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Table of Contents for the April Issue of Concussion Litigation Reporter

April 2017, Vol. 5, No. 10

Timely reporting on developments and legal strategies at the intersection of sports and concussions—articles that benefit practicing attorneys who may be pursuing a claim or defending a client.

Articles

New Study Strengthens Calls for Further Investigation into CTE Links with Soccer.

Appeals Court: Use of Oklahoma Drill May Have Been Gross Negligence

Discussion on NCAA and Concussions Steals the Show at Harvard Law School Symposium

Appeals Court: What Coaches Don’t Know About a History of Concussion Cannot Hurt Them

Soccer Goalie Alleges Team Failed to Hold Him out of Practice After Suffering Concussion, Exacerbating Symptoms

BIAPA Executive Talks About Role of Organization and Membership’s Biggest Concerns

Concussion in Sport: Liability of Governing Bodies

Senate Bill 12 – An Analysis

NFLPA Assails Possible Change in Worker’s Comp Law in Illinois

Attorney Weighs in on Change to Workers’ Comp Law for Professional Athletes

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TBI in Emergency Departments a Substantial Economic Burden TBI in Emergency Departments a Substantial Economic Burden

A new study that looked at nearly 134,000 emergency department visits for traumatic brain injury, including concussion, during a one year period in Ontario estimated that those visits had a total cost of $945 million over the lifetimes of those patients.

Medical treatments accounted for $292 million (31 per cent) of the estimated lifetime costs, and lost productivity amounted to $653 million (69 per cent), according to the report, published online in the Canadian Journal of Neurological Science.

Policy makers are increasingly using cost-of-illness studies such as this one to guide resource allocation and identify opportunities for improving health-care sustainability, said Dr. Michael Cusimano, a neurosurgeon at St. Michael’s Hospital and a senior author of the study.

“Traumatic brain injuries are occurring at alarmingly high rates and have the potential for long-term disability, so it’s important to understand how best to prevent them using available resources,” he said. “Determining the patterns, causes, effects, and costs of TBI-related emergency department visits is one way to do that.”

Looking at data from 2009, researchers found there were 133,952 TBI-related visits to Ontario EDs that year. They were also able to break these visits down into demographic groups.

Young children and the elderly had the highest rates of TBI-related ED visits compared with those aged five to 65, according to the authors.

The rate of TBI-related ED visits was higher for men than women across all age groups younger than 65, according to the authors. This gender difference was particularly evident within the 15 to 24 and 25 to 34 age categories, in which men were twice as likely as women to go to an ED with a TBI.

Costs were greater for men than women across nearly all age groups, with men incurring double the costs overall. This finding is consistent with the fact that men suffer a higher rate of fatal injury and earn a higher income on average, compared with women, according to the report. One exception was the over 85 years category, in which costs were 56 per cent higher for females than males. Women live longer than men on average; therefore women are more likely to sustain a TBI because they are overrepresented in the over 85 age range, according to the authors.

Falls were the cause of almost half (47 per cent) of TBIs in the year studied. The highest rate of falls occurred among children under four and the elderly (age 75 years and older), who together were six times more likely to sustain a fall-related TBI compared with other age groups.

Other common causes of TBI were struck by/against injuries, in which TBI was sustained when a person was struck by or struck against another person or an object (37 per cent), motor vehicle crashes (10 per cent) and sports- and bicycle-related accidents (combined 12 per cent).

The highest rates of motor vehicle crash-related TBI occurred among adolescents and young adults. Although they accounted for only 10 per cent of TBIs, they accounted for more than 17 per cent of total costs. This disproportionately large cost reflects the long-term disabilities resulting from the original injury resulting from motor vehicle accidents and the increased likelihood of younger age groups being affected by motor vehicle crashes, resulting in high lifetime medical and lost productivity costs, the authors wrote.

The findings underscore the importance of ongoing surveillance and prevention efforts targeted to vulnerable populations, said Terence Fu, a medical student at St. Michael’s and an author on the study.

“An emphasis on efforts such as falls prevention among the elderly, motor vehicle accident prevention among young adults, and sports-related TBI prevention among youth, could help decrease the incidence and economic burden of these injuries,” he said.

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Researchers Identify How Inflammation Spreads Through the Brain After Injury

Researchers have identified a new mechanism by which inflammation can spread throughout the brain after injury. This mechanism may explain the widespread and long-lasting inflammation that occurs after traumatic brain injury, and may play a role in other neurodegenerative diseases.

The findings were published in a study in the Journal of Neuroinflammation.

This new understanding has the potential to transform how brain inflammation is understood, and, ultimately, how it is treated. The researchers showed that microparticles derived from brain inflammatory cells are markedly increased in both the brain and the blood following experimental traumatic brain injury (TBI). These microparticles carry pro-inflammatory factors that can activate normal immune cells, making them potentially toxic to brain neurons. Injecting such microparticles into the brains of uninjured animals creates progressive inflammation at both the injection site and eventually in more distant sites.

Research has found that neuroinflammation often goes on for years after TBI, causing chronic brain damage. The researchers say that the microparticles may play a key role in this process.

Chronic inflammation has been increasingly implicated in the progressive cell loss and neurological changes that occur after TBI. These inflammatory microparticles may be a key mechanism for chronic, progressive brain inflammation and may represent a new target for treating brain injury.

The researchers on the paper include four University of Maryland School of Medicine researchers: Alan Faden, Stephen R. Thom, Bogdan A. Stoica, and David Loane.

“These results potentially provide a new conceptual framework for understanding brain inflammation and its relationship to brain cell loss and neurological deficits after head injury, and may be relevant for other neurodegenerative disorders such as Alzheimer disease in which neuroinflammation may also play a role,” said Dr. Faden. “The idea that brain inflammation can trigger more inflammation at a distance through the release of microparticles may offer novel treatment targets for a number of important brain diseases.”

The researchers studied mice, and found that in animals who had a traumatic brain injury, levels of microparticles in the blood were much higher. Because each kind of cell in the body has a distinct fingerprint, the researchers could track exactly where the microparticles came from. The microparticles they looked at in this study are released from cells known as microglia, immune cells that are common in the brain. After an injury, these cells often go into overdrive in an attempt to fix the injury. But this outsized response can change protective inflammatory responses to chronic destructive ones.

The findings have important potential clinical implications. The researchers say that microparticles in the blood have the potential to be used as a biomarker – a way to determine how serious a brain injury may be. This could help guide treatment of the injuries, whose severity is often difficult to gauge.

They also found that exposing the inflammatory microparticles to a compound called PEG-TB could neutralize them. This opens up the possibility of using that compound or others to treat TBI, and perhaps even other neurodegenerative diseases.

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