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CONCUSSION

Assignment #2
LITERATURE SEARCH

SGL Group 6

November 6, 2019

Wikipedia Search: Pathophysiology of Concussion Meaghan Conrad

1. My search was based on evidence that would be required to make corrections to the “Pathophysiology” section of the Wikipedia

page for concussion. As such, my search strategy was as follows:

Following the search (above), I scanned titles/abstracts for potential relevance since my search was limited to a manageable number of

results (61), given my criteria. From there I was able to identify several relevant sources.

2. Potential sources for consideration included:

King, D., Brughelli, M., Hume, P. et al. Sports Med (2014) 44: 449. https://doi.org/10.1007/s40279-013-0134-x

And:

Chancellor, S. E., Franz, E. S., Minaeva, O. V., & Goldstein, L. E. (2019). Pathophysiology of Concussion. Seminars in Pediatric Neurology,

30, 14–25. doi: 10.1016/j.spen.2019.03.004

3. My choice of source: A ssessment, Management and Knowledge of Sport-Related Concussion: Systematic Review. Although

both articles I considered gave a good overview of the known pathophysiological mechanisms for concussion, I selected this source

because it included a more rigorous appraisal of evidence. This article was a systematic review and although it also focused on several

other aspects of concussion, there was a strict methodology through which primary evidence was assessed. The other article

Pathophysiology of Concussion was focused on only pathophysiology, but it was a review article that provided a broad overview of the

topic as a whole, including the history of concussion. Although the second source was more recent (2019 vs 2014), I felt that overall the

first source was a more reliable evidence to be used in making changes to the Wikipedia page.

4. Wiki Criteria: As per the WP:MEDRS page, this article is a s ystematic review, therefore a secondary source. This evidence is

fairly r ecent at 5 years old, which is more up to date than the large majority of sources on our wiki page (which on average were from the

early 2000’s). Lastly, I selected it because it was f reely accessible in f ull-text, meaning that it met the criteria of not citing only the

abstract of an article to be able to give an accurate representation of the content.

5. Intended Use: Because many of the citations in our Wikipedia article on concussion were very old or potentially out of date,

my intent is to use this article to help corroborate previous findings regarding the pathophysiology of concussion; or to disprove prior

facts and help to appropriately update that section of the wiki using more current high quality evidence.

Wikipedia Literature Search Assignment Kevin Cheung

Topic: Concussion

1) How you searched for a source (search strategy – where you went to find it).

I utilized the Trip Database ( www.tripdatabase.com ) to look for either guidelines or systematic reviews on concussion. I began with a

simple generalized search of “concussion” which gave me 3455 results. I further narrowed down my results by limiting it to “All

Secondary Evidence” and “Since 2016”, which brought my search results down to 79.

2) What potential sources were identified and considered (give examples of 1 or 2)

There were two potential resources that I identified:

- “Concussion” BMJ Best Practice Evidence Based Synopses

- “Concussion and mild traumatic brain injury” DynaMed Plus Systematic Review

3) Why the source was chosen (what made it better than other choices).

I decided to go with the “Concussion and mild traumatic brain injury” - Dynamed Systematic Review resource because it was the

most focused on the topic at hand. The other available systematic reviews and guideline were more sports specific. I also choose to

go with a systematic review rather than a guideline as it would provide me more comprehensive information.

4) List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS)

criteria.

a. Secondary Source that is behind a subscription wall

b. Systematic review = Higher quality evidence

c. Relatively recent resource that has been continually updated, last update was September 2018

d. Scientific Consensus – DynaMed is a clinician-focused tool designed to facilitate efficient and evidence-based patient care

e. No overt biases present/listed

5) How do you plan to use the source for improving the article?

I plan to utilize this article as a basis from which to update some of the information in the Wikipedia article. In particular, I am

hoping to update information regarding risk factors for concussion and comment on incidence rate/prevalence.

Wikipedia Literature Search Assignment Zahra Haq

1. How you searched for a source (search strategy- where you went to find it)

I initially searched on Cochrane to see if I could find any literature on concussion outcomes, and found nothing. I searched for a

source on PubMed multiple times (21 times). I kept adding and removing limitations. I went back and looked at the MeSH headings and

tried to more inclusive by using Brain Injuries, Traumatic header that includes Brain Concussion, Contusion and Chronic Traumatic

Encephalopathy. Since I wanted a secondary source, I limited publication type to Systematic Review. I am looking for updated data on

outcomes from concussions in the population in the last 4 years, which is how I arrived at this search.

2. What potential sources were identified and considered (give examples of 1 or 2)

Citations are provided in APA format.

