Deficient follow-up care leads to worse outcomes after ED visits (4/3/25 Newsletter)
This week, our lead article, Deficient follow-up care leads to worse outcomes after ED visits, is in the Statistics category.
In this newsletter: Opportunities, Sports, Cannabis & Psychedelics, Diagnostics, Canadian Concussion Centre Webinar Recording & Statistics.
Writers: Josh Wu, Myla Hightower, Sravya Valiveti, Ella Webster
Editors: Malayka Gormally and Conor Gormally
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Opportunities
Tuesday, April 8, 6 pm EST: A free webinar, Legal / Legislation / Guidelines Issues, presented by Dr. Charles Tator and Patrick Brown, hosted by the Canadian Concussion Centre. Register in advance.
Wednesday, April 9, 6 pm EST: A webinar, Adaptive Yoga for Physical Disabilities: An Empowering Journey, presented by Rodrigo Souza and hosted by the nonprofit LoveYourBrain. Registration is self-selected, from free to $50.
Thursday, April 10, starting at 10 am EST: A free virtual conference, the NCAA-DoD Grand Alliance Seventh Annual Concussion Conference, hosted by the NCAA, the Department of Defence, the Big Ten Conference, and the University of Michigan. Register in advance.
Thursday, April 10, 3 pm EST: A webinar, Won’t You Be My Neighbor? How Neighborhood Factors Affect Life After Traumatic Brain Injury, presented by Raj G. Kumar, Ph.D. and Shannon B. Juengst, Ph.D., CRC, hosted by the Brain Injury Association of America. Free for survivor/family members, $50 for 1 ACBIS CEU. Register in advance.
Thursday, April 10, 12 pm PST: A free webinar, How to Build Credit, part of the Financial Class Series with Ruth Daugherty of NW Access Fund, hosted by Brain Northwest. Register in advance.
Thursday, April 17, 12:00 pm PST: A free webinar, How to Manage Debt, part of the Financial Class Series with Ruth Daugherty of NW Access Fund, hosted by Brain Northwest. Register in advance.
April 22, 6 pm EST: a free webinar, Imaging in Concussion presented by Dr. Andrea Para, hosted by the Canadian Concussion Centre. Register in advance.
Sports
White matter, cerebral blood flow changes persist for at least a year after concussion in athletes
A recent longitudinal study published in Neurology looked at post-concussion brain changes in athletes. Nathan W. Churchill et al. found differences in concussed athletes' cerebral blood flow and white matter compared to their non-concussed counterparts that persisted beyond medical clearance for Return-to-Play (RTP) and up to one year post-injury. Cerebral blood flow delivers essential nutrients and oxygen to the brain, and white matter helps neurons communicate with each other. According to an article by Unity Health Toronto, "Any interruption of cerebral blood flow or damage to white matter due to injury can affect cognition, emotions, and can cause debilitating physical symptoms, such as headache, dizziness, and fatigue." The study authors also found a particularly strong correlation between changes (decreases) in cerebral blood flow and prolonged recovery durations. The study authors note, "While athletes may appear to be clinically recovered, our findings reveal that their brains may still be healing, which could have implications for long-term brain health and functioning."
For this study, 187 healthy athletes were recruited from one sports medicine clinic at the University of Toronto. Clinical data and MRI imaging were performed before the season to obtain a baseline of cerebral blood flow and white matter physiology. Twenty-five athletes within this cohort went on to get a concussion and were matched with 27 non-injured athletes as a control. These individuals were re-assessed with an MRI at four different time points: 1–7 days after injury, date of Return to Play (RTP), 1–3 months after RTP, and 1 year after RTP.
The results offer new information on the long-term brain alterations that follow a concussion and help explain why some athletes who have experienced multiple concussions have shown notable reductions in their mental, cognitive, and brain health over time, according to the Unity Health article. Additionally, it contributes to the continuous discussion about appropriate concussion care, especially in professional and varsity sports where regular body-to-body contact occurs. More investigation is required to monitor these alterations and their long-term effects on brain health.
Cannabis & Psychedelics
Psilocybin therapy center opens for TBI recovery in Oregon
Experience Onward, a licensed psilocybin service center, opened in Portland in December 2024 with a mission to support individuals recovering from traumatic brain injuries (TBI), post-concussion syndrome, depression, and related mental health conditions. Founded by former NHL player Daniel Carcillo, the center is the first in the United States to focus specifically on TBI recovery using psilocybin therapy within a state-regulated framework, according to a March 2025 press release in Business Insider. Carcillo, a two-time Stanley Cup champion, was forced to retire at 30 due to repeated concussions and a resultant early-onset dementia diagnosis. He credits high-dose psilocybin experiences with saving his life after traditional treatments failed.
“I—like so many others in professional sports—endured relentless hits, repeated concussions, and the emotional toll my injuries created in my life… That’s why I’m committed to making these therapies accessible—to help others reclaim their lives and restore their well-being,” Carcillo noted, framing the center as a path to healing for others facing similar struggles.
The 4,600-square-foot facility includes 10 private treatment rooms and a group space designed for guided, legal psychedelic sessions. Experience Onward offers trauma-informed care for athletes, veterans, executives, and others seeking healing.
The press release states these therapies are “science-backed,” referencing a 2021 Frontiers in Neurology Mini-Review stating that research to date suggests “psychedelic pharmacotherapies may influence the future of brain injury treatment through modulation of neuroinflammation, hippocampal neurogenesis, neuroplasticity, and brain complexity.” Data on therapeutic outcomes will be collected through an independent Institutional Review Board (IRB), ensuring that any future research from this service center meets ethical and regulatory standards.
