{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T14:31:54Z","timestamp":1794493914580,"version":"4.9.1"},"reference-count":75,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T00:00:00Z","timestamp":1566345600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/ mailto:journals.permissions@oup.com"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurosurg.","NEUROS"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Concussion is a heterogeneous mild traumatic brain injury (mTBI) characterized by a variety of symptoms, clinical presentations, and recovery trajectories. By thematically classifying the most common concussive clinical presentations into concussion subtypes (cognitive, ocular-motor, headache\/migraine, vestibular, and anxiety\/mood) and associated conditions (cervical strain and sleep disturbance), we derive useful definitions amenable to future targeted treatments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To use evidence-based methodology to characterize the 5 concussion subtypes and 2 associated conditions and report their prevalence in acute concussion patients as compared to baseline or controls within 3 d of injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A multidisciplinary expert workgroup was established to define the most common concussion subtypes and their associated conditions and select clinical questions related to prevalence and recovery. A literature search was conducted from January 1, 1990 to November 1, 2017. Two experts abstracted study characteristics and results independently for each article selected for inclusion. A third expert adjudicated disagreements. Separate meta-analyses were conducted to do the following: 1) examine the prevalence of each subtype\/associated condition in concussion patients using a proportion, 2) assess subtype\/associated conditions in concussion compared to baseline\/uninjured controls using a prevalence ratio, and 3) compare the differences in symptom scores between concussion subtypes and uninjured\/baseline controls using a standardized mean difference (SMD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The most prevalent concussion subtypes for pediatric and adult populations were headache\/migraine (0.52; 95% CI\u00a0=\u00a00.37, 0.67) and cognitive (0.40; 95% CI\u00a0=\u00a00.25, 0.55), respectively. In pediatric patients, the prevalence of the vestibular subtype was also high (0.50; 95% CI\u00a0=\u00a00.40, 0.60). Adult patients were 4.4, 2.9, and 1.7 times more likely to demonstrate cognitive, vestibular, and anxiety\/mood subtypes, respectively, as compared with their controls (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.05). Children and adults with concussion showed significantly more cognitive symptoms than their respective controls (SMD\u00a0=\u00a00.66 and 0.24;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001). Furthermore, ocular-motor in adult patients (SMD\u00a0=\u00a00.72;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) and vestibular symptoms in both pediatric and adult patients (SMD\u00a0=\u00a00.18 and 0.36;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.05) were significantly worse in concussion patients than in controls.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Five concussion subtypes with varying prevalence within 3 d following injury are commonly seen clinically and identifiable upon systematic literature review. Sleep disturbance, a concussion-associated condition, is also common. There was insufficient information available for analysis of cervical strain. A comprehensive acute concussion assessment defines and characterizes the injury and, therefore, should incorporate evaluations of all 5 subtypes and associated conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/neuros\/nyz332","type":"journal-article","created":{"date-parts":[[2019,8,11]],"date-time":"2019-08-11T07:19:24Z","timestamp":1565507964000},"page":"2-13","source":"Crossref","is-referenced-by-count":140,"title":["Concussion Guidelines Step 2: Evidence for Subtype Classification"],"prefix":"10.1227","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9102-8791","authenticated-orcid":false,"given":"Angela","family":"Lumba-Brown","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Brain Performance Center, Stanford University, Stanford, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaru","family":"Teramoto","sequence":"additional","affiliation":[{"name":"Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O Josh","family":"Bloom","sequence":"additional","affiliation":[{"name":"Carolina Sports Concussion Clinic, Cary, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Brody","sequence":"additional","affiliation":[{"name":"Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Chesnutt","sequence":"additional","affiliation":[{"name":"Depts. of Family Medicine, Neurology, Orthopedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James R","family":"Clugston","sequence":"additional","affiliation":[{"name":"Departments of Community Health and Family Medicine and Neurology, University of Florida, Gainesville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"Gioia","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neuropsychology, Safe Concussion Outcome Recovery & Education Program, Children's National Health System, Depts. of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine, Rockville, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Kontos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania"},{"name":"Department of 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