Brain Injury Research in Children (BIRCh) Laboratory

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Each year, millions of children sustain concussions/mild traumatic brain injuries (mTBI), and 15-25% suffer persistent symptoms and declines in quality of life. Clinicians caring for these children face three critical, unanswered questions: how to diagnose concussion, how to predict which children will suffer persistent symptoms, and how to treat those who do? The overall goal of the Brain Injury Research in Children lab is to answer these questions through an interdisciplinary program that combines systematic research, integrated knowledge translation, and training/mentoring. The long-term vision is to transform clinical care and improve outcomes for children with concussion.

Dr. Yeates’s research program, which is supported by a Canadian Institutes of Health Research (CIHR) Foundation Grant entitled, “Advancing Concussion Assessment and Treatment in Children and Youth (A-CATChY),” has two core aims. The first is to improve diagnosis and prognosis of mTBI by focusing on assessment.

Dr. Yeates directs a prospective, longitudinal, multi-site cohort study, entitled “Assessing Concussion Assessment in Pediatrics (A-CAP)”. The objective of A-CAP is to improve ability to diagnose pediatric concussion and make prognostic predictions about outcomes. A-CAP is assessing a broad pool of neurobiological and psychosocial markers, including some not yet studied in any large-scale study (e.g., genes; psychological resilience; multi-modal magnetic resonance imaging), and assess outcomes over 6 months post-injury. The study will have a large sample (700 concussion, 300 mild orthopaedic injuries), recruited at five sites across Canada, to enable the analysis of complex interactions among diagnostic and prognostic markers.

Dr. Yeates also directs a related project, “Mild Injury Outcomes in Children (MIOS),” in the United States. The overall goal of MIOS, which is funded by the National Institutes of Health (NIH), is to examine the utility of diagnostic methods commonly used in clinical settings in the prediction of persistent postconcussive symptoms and functional impairments. Participants include 8- to 15-year-old children with mTBI (n = 200) or mild orthopedic injuries (n = 100), recruited in the Emergency Departments (ED) at two large children’s hospitals. Acute signs and symptoms of concussion, as well as mental status and balance, are assessed using standardized methods at the time of recruitment. All children complete computerized neuropsychological testing and magnetic resonance imaging (MRI) within 7 days of injury. The proposed research is innovative because no previous study has compared the predictive utility of these commonly-used methods for assessing pediatric mild TBI.

The second aim of Dr. Yeates’s research program is to develop and test interventions to reduce children’s post-concussive symptoms using a personalized approach that matches treatments to clinical presentation. The interventions will be tested in randomized controlled trials (RCTs), first individually and subsequently in multi-arm RCTs involving promising biomedical treatments (e.g., melatonin, cervico-vestibular therapy, cognitive-behavioral therapy).

Dr. Yeates has recently been awarded a grant from the Alberta Health Services (AHS) Health Outcomes Improvement Fund to conduct an expanded evaluation of the implementation of a clinical pathway for the acute care of pediatric concussion across four acute care sites in Alberta. The project has three objectives: (1) Design an evidence-based, knowledge-user informed, and theory-driven approach to implementation of the clinical pathway acute care of pediatric concussion; (2) Evaluate the impact of the implementation on patient-centered outcomes using a stepped wedge cluster randomised trial; (3) Determine whether implementation of the clinical pathway is associated with changes in health care utilization and associated costs

The BIRCh lab research program responds directly to the concerns of patients, families, clinicians, institutional decision makers, and other end users. It builds on these partnerships via an integrated knowledge translation plan, which includes an advisory committee to provide ongoing stakeholder participation, patient engagement researchers to generate research by and for patients, and a dedicated knowledge broker to weave a broad translational network and build a strategy for the dissemination and uptake of study findings by scientists and end users.

The program builds research capacity via interdisciplinary training and mentoring along a “multi-generational” chain. Dr. Yeates’s trainees, as well as those supervised by other research team members, are immersed in the research program and engage in program-specific training activities (e.g., mentoring committees, lab rotations, annual conference) while capitalizing on institutional educational opportunities. In addition, senior investigators on the team mentor junior members and support them in developing independent research.

See: "Yeates K O, Beauchamp M, Craig W, et al. Advancing Concussion Assessment in Pediatrics (A-CAP): a prospective, concurrent cohort, longitudinal study of mild traumatic brain injury in children: study protocol. BMJ Open 2017;7:e017012. doi:10.1136/bmjopen-2017-017012"

Also: "Emery, C. A., Barlow, K. M. et al. (2016) A systematic review of psychiatric, psychological, and behavioural outcomes following mild traumatic brain injury in children and adolescents. The Canadian Journal of Psychiatry. 61 (5), 259-269"

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