocial outcome following traumatic brain injury in adults: a long-term population based follow up. Brain Injury 2013;27:1500–7.Google Scholar
Feigin, VL, Theadom, A, Barker-Collo, S, et al. Incidence of traumatic brain injury in New Zealand: a population based study. Lancet Neurol 2013;12 (1):53–64.CrossRefGoogle ScholarPubMed
Kay, A, Teasdale, G. Head injury in the United Kingdom. World J Surg 2001;25:1210–20.Google Scholar
Tennant, A 2015. www.headway.org.uk/media/2883/acquired-brain-injury-the-numbers-behind-the-hidden-disability.pdfGoogle Scholar
McMillan, TM, Teasdale, GM, Weir, CJ, et al. Death after head injury: the 13 year outcome of a case control study. J Neurol Neurosurg Psychiatry 2011;82:931–5.CrossRefGoogle ScholarPubMed
Williams, MW, Rapport, LJ, Millis, SR, et al. Psychosocial outcomes after traumatic brain injury: life satisfaction, community integration, and distress. Rehabil Psychol 2014;59 (3):298–305.Google Scholar
Parsonage, M. Traumatic Brain Injury and Offending: an economic analysis. Barrow and Cadbury Trust Centre for Mental Health July 2016.Google Scholar
Beecham, J, Perkins, M, Snell, T, et al. Treatment paths and costs for young adults with acquired brain injury in the United Kingdom. Brain Inj 2009;23 (1):30–8.CrossRefGoogle ScholarPubMed
Ponsford, JL, Downing, MG, Olver, J, et al. Longitudinal follow-up of patients with traumatic brain injury: outcome at two, five, and ten years post-injury. J Neurotrauma 2014;31 (1):64–77.Google Scholar
McMillan, TM, Weir, CJ, Wainman-Lefley, J. Mortality and morbidity 15 years after hospital admission with mild traumatic brain injury: a prospective case-controlled population study. J Neurol Neurosurg Psychiatry 2014;85:1214–20.Google Scholar
Levin, HS. Prediction of recovery from traumatic brain injury. J Neurotrauma 1995;12:913–22.Google Scholar
Brown, AW, Malec, JF, McClelland, RL, et al. Clinical elements that predict outcome after traumatic brain injury: a prospective multicentre recursive partitioning (decision-tree) analysis. J Neurotrauma 2005;22:1040–51.Google Scholar
Whyte, J, Cifu, D, Dikmen, S, et al. Prediction of functional outcomes after traumatic brain injury: a comparison of 2 measures of duration of unconsciousness. Arch Phys Med Rehabil 2001;82:1355–9.Google Scholar
Zafonte, RD, Hammond, FM, Mann, NR, et al. Relationship between Glasgow Coma Scale and functional outcome. Am J Phys Med Rehabil 1996;75:364–9.Google Scholar
Marshall, LF, Marshall, SB, Klauber, MR, et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 1992;9 (suppl 1):S287–92.Google Scholar
Scheid, R, Preul, C, Gruber, O, et al. Diffuse axonal injury associated with chronic traumatic brain injury: evidence from T2* weighted gradient-echo imaging at 3T. AJNR Am J Neuroradiol 2003;24:1049–56.Google Scholar
Sidaros, A, Engberg, AW, Sidaros, K, et al. Diffusion tensor imaging during recovery from severe traumatic brain injury and relation to clinical outcome: a longitudinal study. Brain 2008;131:559–72.Google Scholar
McAllister, TW, Saykin, AJ, Flashman, LA, et al. Brain activation during working memory 1 month after mild traumatic brain injury: a functional MRI study. Neurology 1999;53:1300–8.Google Scholar
Zhang, J, Mitsis, EM, Chu, K, et al. Statistical parametric mapping and cluster counting analysis of[18F] FDG-PET imaging in traumatic brain injury J Neurotrauma 2010;27:35–49.CrossRefGoogle ScholarPubMed
Hanger, C, Fletcher, V, Fink, J, et al. Improving care for stroke patients: adding an acute stroke unit helps. NZ Med J 2007;120 (1250):2450.Google Scholar
Mate, K, Williams, D. Enhancing prehospital emergency care. Healthcare Executive. 2014;29 (5):64–7.Google Scholar
Bullock, M, Chesnut, R, Ghajar, J. Guidelines for the surgical management of traumatic brain injury. Neurosurgery. 2006;58:1–62.Google Scholar