Oregon remains at the forefront of psychedelic therapy after becoming the first state to legalize psilocybin services through Measure 109 in 2020. The law created a regulated framework for supervised psilocybin use by adults 21 and older, overseen by the Oregon Health Authority (Oregon Health Authority, 2021). Experience Onward operates within this framework to offer a new, targeted treatment option for people with neurological trauma who have not found relief through conventional care.
Diagnostics
White matter hyperintensities may not help mTBI diagnosis or prognosis
A journal article published in the American Journal of Roentgenology challenges previous findings on the potential use of white matter hyperintensities (WMHs) on T2-weighted MRI as a marker to guide diagnosis and management of mild traumatic brain injuries (mTBIs). WMHs are small lesions in the brain’s white matter, or axons, that “hyperintense” or show up brightly on imaging scans like MRI. Manoj Tanwar et al. found that WMHs were similar between a group of patients with mTBI and a healthy control group. The study concluded that the association of abnormal WMHs or the presence of WMHs with clinical markers in mTBI was not statistically significant. In addition, the authors found no significant differences in WMHs between the mTBI and control groups.
These findings suggest that, contrary to previous evidence, the presence of white matter hyperintensities on MRI scans is not a reliable marker of mild traumatic brain injuries. As such, they argue that the clinical impact of WMHs as a potential marker of mTBI is limited at this time. The authors highlight that there is a need for objective biomarkers to help guide diagnosis and prognostication of traumatic brain injuries that pose a limitation in patient care.
The goals of the study were to assess associations of WMHs on high-resolution 3-T MRI with clinical markers of mTBI in these patients and to compare differences in WMHs in study groups with and without acute mTBI.
In this study by a research team at the Hospital of Special Surgery, 303 patients with acute mTBI and a matched control group of 148 healthy participants without mTBI were recruited from seven US centers seen during the months of Nov 2015 to Jan 2018. Patients were required to go through four clinical encounters, from baseline through 3 months after enrollment, where key clinical markers of brain injury were evaluated. Neurological symptom assessments included the Riverbed Post-Concussion Symptoms Questionnaire (RPQ-3) and the Rivermead Post-Concussive Symptoms Questionnaire-13 (RPQ-13), which assessed for early postconcussive physical symptoms and late post-concussive symptoms with regards to lifestyle and psychosocial functioning, respectively. The Balance Error Scoring System (BESS) test was also used to evaluate postural stability. 3-T MRI data was collected at each encounter, which included a 3D T2-weighted FLAIR sequence. Neuroradiologists reviewed baseline imaging for participants for the presence of at least one WMH and subsequently compared the data to the control group.
The findings were similar across both groups. The researchers found at least one WMH present in 102 of the 303 mTBI group participants, of which 41 had abnormal WMHs––defined as ≥5 punctate foci (dots of hyperintensity), at least one focus measuring >3 mm, or at least one focus in an atypical location. Additionally, 52 of the 148 control group participants had at least one WMH, of which 18 participants had abnormal WMHs.
Video: Concussion Alliance was featured on the Canadian Concussion Centre Zoom Webinar Series
Concussion Alliance Co-founder and CEO Conor Gormally and Co-founder and CEO Malayka Gormally made a presentation, "Concussion Alliance: Creating Accessible Patient-Facing Resources," for the Canadian Concussion Centre Zoom Webinar Series.
Conor and Malayka were interviewed by Lesley A. Ruttan, PhD, C.Psych, a registered psychologist with Toronto Rehabilitation Institute (TRI)/University Health Network (UHN).
Statistics
Deficient follow-up care leads to worse outcomes after ED visits
A new TRACK-TBI prospective study led by Dr. Shawn Eagle investigated the healthcare provider follow-up of mTBI patients seen in the emergency department of Level 1 trauma centers. Two weeks post-injury, 43% of patients had received clinical follow-up care, and by the end of the study (12-month period), only 63% had received any clinical follow-up; 86% of those receiving follow-up care said it helped. The study tracked whether patients were interested in follow-up care, their perception of the helpfulness of follow-up care, and their symptoms over time. Nearly half of those who initially reported that they didn't think follow-up was necessary experienced poor outcomes: 44% had incomplete recovery, 40% reported persistent post-concussive symptoms, and 19% had reduced quality of life one year later.
These findings suggest a disconnect between patients' perceived need for follow-up and the actual risk of long-term complications after mild TBI. The authors emphasize the importance of discharge education from doctors and proactive follow-up strategies, even for patients who seem fine. Increasing early follow-up rates could help reduce long-term impacts and improve concussion patients' quality of life.
While the full report is pending publication in Frontiers, an abstract is currently available. The study assessed the rates of desired and actual clinical follow-up post-TBI and the differences in outcomes among those who received follow-up care.
This study included 1,916 patients with mTBI, defined by an initial Glasgow Coma Scale (GCS) score between 13 and 15. At 2 weeks and 3 months, participants were asked if they had seen a healthcare provider and if it helped. Outcomes were assessed using the Rivermead Post-Concussion Questionnaire (RPQ), Quality of Life after Brain Injury- Overall Scale (QOLIBRI-OS), and the Glasgow Outcome Scale Extended for TBI (GOSE-TBI) at 2 weeks, 3-, 6-, and 12- months.
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