title: A Novel Tool for Evaluation of Mild Traumatic Brain Injury Patients in the Emergency Department: Does Robotic Assessment of Neuromotor Performance Following Injury Predict the Presence of Postconcussion Symptoms at Follow-up?
abstract: OBJECTIVE
  Postconcussion symptoms (PCS) are a common complication of mild traumatic brain injury (TBI). Currently, there is no validated clinically available method to reliably predict at the time of injury who will subsequently develop PCS. The purpose of this study was to determine if PCS following mild TBI can be predicted during the initial presentation to an emergency department (ED) using a novel robotic-assisted assessment of neurologic function.
  
  
  METHODS
  All patients presenting to an urban ED with a chief complaint of head injury within the preceding 24 hours were screened for inclusion from March 2013 to April 2014. The enrollment criteria were as follows: 1) age of 18 years or greater, 2) ability and willingness to provide written informed consent, 3) blunt head trauma and clinical diagnosis of isolated mild TBI by the treating physician, and 4) blood alcohol level of <100 mg/dL. Eligible mild TBI patients were enrolled and their neuromotor function was assessed in the ED using a battery of five tests that cover a range of proprioceptive, visuomotor, visuospatial, and executive function performance metrics. At 3 weeks postinjury, participants were contacted via telephone to complete the Rivermead Post-Concussion Symptoms Questionnaire to assess the presence of significant PCS.
  
  
  RESULTS
  A total of 66 mild TBI patients were enrolled in the study with 42 of them completing both the ED assessment and the follow-up; 40 patients were included in the analyses. The area under the receiver operating characteristic curve (AUC) for the entire test battery was 0.72 (95% confidence interval [CI] = 0.54 to 0.90). The AUC for tests that primarily measure visuomotor and proprioceptive performance were 0.80 (95% CI = 0.65 to 0.95) and 0.71 (95% CI = 0.53 to 0.89), respectively.
  
  
  CONCLUSIONS
  The robotic-assisted test battery has the ability to discriminate between subjects who developed PCS and those who did not. Additionally, poor visuomotor and proprioceptive performance were most strongly associated with subsequent PCS.
authors.affiliation: Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, OH.
authors.forename: Vignesh
authors.initials: V
authors.lastname: Subbian
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Ratcliff
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Korfhagen
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Meunier
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: George J
authors.initials: GJ
authors.lastname: Shaw
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.affiliation: Department of Electrical Engineering and Computing Systems, University of Cincinnati, Cincinnati, OH.
authors.forename: Fred R
authors.initials: FR
authors.lastname: Beyette
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications*; D003943:Diagnostic Techniques, Neurological; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D016489:Head Injuries, Closed / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D038223:Post-Concussion Syndrome / Q000175:diagnosis* / Q000209:etiology*; D012371:Robotics / Q000379:methods*; D012680:Sensitivity and Specificity; D014505:Urban Population; D055815:Young Adult