Timofeev, I, Dahyot-Fizelier, C, Keong, N, et al. Ventriculostomy for control of raised ICP in acute traumatic brain injury. Acta Neurochir Suppl (Wien). 2008;102:99–104.CrossRefGoogle ScholarPubMed
Liu, H, Wang, W, Cheng, F, et al. External ventricular drains versus intraparenchymal intracranial pressure monitors in traumatic brain injury: a prospective observational study. World Neurosurg. 2015;83:794–800.Google Scholar
Van Essen, TA, de Ruiter, GC, Kho, KH, et al. Neurosurgical treatment variation of traumatic brain injury: evaluation of acute subdural hematoma management in Belgium and The Netherlands. J Neurotrauma 2017;34:881–9.Google Scholar
Compagnone, C, Murray, GD, Teasdale, GM, et al. The management of patients with intradural post-traumatic mass lesions: a multicenter survey of current approaches to surgical management in 729 patients coordinated by the European Brain Injury Consortium. Neurosurgery 2005;57: 1183–92.Google Scholar
Ghajar, J, Hariri, RJ, Narayan, RK, et al. Survey of critical care management of comatose, head-injured patients in the United States. Crit Care Med 1995;23: 560–7.Google Scholar
Seelig, JM, Becker, DP, Miller, JD, et al. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 1981;304:1511–18.Google Scholar
Tallon, JM, Ackroyd-Stolarz, S, Karim, SA, et al. The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries: a population-based study. Can J Surg 2008;51:339–45.Google ScholarPubMed
Li, LM, Kolias, AG, Guilfoyle, MR, et al. Outcome following evacuation of acute subdural haematomas: a comparison of craniotomy with decompressive craniectomy. Acta Neurochir (Wien) 2012;154:1555–61.CrossRefGoogle ScholarPubMed
Nijboer, JMM, van der Naalt, J, Duis, HJ. Patients beyond salvation? Various categories of trauma patients with a minimal Glasgow Coma Score. Injury 2010;41:52–7.Google Scholar
Dent, DL, Croce, MA, Menke, PG, et al. Prognostic factors after acute subdural hematoma. J Trauma 1995;39:36–42.Google Scholar
Mathew, P, Oluoch-Olunya, DL, Condon, BR, et al. Acute subdural haematoma in the conscious patient: outcome with initial non-operative management. Acta Neurochir (Wien) 1993;121:100–8.CrossRefGoogle ScholarPubMed
Servadei, F, Nasi, MT, Cremonini, AM, et al. Importance of a reliable admission Glasgow Coma Scale score for determining the need for evacuation of post traumatic subdural hematomas: a prospective study of 65 patients. J Trauma 1998;44:868–73.CrossRefGoogle Scholar
Wang, R, Li, M, Gao, WW, et al. Outcomes of early decompressive craniectomy versus conventional medical management after severe traumatic brain injury: a systematic review and meta-analysis. Medicine (Baltimore) 2015; 94:e1733.Google Scholar
Chang, EF, Meeker, M, Holland, MC. Acute traumatic intraparenchymal haemorrhage: risk factors for progression in the early post-injury period. Neurosurgery 2006;58:647–56.Google Scholar
Cai, X, Robinson, J, Muehlschlegel, S, et al. Patient preferences and surrogate decision making in neuroscience intensive care units. Neurocrit Care 2015;23:131–41.CrossRefGoogle ScholarPubMed
Yang, XF, Wen, L, Shen, F, et al. Surgical complications secondary to decompressive craniectomy in patients with a head injury: a series of 108 consecutive cases. Acta Neurochir (Wien) 2008;150:1241–7.Google Scholar
Servadei, F, Compagnone, C, Sahuquillo, J. The role of surgery in traumatic brain injury. Curr Opin Crit Care 2007;13:163–8.Google Scholar
Honeybul, S, Janzen, C, Kruger, K, et al. Decompressive craniectomy for severe traumatic brain injury: is life worth living? J Neurosurg. 2013;119:1566–75.Google Scholar
Guerra, WK, Gaab, MR, Dietz, H, et al. Surgical decompression for traumatic brain swelling: indications and results. J Neurosurg 1999;90:187–96.Google Scholar
