Risk Stratification Using Physiologic Markers and Mobile Health-Facilitated Specialist Management to Improve Outcomes in Pediatric Concussion Patients

候选人：我的长期职业目标是减少体育运动后的认知、身体和情感疾病。 通过对脑震荡后持续性脑震荡风险最高的患者实施早期干预， 症状（PPCS）。我将75%的时间用于以患者为导向的研究和职业发展， 短期目标是开发一种预测模型，以最准确地识别那些风险最高的患者。 开发PPCS，并使用新的移动的健康（mHealth）干预措施，以改善专家从 急诊科（艾德）设置。这个建议建立在我以前的工作，研究客观马克- 脑震荡后功能障碍的患者，并将使我获得先进的预测建模技能， 促进早期风险分层，利用先进的基于移动医疗的干预措施促进护理连续性， 定位这些干预措施的采用和可持续性，并设计和领导临床试验， 艾德设置，利用创新的方法来创建移动健康干预措施采用的证据基础。 环境：本提案利用了我在费城儿童医院可用的大量资源- 德尔菲亚，通过急诊医学部，伤害研究和预防中心，创新 生态系统，运动医学和性能中心;在宾夕法尼亚大学，通过 临床流行病学和生物统计学中心，宾夕法尼亚损伤科学中心，和伦纳德戴维斯在- 卫生经济学研究所;并通过儿科急诊应用研究网络。男人们- 除了临床实践经验外， 四级护理儿科艾德，为我的职业发展创造一个理想的环境。 研究：脑震荡是儿科人群中常见的伤害。虽然大多数症状在 脑震荡青年解决1个月内，一个显着的比例（30%）的经验，症状持续数月 甚至好几年一些观察性研究已经确定了与PPCS相关的风险因素，然而， 目前对脑震荡青少年进行风险分层的最佳方法只有适度的区分， 依赖于主观症状此外，虽然传统上，儿科脑震荡是用pas- 近年来，积极治疗已成为专业环境中的护理标准。然而，在这方面， 传统的转诊模式对艾德脑震荡的护理连续性和专家访问提出了几个障碍， 锡永。新型移动健康干预措施有可能改善护理连续性，作为桥梁 在脑震荡青少年的护理机构之间。为了促进改善护理并最终减轻症状 该建议旨在：（1）提高脑震荡风险分层的准确性 从艾德使用生理标志物的损伤;和（2）评估的可行性的移动健康工具，以促进 专家访问和护理连续性。研究结果将允许我制定临床试验的R 01提案 评估移动健康促进的目标转诊的有效性，以减少PPCS的发生率。

Candidate: My long-term career goal is to reduce the cognitive, physical, and emotional morbidity following pe- diatric concussion by implementing early interventions to those at highest risk for persistent post-concussion symptoms (PPCS). With 75% of my time dedicated to patient-oriented research and career development, my short-term goals are to develop a predictive model to most accurately identify those patients at highest risk of developing PPCS, and to use a novel mobile health (mHealth) intervention to improve specialist access from the emergency department (ED) setting. This proposal builds on my prior work in researching objective mark- ers of dysfunction following concussion, and will position me to gain skills in advanced predictive modeling to facilitate early risk stratification, utilizing advanced mHealth-based interventions to facilitate care continuity and positioning such interventions for adoption and sustainability, and designing and leading clinical trials from the ED setting that utilize innovative methods to create the evidence base for mHealth intervention adoption. Environment: This proposal leverages the substantial resources available to me at Children’s Hospital of Phila- delphia, through the Division of Emergency Medicine, Center for Injury Research and Prevention, Innovation Ecosystem, and Sports Medicine and Performance Center; at The University of Pennsylvania, through the Center for Clinical Epidemiology and Biostatistics, The Penn Injury Science Center, and the Leonard Davis In- stitute of Health Economics; and through the Pediatric Emergency Care Applied Research Network. The men- tored research experience and formal didactic training, in addition to the clinical experience of practicing in a quaternary care pediatric ED, create an ideal environment for my ongoing career development. Research: Concussions are prevalent injuries in the pediatric population. While the majority of symptoms in concussed youth resolve within 1 month, a significant proportion (30%) experience symptoms lasting months to even years. Several observational studies have identified risk factors associated with PPCS, however the best current methods to risk stratify concussed youth do so with only moderate discrimination, and are heavily reliant on subjective symptoms. In addition, while traditionally, pediatric concussions were managed with pas- sive rest, more recently, active therapies have become the standard of care in the specialty setting. However, the traditional referral model presents several barriers to care continuity and specialist access for ED concus- sion patients. Novel mHealth interventions have the potential to improve care continuity, serving as a bridge between care settings for concussed youth. In order to facilitate improved care and ultimately reduce symptom burden to highest risk children, this proposal aims to: (1) Improve accuracy of concussion risk stratification from the ED using physiologic markers of injury; and (2) Assess the feasibility of a mHealth tool to facilitate specialist access and care continuity. Study results will allow me to develop a R01 proposal of a clinical trial evaluating the effectiveness of mHealth-facilitated targeted referral to reduce the incidence of PPCS.