Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: clinical article.
Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: clinical article.
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DOI：
10.3171/2012.8.jns112298
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发表时间：
2012-12
影响因子：
4.1
通讯作者：
Greenwald RM
中科院分区：
文献类型：
--
作者：
Duhaime AC;Beckwith JG;Maerlender AC;McAllister TW;Crisco JJ;Duma SM;Brolinson PG;Rowson S;Flashman LA;Chu JJ;Greenwald RM
脑震荡损伤在医疗和公共领域受到了广泛关注，因为人们对体育和其他活动中受伤的潜在短期和长期后果提出了担忧。虽然许多学生运动员在脑震荡后需要进行评估，但脑震荡的确切定义因学科和时间的推移而有所不同。作者使用了在戴头盔的大学运动员头部撞击生物力学的多机构纵向研究中收集的数据来描述哪些体征、症状和临床病史被用来指定运动员患有持续性脑震荡。 3 支大学橄榄球队和 4 支冰球队（男队和女队）的球员在 2-4 个赛季的训练和比赛中佩戴配备头部撞击遥测 (HIT) 技术的头盔。季前临床筛查小组评估了基线认知和报告的症状。如果球队医务人员诊断出脑震荡，则会在就诊时收集基本描述信息，并对脑震荡球员进行连续重新评估。分析了与急性脑震荡诊断相关的具体症状或发现、与具体冲击事件的关系、症状出现和诊断的时间以及记录的生物力学参数。数据收集自 450 名运动员，记录了 486,594 次头部撞击。 44 名球员被诊断出 48 起不同程度的脑震荡。精神恍惚、头痛和头晕是最常见的症状。 31 例确诊病例与已确定的影响事件有关；在 17 个案例中，没有发现具体的影响事件。 24 名球员立即出现症状，11 名球员出现延迟，13 名球员症状未明确。其中 8 例是在头部撞击后立即做出诊断，但大多数情况下诊断都是延迟的（中位 17 小时）。一名被诊断为脑震荡的患者在 30 秒内失去知觉；其他玩家都保持着警惕。大多数诊断都是基于自我报告的症状。与特定识别影响相关的情况的平均峰值角加速度和旋转加速度值分别为 86.1 ± 42.6g（范围 16.5–177.9g）和 3620 ± 2166 rad/sec2（范围 183–7589 rad/sec2）。大约三分之二的确诊脑震荡与特定的接触事件有关。在所有被诊断患有脑震荡的球员中，有一半的症状出现时间延迟或不清楚。大多数没有外部观察到的发现。诊断通常基于不同延迟后的一系列自我报告症状。所有撞击事件的加速度都集中在较高的百分位数，但涵盖范围很广。这些数据凸显了脑震荡诊断标准的异质性，在这种体育背景下，其严重依赖于自我报告的症状。未来的研究工作以及临床诊断领域可能需要对“脑震荡谱”的临床和客观相关性进行更具体和标准化的定义。
Concussive head injuries have received much attention in the medical and public arenas, as concerns have been raised about the potential short- and long-term consequences of injuries sustained in sports and other activities. While many student athletes have required evaluation after concussion, the exact definition of concussion has varied among disciplines and over time. The authors used data gathered as part of a multiinstitutional longitudinal study of the biomechanics of head impacts in helmeted collegiate athletes to characterize what signs, symptoms, and clinical histories were used to designate players as having sustained concussions. Players on 3 college football teams and 4 ice hockey teams (male and female) wore helmets instrumented with Head Impact Telemetry (HIT) technology during practices and games over 2–4 seasons of play. Preseason clinical screening batteries assessed baseline cognition and reported symptoms. If a concussion was diagnosed by the team medical staff, basic descriptive information was collected at presentation, and concussed players were reevaluated serially. The specific symptoms or findings associated with the diagnosis of acute concussion, relation to specific impact events, timing of symptom onset and diagnosis, and recorded biomechanical parameters were analyzed. Data were collected from 450 athletes with 486,594 recorded head impacts. Forty-eight separate concussions were diagnosed in 44 individual players. Mental clouding, headache, and dizziness were the most common presenting symptoms. Thirty-one diagnosed cases were associated with an identified impact event; in 17 cases no specific impact event was identified. Onset of symptoms was immediate in 24 players, delayed in 11, and unspecified in 13. In 8 cases the diagnosis was made immediately after a head impact, but in most cases the diagnosis was delayed (median 17 hours). One diagnosed concussion involved a 30-second loss of consciousness; all other players retained alertness. Most diagnoses were based on self-reported symptoms. The mean peak angular and rotational acceleration values for those cases associated with a specific identified impact were 86.1 ± 42.6g (range 16.5–177.9g) and 3620 ± 2166 rad/sec2 (range 183–7589 rad/sec2), respectively. Approximately two-thirds of diagnosed concussions were associated with a specific contact event. Half of all players diagnosed with concussions had delayed or unclear timing of onset of symptoms. Most had no externally observed findings. Diagnosis was usually based on a range of self-reported symptoms after a variable delay. Accelerations clustered in the higher percentiles for all impact events, but encompassed a wide range. These data highlight the heterogeneity of criteria for concussion diagnosis, and in this sports context, its heavy reliance on self-reported symptoms. More specific and standardized definitions of clinical and objective correlates of a “concussion spectrum” may be needed in future research efforts, as well as in the clinical diagnostic arena.