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4 Impact of Concussion on Symptoms, Cognitive Functions and Heart Rate Variability: Exploring Biological Sex-Related Differences
- Mariane Doucet, Hélène Brisebois, Michelle McKerral
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 304
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Objective:
To explore the use of Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Heart Rate Variability (HRV) tests in the follow-up of concussions among college athletes. To provide a foundation for interpreting changes following a concussion by exploring the effects of self reported biological sex at birth on ImPACT and HRV values at baseline and after a concussion.
Participants and Methods:Data was prospectively collected within a pre-existing concussion management program. Baseline assessment (T1) included psychological questionnaires, the ImPACT test, and six minutes of HRV recording (standing, sitting, following a pacer). When a concussion occurred, the athlete was re-tested within 72 hours (T2) and tested again before returning to play (T3). 169 (55 females) athletes aged 16 to 22 years old completed the baseline testing and 30 (8 females) concussion cases were followed.
Results:At baseline, females had higher Total Symptom scores, Sleep-Arousal Symptoms scores and Affective Symptoms scores (p ≤ 0.001). They also displayed significantly higher relative power of the very low-frequency bands (%VLF) (p < 0.05) in sitting position compared to males. There were no significant sex-related differences for any of the five ImPACT Index scores (Verbal Memory, Visual Memory, Impulse Control, Visual Motor, Reaction Time).
Mixed model repeated measure ANOVAs were performed within the concussed group. Significant differences were found between T1 and T2 as well as between T2 and T3 for Vestibular-Somatic Symptoms scores (p < 0.05); as expected, athletes displayed higher scores at T2 and scores were similar at T1 and T3. Total Symptoms scores and Cognitive-Sensory Symptoms scores were only found significantly higher at T2 compared to T3. Affective Symptoms scores were significantly higher at T1 and T2 compared to T3. < 0.05). There was no significant influence of sex on symptom scores. Of the ImPACT scores, the Visual Memory Index score showed a significant increase after concussion (T2 vs T1) (p < 0.05), with no significant difference between T2 and T3. For HRV, concussion showed a significant effect on %High Frequency (HF) HRV value sitting (p < 0.05) where T2 was significantly lower than T3.There was also a significant effect of sex on %HF when time and position were considered, with males having higher %HF values at T1 and lower %HF at T2 and T3 than females.
Conclusions:At baseline, females displayed higher symptoms scores than males but after a concussion there were no significant differences in symptoms scores. No sex-related differences were found for any of the ImPACT scores at baseline nor after a concussion. Before concussion, female athletes had higher HRV %VLF while sitting, suggesting more activation of their sympathetic nervous system and stress. For concussed athletes, Vestibular-Somatic Symptoms seemed to be the most stable and reliable when assessing symptoms at baseline and before returning to play. For ImPACT, Visual Memory Index was decreased significantly after a concussion. HRV %HF values showed significant variations according to sex after a concussion. HF values are thought to reflect parasympathetic nervous system activation. Our results support the idea that the activity of the autonomic nervous system can be disturbed in the days/weeks following a concussion.