Cooper, DJ, Rosenfeld, JV, Murray, L et al: DECRA Trial Investigators: Australian and New Zealand Intensive Care Society Clinical Trials Group. Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med. 2011;364:1493–502.Google Scholar
Hutchinson, PJ, Kolias, AG, Timofeev, IS et al. RESCUEicp Trial Collaborators. Trial of decompressive craniectomy for traumatic intracranial hypertension. N Engl J Med. 2016;375:1119–30.Google Scholar
Van Essen, TA, Dijkman, MD, Cnossen, MC, et al. Comparative effectiveness of surgery for acute subdural hematoma. J Neurotrauma. 2016;33:A-20.Google ScholarPubMed
Gregson, BA, Rowan, EN, Francis, R, et al. STITCH (TRAUMA) Investigators. Surgical Trial In Traumatic intraCerebral Haemorrhage (STITCH): a randomised controlled trial of early surgery compared with initial conservative treatment. Health Technol Assess. 2015;19:1–138.Google Scholar
Chan, AW, Tetzlaff, JM, Gotzsche, PC, et al. SPIRIT 2013 explanation and elaboration: guidelines for protocols of clinical trials. BMJ 2013;346:e7586.CrossRefGoogle ScholarPubMed
Silver, JM, McAllister, TW, Yudofsky, SC. Textbook of Traumatic Brain Injury. Washington DC: American Psychiatric Pub 2011.CrossRefGoogle Scholar
Kurland, D, Hong, C, Aarabi, B, et al. Haemorrhagic progression of a contusion after traumatic brain injury: a review. J Neurotrauma 2012;29:19–31.CrossRefGoogle ScholarPubMed
Khoshyomn, S, Tranmer, BI. Diagnosis and management of paediatric closed head injury. Semin Pediatr Surg 2004;13:80–6.Google Scholar
Haselsberger, K, Pucher, R, Auer, LM. Prognosis after acute subdural or epidural haemorrhage. Acta Neurochir 1988;90:111–6.Google Scholar
Arciniegas, D, Adler, L, Topkoff, J, et al. Attention and memory dysfunction after traumatic brain injury: cholinergic mechanisms, sensory gating, and a hypothesis for further investigation. Brain Inj 1999;13 (1):1–13.Google Scholar
Mathias, JL, Wheaton, P. Changes in attention and information-processing speed following severe traumatic brain injury: a meta-analytic review. Neuropsychology 2007;21 (2):212–23.CrossRefGoogle ScholarPubMed
Cicerone, K, Levin, H, Malec, J, et al. Cognitive rehabilitation interventions for executive function: moving from bench to bedside in patients with traumatic brain injury. J Cogn Neurosci 2006;18 (7):1212–22.Google Scholar
Jorge, RE, Arciniegas, DB. Mood disorders after TBI. Psychiatric Clinics of North America 2014;37 (1):13–29.Google Scholar
Rao, V, Lyketsos, C. Neuropsychiatric sequelae of traumatic brain injury. Psychosomatics 2000;41 (2):95–103.Google Scholar
Wood, RL, Liossi, C, Wood, L. The impact of head injury neurobehavioural sequelae on personal relationships: preliminary findings. Brain Injury 2005;19 (10):845–51.Google Scholar
Claude Blais, M, Boisvert, JM. Psychological and marital adjustment in couples following a traumatic brain injury (TBI): a critical review. Brain Injury 2005;19 (14): 1223–35.Google Scholar
Sariaslan, A, Sharp, DJ, D’Onofrio, BM, et al. Long term outcomes associated with traumatic brain injury in childhood and adolescence: a nationwide Swedish cohort study of a wide range of medical and social outcomes. PLoS Med 2016;13 (8):e1002103.Google Scholar
Radford, K, Phillips, J, Drummond, A, et al. Return to work after traumatic brain injury: cohort comparison and economic evaluation. Brain Inj 2013;27 (5):507–20.Google Scholar
Alexander, MP. Mild traumatic brain injury: pathophysiology, natural history and clinical management. Neurology 1995;45:1253–60.Google Scholar
Ponsford, J, Willmott, C, Rothwell, A, et al. Factors influencing outcome following mild traumatic brain injury in adults. J Int Neuropsychol Soc 2000;6:568–79.CrossRefGoogle ScholarPubMed
Hou, R, Moss-Morris, R, Peveler, R, et al. When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury. J Neurol Neurosurg Psychiatry 2012;83:217–23.Google Scholar
Ryan, LM, Warden, DL. Post concussion syndrome. Int Rev Psychiatry 2003;15:310–16.Google Scholar
