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Q & A with Roger Zemek

Q: What drives your concussion research?
A: At CHEO in the Emergency Department, we see about 900 concussion cases a year. Although concussion is considered a mild traumatic brain injury, we all recognize that there is nothing mild about having your child being symptomatic for a month. Quite simply, I want to help more kids get better faster.

Q: How did you begin your concussion research?
A: Not long ago, we completed a highly successful systematic review of concussion; looking for predictors of persistent symptoms. We looked at the current literature and discovered that at least 25 percent of kids have symptoms beyond one month. When compared to the typical assumption that concussion symptoms last two weeks, our findings were significant. This was recently published in JAMA Pediatrics.

Q: What other observations did you uncover in your research?
A: Most notably, we identified clear information gaps or groups often neglected in concussion research, namely: girls; young children; non-sports related injuries; and children with mild developmental or behavioural problems, such as ADHD or minor learning disabilities. Concussion research as it stands today cannot be generalized across the range of kids we see in the Emergency Department everyday.

Q: Did you apply your findings in the Emergency Department?
A: We completed a pilot study to look at predictors of persistent concussion symptoms in children. Our research was the first prospective study in the Emergency Department to include 100 kids between the ages of 5-17 years old and everyone was included. In addition, we considered some exploratory angles, like figuring out the role of parental anxiety because it hadn’t been looked at before. We found many interesting results, including: girls were twice as likely as boys to report persistent symptoms at one month; kids between ages 8-17 were at highest risk; and parental anxiety did not play a role.

Q: How will your concussion research continue to evolve?
A: We received excellent input from concussion experts around the world, when CHEO hosted a two-day international symposium on this topic not long ago. We collectively brainstormed ways to take the lessons learned from CHEO’s pilot study to a nation-wide clinical trial more than 10 times the size. The partnerships we forged and continue to leverage, as well as the research plans we have underway are very promising.

Q: What’s the end goal for your concussion research?
A: We’re hoping to develop an evidence-based “clinical decision rule” to help identify children at high risk for prolonged concussion symptoms. I envision the rule being applied at hospitals and by healthcare practitioners across Canada in the next couple of years.

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