Date of Award

January 2017

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Edward Melnick

Abstract

Concussion management in the ED is inconsistent due to a lack of available empirical testing. This project aims to assess the feasibility of a large multi-centered study for concussion biomarker discovery in the ED.

This prospective cohort pilot and feasibility study was conducted in the adult and pediatric EDs of an urban, academic, Level 1 trauma center. Twelve patients with concussions and twelve age- and gender-matched control patients presenting within 6 hours of an injury sustained during recreational activity were enrolled. ED blood specimens were banked for future proteomic analysis. Clinical outcomes were collected via online survey. Patient recruitment strategies were refined in three phases: (1) identification and notification by clinical staff, (2) email notification automatically-generated by the electronic health record (EHR), and (3) patient financial incentives provided at enrollment and upon completion of the symptom diary.

After Phase 1, the patient identification rate improved from 0% to 22% (p<0.001) with EHR-generated notifications. In Phase 3, the enrollment rate improved from 38% to 100% (p=0.01) with financial incentives.

This pilot and feasibility project is the first step to toward the goal of identifying new diagnostic and prognostic biomarkers as well as novel targets for therapy. EHR-based paging and financial incentives for participation increased subject identification and enrollment rate to inform and optimize the enrollment and recruitment strategies for the eventual larger study.

Comments

This is an Open Access Thesis.

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