Sbordone, RJ, Liter, JC, Pettler-Jennings, P. Recovery of function following severe traumatic brain injury: a retrospective 10-year follow-up. Brain Inj 1995;9 (3):285–99.Google Scholar
Christensen, BK, Colella, B, Inness, E, et al. Recovery of cognitive function after traumatic brain injury: a multilevel modelling analysis of Canadian outcomes. Arch Phys Med Rehabil 2008;89 (12):S3–S15.Google Scholar
Cope, DN, Hall, K. Head injury rehabilitation: benefit of early intervention. Arch Phys Med Rehabil 1982;63 (9):433–7.Google Scholar
Powell, J, Heslin, J, Greenwood, R. Community based rehabilitation after severe traumatic brain injury: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2002;72:193–202.Google Scholar
Oddy, M, da Silva Ramos, S. The clinical and cost benefits of investing in neurobehavioural rehabilitation: a multi-centre study. Brain Injury 2013;27:1500–7.Google Scholar
Walker, WC, Ketchum, JM, Marwitz, JH, et al. A multicentre study on the clinical utility of post-traumatic amnesia duration in predicting global outcome after moderate-severe traumatic brain injury. J Neurol Neurosurg Psychiatry 2010;81 (1):87–9.Google Scholar
Sigurdardottir, S, Andelic, N, Wehling, E et al. Neuropsychological functioning in a national cohort of severe traumatic brain injury: demographic and acute injury–related predictors. J Head Trauma Rehabil, 2015;30 (2):E1–12.CrossRefGoogle Scholar
De Guise, E, Leblanc, J, Feyz, M, et al. Effect of an integrated reality orientation programme in acute care on post-traumatic amnesia in patients with traumatic brain injury. Brain Inj 2005;19 (4):263–9.Google Scholar
Thomas, H, Feyz, M, LeBlanc, J, et al. North Star Project: reality orientation in an acute care setting for patients with traumatic brain injuries. J Head Trauma Rehabil 2003;18 (3):292–302.Google Scholar
Langhorn, L, Sorensen, JC, Pedersen, PU. A critical review of the literature on early rehabilitation of patients with post‐traumatic amnesia in acute care. J Clin Nurs 2010;19 (21–22):2959–69.Google Scholar
Cnossen, MC, Lingsma, HF, Tenovuo, O, et al. Rehabilitation after traumatic brain injury: A survey in 70 European neurotrauma centres participating in the CENTER-TBI study. J Rehabil Med 2017;49 (5):395–401.Google Scholar
Turner-Stokes, L, Disler, PB, Nair, A, et al. Multi-disciplinary rehabilitation for acquired brain injury in adults of working age. Cochrane Database Syst Rev 2005;3(3):CD004170.Google Scholar
Slade, A, Tennant, A, Chamberlain, MA. A randomised controlled trial to determine the effect of intensity of therapy upon length of stay in a neurological rehabilitation setting. J Rehab Med 2002;34 (6):260–6.Google Scholar
Goldman, SM, Kamel, F, Ross, GW, et al. Head injury, alpha-synuclein Rep 1, and Parkinson’s Disease. Ann Neurol 2012;71:40–8.CrossRefGoogle Scholar
Mayeux, R, Ottman, R, Maestre, G, et al. Synergistic effects of traumatic head injury and apolipoprotein-epsilon 4 in patients with Alzheimer’s Disease. Neurology 1995;45 (3 Pt 1):555–7.Google Scholar
McKee, AC, Stern, RA, Nowinski, CJ, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain 2013;136 (Pt 1):43–64.Google Scholar
Roozenbeek, B, Maas, AIR, Menon, DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013;9 (4):231–6.Google Scholar
WHO Global status report on road safety 2015.Google Scholar
WHO, UNODC, UNDP. Global status report on violence prevention 2014.Google Scholar
Liu, BC, Ivers, R, Norton, R, et al. Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev. 2008;(1):CD004333.Google Scholar
Macpherson, A, Spinks, A. Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries. Cochrane Database Syst Rev. 2008;(3):CD005401.Google Scholar
Debinski, B, Clegg Smith, K, Gielen, A. Public opinion on motor vehicle-related injury prevention policies: a systematic review of a decade of research. Traffic Inj Prev. 2014;15:243–51.Google Scholar