Source 1: Lasry, O., Liu, E. Y., Powell, G. A., Ruel-Laliberté, J., Marcoux, J., & Buckeridge, D. L. (2017). Epidemiology of recurrent

traumatic brain injury in the general population: a systematic review. N eurology, 8 9(21) , 2198-2209.

This source came up in the search. While this paper talks about the epidemiology, which is good, it narrows in on recurrent TBIs- so

traumatic brain injuries that happen more than once. Since I am interested in finding out the general most common type of traumatic

brain injury, it is not exactly what I am looking for.

Source 2: Nguyen, R., Fiest, K. M., McChesney, J., Kwon, C. S., Jette, N., Frolkis, A. D., ... & Pringsheim, T. (2016). The international

incidence of traumatic brain injury: a systematic review and meta-analysis. Canadian Journal of Neurological Sciences, 4 3(6) , 774-785.

This paper focuses more on an international level and also identifies traumatic brain injury in general, and not just focusing in on one

type. It is a systematic review, which fits the criteria. It also reports what type of TBI is most common, which is what I am looking for.

3. Why the source was chosen (what made it better than other choices).

The second paper by Nguyen et al (2016) was chosen because it fits all the criteria I was looking for, and more specifically, it

explains traumatic brain injury and not just limiting it down to different types of traumatic brain injury- for example, concussions or

repeat TBIs.

4. List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria.

It is a secondary sourc e and not original research, it is a s ystematic revie w – not an original research article, and it is published in 2016,

so within the last 5 year s meaning it is recent

5. How do you plan to use the source for improving the article?

The current Wikipedia sentence reads outcomes are generally good, with a reference from about 15 years ago. This source will be used to

expand what the outcomes after a traumatic brain injury are with more recent literature.

Amanda Mattioli

1) How you searched for a source (search strategy – where you went to find it).

- First checked Cochrane database searching “concussion” and didn’t find any articles

- Next searched PubMed with keywords “concussion duration,” “concussion AND duration,” and “concussion AND recovery”

and applied the filters: review, last 5 years, human

2) What potential sources were identified and considered (give examples of 1 or 2).

1. McCrory P, Meeuwisse W, Dvorak J, et al Consensus statement on concussion in sport—the 5th international

conference on concussion in sport held in Berlin, October 2016 British Journal of Sports Medicine 2017;51:838-847.

( https://bjsm.bmj.com/content/bjsports/early/2017/04/26/bjsports-2017-097699.full.pdf )

2Æ†Concussion: pathophysiology and clinical translation.

Giza C, Greco T, Prins ML.

Handb Clin Neurol. 2018;158:51-61. doi: 10.1016/B978-0-444-63954-7.00006-9. Review.

PMID: 30482375 [PubMed - indexed for MEDLINE]

3) Why the source was chosen (what made it better than other choices).

- This article (McCrory et al) is the result of a conference of professionals who reviewed over 60 000 publications and have

compiled expert data over 4 previous conferences. Formal systematic reviews were done for each consensus question and

are referenced.

- This article provides up-to-date, consensus-driven information

- I had access to the full text to article 1 but not article 2 (which would not meet Wikipedia’s reliable medical source

criteria)

- The article is specifically about SRCs but states that the definition for concussion is vague and varies between papers

4) List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources

(MEDRS) criteria.

- It is a consensus statement done by an international body of experts (Concussion in Sport Group)

- The information in the article is based on multiple systematic reviews

- The statement is from the 5 th and most recent conference proceedings (most up-to-date consensus)

5) How do you plan to use the source for improving the article?

- I plan to use the consensus statement definitions of normal clinical recovery times for adults and children to improve the

introduction section of the Wikipedia article. The Wikipedia article gives a blanket statement that “it is not unusual for

symptoms to last four weeks.” I would like to clarify that this is the maximum normal clinical recovery time for pediatrics,

but for adults a normal recovery time is actually half that.

Julian Rubino (20093837)

1. How you searched for a source (search strategy – where you went to find it).

Concussion and mild traumatic brain injury were linked using OR, and this was linked to pathophysiology using AND. I then narrowed the

search to Reviews, Systematic Reviews, and Meta-Analyses within the 2014-present time period.

2. What potential sources were identified and considered (give examples of 1 or 2).

Hiskens, M. I., Angoa‐Pérez, M., Schneiders, A. G., Vella, R. K., & Fenning, A. S. (2019). Modeling sports‐related mild traumatic brain

injury in animals—A systematic review. J ournal of Neuroscience Research. doi: https://doi-org.proxy.queensu.ca/10.1002/jnr.24472

Romeu-Mejia, R., Giza, C. C., & Goldman, J. T. (2019). Concussion pathophysiology and injury biomechanics. C urrent Reviews in

Musculoskeletal Medicine, 1 2 (2), 105-116.

