CHICAGO—Collegiate football players may need up to 7 days to recover from a concussion, including full recovery of cognitive function and balance, according to an article in the November 19 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, overall, concussion is one of the most common injuries in many collegiate sports. Recent data from the National Collegiate Athletic Association (NCAA) Injury Surveillance System reveal that concussion accounted for a significant percentage of total injuries among athletes participating in collegiate ice hockey, football, and soccer during the 2002-2003 season. Studies in basic neuroscience have demonstrated that mild traumatic brain injury (concussion) is followed by a complex cascade of events that can adversely affect cerebral function for several days to weeks. Clinically, concussion can result in neurological deficits, cognitive impairment, and other symptoms. Lack of data on recovery time following a sport-related concussion has hampered clinical decision making about when it is appropriate for an athlete to return to play after the injury.

Michael McCrea, Ph.D., of the Neuroscience Center, Waukesha Memorial Hospital, Waukesha, Wis., and colleagues conducted a study to measure the effects of concussion and the time course to recovery following the injury in competitive athletes participating in collegiate football. The study included 1,631 football players from 15 U.S. colleges. All players underwent preseason baseline testing on concussion assessment measures in 1999, 2000, and 2001. Ninety-four players with concussion (based on American Academy of Neurology criteria) and 56 noninjured controls underwent assessment of symptoms, cognitive functioning, and balance stability immediately, 3 hours, and 1, 2, 3, 5, 7, and 90 days after injury.

A total of 79 players with concussion (84 percent) completed the protocol through day 90. Compared with controls, players with concussion exhibited more severe symptoms, cognitive impairment, and balance problems immediately after concussion. On average, symptoms gradually resolved by day 7, cognitive functioning improved to baseline levels within 5 to 7 days, and balance deficits dissipated within 3 to 5 days after injury. Mild impairments in cognitive processing and verbal memory evident on neuropsychological testing 2 days after concussion resolved by day 7. There were no significant differences in symptoms or functional impairments in the concussion group and the control group 90 days after concussion.

"These findings suggest that clinicians cannot necessarily expect that all collegiate football players will reach a complete recovery within 7 days after a concussion, as approximately 10 percent of players in this study required more than a week for symptoms to fully resolve. Furthermore, not all players demonstrated the same pattern of recovery in symptoms, cognition, and balance," the authors write.

CHICAGO—Expanded newborn screening for biochemical genetic disorders may lead to improved health outcomes for affected children and lower stress for their parents, however, false-positive screening results may place families at risk of increased stress, according to a study in the November 19 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, routine newborn screening is required practice for newborn care throughout the United States. Traditionally, testing for various disorders required a separate test, but now with a measuring device called the tandem mass spectrometry, biochemical genetic screening of up to 20 disorders can be performed from only one blood sample from the newborn. To date 24 states have started this expanded newborn screening using tandem mass spectrometry. Four states have not yet implemented mandated programs and four states offer non-mandated expanded screening.

In this study, Susan E. Waisbren, Ph.D., from Children's Hospital, Boston, and colleagues compared newborn identification by expanded screening with clinical identification of biochemical genetic disorders. The researchers also assessed the impact on families of a false-positive screening result compared with a normal result. False-positive results are defined by the researchers as initial out-of-range screening results that do not signify a metabolic disorder on further evaluation of the child.

The sample included families of 50 affected children identified through expanded newborn screening and 33 affected children identified clinically. In addition, families of 94 children found to have false-positive newborn screening results and 81 children having normal newborn screening results were also enrolled. A total of 254 mothers and 153 fathers were interviewed.

"Within the first six months of life, 28 percent of children identified by newborn screening compared with 55 percent of clinically identified children required hospitalization," the researchers report. "One child identified by newborn screening compared with eight (42 percent) identified clinically performed in the range of mental retardation. Mothers in the screened group reported lower overall stress on the Parental Stress Index than mothers in the clinically identified group." The researchers also found that children with false-positive results compared with children with normal results were twice as likely to be hospitalized (21 percent vs. 10 percent). And mothers of children in the false-positive group compared with mothers of children with normal screening results had higher scores on the Parental Stress Index and the Parent-Child Dysfunction subscale.

CHICAGO—Factors identifiable at the time of hospitalization can predict the risk of death for heart failure patients, according to an article in the November 19 issue of The Journal of the American Medical Association (JAMA).

Heart failure is a condition with a poor prognosis: 1-year death rates in population-based studies have been reported to be 35 percent to 40 percent, according to background information in the article. Although heart failure is a common, serious condition treated by both generalist and specialist physicians, few methods exist to help quantatitively estimate patient prognosis. Knowledge of predictors of death could be used to generate predictive models that could aid clinicians' decision making, in particular by identifying patients who are at high or low risk of death, and could be useful for clinicians to improve communication with and care of hospitalized patients.

Douglas S. Lee, M.D., of the University of Toronto, Ontario, and colleagues conducted a study to develop a method to predict the risk of death at both 30 days and 1 year in heart failure patients based on information routinely available to clinicians at the time of admission to the hospital, such as demographic features, vital signs, and other patient conditions. The study included 4,031 patients presenting with heart failure at multiple hospitals in Ontario, Canada, who had been identified as part of the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study.

The researchers found that predictors of death at both 30 days and 1 year included older age, lower systolic blood pressure, higher respiratory rate, higher blood urea nitrogen levels, and hyponatremia (low sodium level in the blood). Other conditions associated with death included presence of cerebrovascular disease (43 percent increased risk of death at 30-days), chronic obstructive pulmonary disease (66 percent increased risk of death), hepatic cirrhosis (more that three times increased risk of death), dementia (2.5 times increased risk of death), and cancer (nearly two times increased risk of death).

A risk index stratified the risk of death and identified low- and high-risk individuals. Patients with very low risk scores (60 or less) had a death rate of 0.4 percent at 30 days and 7.8 percent at 1 year. Patients with very high risk scores (greater than 150) had a mortality rate of 59.0 percent at 30 days and 78.8 percent at 1 year. Patients with higher 1-year risk scores had reduced survival at all times up to 1 year.

COLLEGE FOOTBALL CONCUSSIONS CAN HAVE SUBTLE SYMPTOMS - PLAYERS NEED AT LEAST SEVEN DAYS TO RECOVER