Sethi, M, Heidenberg, J, Wall, SP, et al. Bicycle helmets are highly protective against traumatic brain injury within a dense urban setting. Injury. 2015;46:2483–90.Google Scholar
Chiu, WT, Kuo, CY, Hung, CC, et al. The effect of the Taiwan motorcycle helmet use law on head injuries. Am J Public Health. 2000;90:793–6.Google Scholar
Busko, A, Hubbard, Z, Zakrison, T. Motorcycle-helmet laws and public health. N Engl J Med. 2017;376:1208–9.Google Scholar
Coben, JH, Zhu, M. Keeping an eye on distracted driving. JAMA. 2013;309:877–8.Google Scholar
Perel, P, Prieto-Merino, D, Shakur, H, et al. Predicting early death in patients with traumatic bleeding: development and validation of prognostic model. BMJ 2012;345:e5166.Google Scholar
Health and Social Care Information Centre. Accident and emergency attendances in England—2012–2013. January 2014.Google Scholar
Obermeyer, Z, Abujaber, S, Maker, M, et al. on behalf of the Acute Care Development Consortium. Emergency care in 59 LMICs: a systematic review. Bull World Health Organ 2015;93:577–86.Google Scholar
El Khamlichi, A. Neurosurgery in Africa. Clin Neurosurg 2005;52:214–17.Google Scholar
Hartholt, KA, Van Lieshout, EM, Polinder, S, et al. Rapid increase in hospitalizations resulting from fall-related traumatic head injury in older adults in The Netherlands 1986–2008. J Neurotrauma 2011;28:739–44.Google Scholar
Harvey, LA, Close, JC. Traumatic brain injury in older adults: characteristics, causes and consequences. Injury 2012;43:1821–6.Google Scholar
Murphy, TE, Baker, DI, Leo-Summers, LS, et al. Trends in fall-related traumatic brain injury among older persons in Connecticut from 2000–2007. J Gerontol Geriatr Res. 2014;3:1000168.Google Scholar
Dams-O’Connor, K, Gibbons, LE, Landau, A, et al. Health problems precede traumatic brain injury in older adults. J Am Geriatr Soc 2016;64:844–8.Google Scholar
Nakahara, S, Ichikawa, M, Kimura, A. Population strategies and high-risk-individual strategies for road safety in Japan. Health Policy 2011;100:247–55.Google Scholar
Youngers, EH, Zundel, K, Gerhardstein, D, et al. Comprehensive review of the ThinkFirst injury prevention programs: a 30-year success story for organized neurosurgery. Neurosurgery 2017;81:416–21.Google Scholar
Utomo, WK, Gabbe, BJ, Simpson, PM, et al. Predictors of in-hospital mortality and 6-month functional outcomes in older adults after moderate to severe traumatic brain injury. Injury 2009;40 (9):973–7.Google Scholar
Mosenthal, AC, Lavery, RF, Addis, M, et al. Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma 2002;52 (5):907–11.Google Scholar
Cremer, OL, Moons, KGM, van Dijk, GW, et al. Prognosis following severe head injury: development and validation of a model for prediction of death, disability and functional recovery. J Trauma 2006;61 (6):1484–91.Google Scholar
Fuller, GW, Kemp, SP. The International Rugby Board (IRB) pitch side concussion assessment trial: a pilot test accuracy study. Br J Sports Med 2015; 49:529–35.Google Scholar
McCrory, P, Meeuwisse, W, Dvořák, J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51: 838–47.Google Scholar
Harmon, KG, Drezner, JA, Gammons, M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47:15–26.Google Scholar
Giza, CC, Kutcher, JS, Ashwal, S, et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013;80:2250–7.Google Scholar
Vagnozzi, R, Tavazzi, B, Signoretti, S, et al. Temporal window of metabolic brain vulnerability to concussions: mitochondrial-related impairment—part I. Neurosurgery 2007;61:379–88.Google Scholar
Cantu, RC. Second impact syndrome. Clin Sports Med 1998;17:37–44.Google Scholar
Bey, T, Ostick, B. Second impact syndrome. West J Emerg Med. 2009;10 (1):6–10.Google Scholar

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