P072: Comparing met vs. unmet palliative care needs in patients with end-stage conditions presenting to two Canadian emergency departments
- M. Garrido Clua, M. Kruhlak, S. Kirkland, C. Villa-Roel, A. Elwi, B. O'Neill, A. Brisebois, S. Duggan, B. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S89
- Print publication:
- May 2019
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Introduction: Patients with end-stage conditions require integrated physical, spiritual, psychological and social care. Despite efforts to provide comprehensive community care, those with severe symptoms often present to emergency departments (EDs) with palliative care (PC) needs. The objective of this study was to identify patients with end-stage diagnoses presenting to EDs, and to document and compare their PC needs. Methods: A four-month prospective cohort study was conducted in two Canadian EDs. Using a modified PC screening tool, volunteer emergency physicians identified adult patients with end-stage illnesses and documented their PC needs. This tool has the ability to classify patients as having met vs. unmet PC needs based on the documentation of risk factors. Research assistants documented demographic information, severity at presentation (Canadian Triage and Acuity Scale {CTAS}), disposition and revisits from an electronic repository. Bivariate comparisons between patients with met vs. unmet PC needs were completed. Results: Overall, 663 patients were enrolled, of which 78% (n = 518/663) were identified as having unmet PC needs according to the screening tool. Cancer was the most prevalent condition in each group (43% unmet needs, 37% met needs). There was no significant difference between the two groups in terms of age, sex or CTAS score. The unmet PC needs group was more likely to be admitted (68% vs. 50%; p = 0.0001) when compared to patients with PC needs assessed as being met. No significant difference was noted in terms of time to physician assessment or ED length of stay. The two groups did not significantly differ in the proportion of return visits within 30 days (34% vs. 32%) or the average number of return visits (3 vs. 2 visits). A higher proportion of patients with unmet PC needs made at least one visit to the ED in the 6 months prior to their index visit compared to patients with met PC needs (74% vs. 51%, p < 0.001); yet, the average number of ED visits was similar between the groups (3 visits). Conclusion: This study revealed that patients with end-stage diagnoses, especially cancer, commonly have unmet PC needs. They are also more likely to present to the ED and to require hospitalization than patients in whom PC needs have been met. Further investigations into their clinical profile and health care utilization may clarify the impact of their unmet PC needs on the healthcare system.
MP08: The frequency of emergency departments visits for patients with end-of-life conditions: a call for action
- S. Kirkland, M. Kruhlak, M. Garrido Clua, C. Villa-Roel, S. Couperthwaite, A. Brisebois, A. Elwi, B. O'Neil, S. Duggan, B. Rowe
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, pp. S44-S45
- Print publication:
- May 2019
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Introduction: An increasing number of patients with end-stage diseases present to emergency departments (EDs) for physical, spiritual, psychological and social care. The objective of this study was to identify patients with end-stage diseases with palliative care (PC) needs and document their frequency of ED visits. Methods: This prospective cohort study was conducted in two Canadian EDs. Using a modified palliative care screening tool, volunteer ED physicians were asked to identify adult patients with end-stage, chronic conditions including cancer, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), heart failure (HF), cirrhosis, dementia and/or progressive central nervous system (PCNS) disease. Demographic data were collected from these tools and data regarding patients’ visits in both the 6 months prior to and 30 days following their index visits were collected from the ED Information System. Bivariate analyses were completed using Student's t and chi-square test. Results: A total of 663 patients with end-stage illness were identified; 338 (51%) were female and the median age was 76 (IQR: 63, 85). Cancer was the most common presentation (41%), followed by dementia (23%), COPD (16%), HF (9%), CKD (9%), PCNS disease (9%) and cirrhosis (7%). These patients made a total of 1277 visits in the 6 months prior to and 288 in the 30 days following the index visit. Patients presenting to the EDs with cancer (p = 0.001), cirrhosis (p = 0.005) and CKD (p = 0.03) were more likely to visit an ED in the 6 months prior to their index visit. In contrast, patients presenting with dementia (p < 0.0001) and PCNS disease (p = 0.02) were significantly less likely to present to an ED in the 6 months prior to their index visit. Patients presenting with cirrhosis or CKD had the highest average number of ED visits in the 6 months prior to their index visit (cirrhosis: 4.59 visits, SD: 3.8, p < 0.0001; CKD: 4.39 visits, SD: 3.8, p = 0.0001). Of these patients, those presenting with end-stage cirrhosis were significantly more likely to make a return visit to an ED within 30 days after their index visit (p = 0.014). Conclusion: Cancer is the most common condition for patients with end-stage, chronic illnesses in these EDs. Those presenting with cirrhosis or CKD are at a significantly higher risk of repeat visits to the EDs. This study has identified potential deficits in care and can serve as a baseline for future intervention studies.