3. Why the source was chosen (what made it better than other choices).

I chose the latter source, concussion pathophysiology and injury biomechanics. The former article was a good study, however, because of

the nature of the article, a systematic review, the question was too focussed for the purpose of the section I am editing. For

pathophysiology, I wanted a relevant article that addresses many broader aspects and topics in a comprehensive manner, including

biochemistry, which is focussed upon heavily within the Pathophysiology section of the Wikipedia article.

4. List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources

(MEDRS) criteria.

The article I chose follows the MEDRS criteria. Firstly, the article represents a secondary source. It is a review article published by a third

party journal. The article is also published in an unbiased manner, all conflicts of interests are disclosed, with only one of the three

authors reporting receiving grant funding from Concussion Research institutions. The review was also very recently published, within the

past year. Furthermore, access to the journal is open to the public and is not behind a paywall.

5. How do you plan on using the source for improving the article?

The final paragraph of the Wikipedia article section on “Pathophysiology” attempts to editorialize the article and provide consensus.

However, much of the research is done on animal models and is not definitive. Furthermore, in the entire text of that paragraph, only one

source is cited from 2005. I plan on using the source to either corroborate or update that paragraph with more relevant information

incorporated from this recent review article.

Gillian Forster (20048918)

1. I searched for concussion prevention using the MeSH term “brain concussion” and prevention. I also ensured in my search that I

was looking for review articles from the last five years.

2. Here are two of the potential sources I identified:

Source 1:

Sone, J. Y., Kondziolka, D., Huang, J. H., & Samadani, U. (2017). Helmet efficacy against

concussion and traumatic brain injury: a review. Journal of neurosurgery, 126(3), 768-781.

Source 2:

Register-Mihalik, J., Baugh, C., Kroshus, E., Y. Kerr, Z., & Valovich McLeod, T. C. (2017). A

multifactorial approach to sport-related concussion prevention and education: application of the socioecological framework. Journal

of athletic training, 52(3), 195-205.

3. I chose source 1 because of the information discussed within it. This review discussed specifically helmets and there use in

concussion prevention as well as it did not focused on a single population. Although some of the articles discussed in the article were

sport-related this review seemed more generalized to the whole population than the other article. the source is more related to the

current information on our Wikipedia page.

4. The source is a secondary source as it is a review. The source is recent as it was published within the last five years (2017).

The source was fully accessible and is published in a peer-reviewed journal.

5. This source will provide an up-to-date perspective on helmet use as concussion prevention. Within concussion prevention on

the Wikipedia page, there are several statements about concussion prevention, but the sources are older. This review may help to

update some of this out-of-date information.

1

Wikipedia Assignment # 2: Literature Search Ishita Aggarwal

1. How you searched for a source (search strategy – where you went to find it).

I was seeking a citation that would enable me to improve the “Prevention” section of the Wikipedia article on

“Concussion.” To find an appropriate source, I searched Concussion AND Prevention in PubMed and filtered by Article

Types (Review), Publication Dates (5 Years), and Species (Human). I obtained 112 results. My search strategy is shown

below:

2. What potential sources were identified and considered (give examples of 1 or 2).

Potential sources included:

 Emery, C.A. (2018). Injury prevention in kids’ adventure and extreme sports: Future directions. Res Sports Med,

26:199-211. doi: 10.1080/15438627.2018.1452239.

 Master, C.L., Mayer, A.R., Quinn, D., et al. (2018). Concussion. Ann Intern Med. 169:ITC1–ITC16. doi:

10.7326/AITC201807030.

 Schneider, D.K., Grandhi, R.K., Bansal, P., et al. (2017). Current state of concussion prevention strategies: A

systematic review and meta-analysis of prospective, controlled studies. Br J Sports Med, 51:1473-1482. doi:

10.1136/bjsports-2015-095645.

3. Why the source was chosen (what made it better than other choices).

I chose Schneider et al. (2017) over Emery (2018) and Master et al. (2018). Although all three sources are current (<5

years old), reliable, and discuss concussion prevention, I found Schneider et al. (2017) to be most systematic,

comprehensive, and relevant. Specifically, Schneider et al. (2017) examined many different concussion prevention

strategies (e.g. equipment, educational programs, training, etc.) in diverse populations (e.g. wide age range, both

genders, various sports, etc.), answering all of my questions. Contrastingly, Emery (2018) only explored concussion

prevention in a narrow subpopulation (i.e. children) and Master et al. (2018) provided a brief and limited overview of

primary and secondary prevention, reducing generalizability and applicability of their findings. Furthermore, while full

texts of Schneider et al. (2017) and Master et al. (2018) were available, I could not access full text of Emery (2018),

failing to meet Wikipedia’s MEDRS criteria.

4. List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS)

criteria.

 The article by Schneider et al. (2017) is a systematic review and meta-analysis, making it a high-quality secondary

source.

 The article by Schneider et al. (2017) is recent (<5 years old) and up-to-date, better ensuring reliability of

information.

 No conflicts of interest were disclosed, reducing risk of bias.

5. How do you plan to use the source for improving the article?

I plan to use this source to improve the “Prevention” section of the Wikipedia article on “Concussion.” The “Prevention”

section focuses almost exclusively on protective equipment (e.g. helmets, airbags and seatbelts, and hard shoes) as

useful tools for preventing concussion. Hence, I hope to add evidence showing educational and training programs are

effective concussion prevention strategies as well.

Assignment #3
MEAGHAN CONRAD

Proposed Changes
The original paragraph was as follows:

“In an effort to restore ion balance, the sodium-potassium ion pumps increase activity, which results in excessive ATP (adenosine triphosphate) consumption and glucose utilization. Lactate accumulates but, paradoxically, cerebral blood flow decreases, which leads to a proposed "energy crisis." After this increase in glucose metabolism, there is a subsequent lower metabolic state which may persist for up to 4 weeks after injury. A completely separate pathway involves a large amount of calcium accumulating in cells, which may impair oxidative metabolism and begin further biochemical pathways that result in cell death. Again, both of these main pathways have been established from animal studies and the extent to which they apply to humans is still somewhat unclear.”

The proposed changes are as follows:

(Additions in Bold)

In an effort to restore ion balance, the sodium-potassium ion pumps increase activity, which results in excessive ATP (adenosine triphosphate) consumption and glucose utilization, quickly depleting glucose stores within cells.

Reword the following sentence:

Lactate accumulates but, paradoxically, cerebral blood flow decreases, which leads to a proposed "energy crisis."

To:

'''Simultaneously, inefficient oxidative metabolism leads to anaerobic metabolism of glucose and increased lactate accumulation. There is a resultant local acidosis in the brain and increased cell membrane permeability, leading to local swelling.'''

Rationale for proposed change
In the first sentence, my change is made to more explicitly clarify that the massive increase in glucose utilization leads to a number of issues such as a depletion of glucose stores in the cell. Previously, this paragraph talks about increased ATP demand and glucose use, then jumps to lactate production without directly explaining the process. I also reworded the second sentence listed above, splitting it into 2 sentences, which better explain how glucose and energy issues lead to problems in the brain and to clarify that glucose depletion leads to more anaerobic respiration, which leads to lactate production. The initial paragraph jumps directly from discussing glucose issues to lactate without any physiological explanation, then uses the blanket term “energy crisis”, which is vague and gives the reader no explanation of the issue. The reference used to corroborate these changes is a review article from 2016, from a journal in physical rehabilitation sciences.

Barkhoudarian, G., Hovda, D. A., & Giza, C. C. (2016). The Molecular Pathophysiology of Concussive Brain Injury – an Update. Physical Medicine and Rehabilitation Clinics of North America, 27(2), 373–393. doi: 10.1016/j.pmr.2016.01.003

Potential Controversy
I don’t believe that there is any controversy with respect to my proposed changes. The information that I am adding is consistent with the pathophysiological processes that were already summarized in the article. At the time that this section was written, the paragraph was based on an extrapolation of proposed mechanisms; whereas currently, there are a number of secondary sources that have compiled research in the field and agree have better agreement regarding the mechanisms of injury in concussion pathophysiology. Hence, I did not remove key content, which may have been controversial, I simply added to improve clarity of the existing section.

Critique of Source
The main potential issue with this source is that it is a narrative review. This means that the process for article selection would not have been as rigorous as a systematic review, and that the review process may have been more up for interpretation by the reviewer. Additionally, since the article does not specify the methods for the review process, it is unclear how article selection may have occurred, so there may be sources of selection bias or publication bias, or issues with internal validity of some of the individual studies. In this case, it would be hard to truly appraise the quality of individual articles that contributed to this review. In terms of addressing my section related to pathophysiology, I believe that this review article was still appropriate, keeping in mind possible limitations. In the absence of high quality systematic reviews (my literature search yielded none) specifically regarding pathophysiology, I think that a narrative review based on substantial evidence is appropriate to lay out proposed biological processes.