Natural History of Concussion in Sport Markers of Severity and Implications for Management
Natural History of Concussion in Sport Markers of Severity and Implications for Management
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DOI：
10.1177/0363546509349491
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发表时间：
2010-03-01
影响因子：
4.8
通讯作者：
McCrory, Paul R.
中科院分区：
文献类型：
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作者：
Makdissi, Michael;Darby, David;McCrory, Paul R.
背景资料：运动中脑震荡后安全恢复比赛需要基于证据的临床数据。目的：本研究的目的是描述运动中脑震荡的自然史，并使用恢复运动决策作为损伤严重程度的替代指标，识别与更严重脑震荡损伤相关的临床特征。研究设计：队列研究方法：对高年级、低年级和社区澳式足球运动员进行季前基线认知测试（数字符号替代测验、线索制作测验-B部分和CogSport计算机化成套测验）。球员们在踢足球时遭受脑震荡后被招募到这项研究中。脑震荡的球员进行了连续测试，直到所有的临床特征，他们的伤害resolved.Results：1015名球员，88脑震荡观察到78名球员。脑震荡相关症状平均持续48.6小时（95%置信区间，39.5-57.7小时），延迟恢复运动与>= 4个症状，头痛持续>= 60小时或自我报告的“疲劳/模糊”相关。使用数字符号替代测试和连线测试B部分的认知缺陷与症状同时恢复，但计算机测试结果在2 - 3天后恢复，并且在症状消退后35%的脑震荡运动员中仍然受损。结论：延迟恢复运动与最初更大的症状负荷、长期头痛或主观注意力缺陷相关。认知测试的恢复情况各不相同，计算机化测试需要2至3天的时间，这表明对损伤的敏感性更高。因此，单独的症状评估可能是预测，但可能低估了时间完全恢复，这可能是更好地估计与计算机化的认知测试。
Background: Evidence-based clinical data are required for safe return to play after concussion in sport.Purpose: The objective of this study was to describe the natural history of concussion in sport and identify clinical features associated with more severe concussive injury, using return-to-sport decisions as a surrogate measure of injury severity.Study Design: Cohort study (prognosis); Level of evidence, 3.Methods: Male elite senior, elite junior, and community-based Australian Rules football players had preseason baseline cognitive testing (Digit Symbol Substitution Test, Trail-Making Test-Part B, and CogSport computerized test battery). Players were recruited into the study after a concussive injury sustained while playing football. Concussed players were tested serially until all clinical features of their injury had resolved.Results: Of 1015 players, 88 concussions were observed in 78 players. Concussion-associated symptoms lasted an average of 48.6 hours (95% confidence interval, 39.5-57.7 hours) with delayed return to sport correlated with >= 4 symptoms, headache lasting >= 60 hours, or self-reported "fatigue/fogginess." Cognitive deficits using the Digit Symbol Substitution Test and Trail-Making Test-part B recovered concomitantly with symptoms, but computerized test results recovered 2 to 3 days later and remained impaired in 35% of concussed players after symptom resolution.Conclusion: Delayed return to sport was associated with initially greater symptom load, prolonged headache, or subjective concentration deficits. Cognitive testing recovery varied, taking 2 to 3 days longer for computerized tests, suggesting greater sensitivity to impairment. Therefore, symptom assessment alone may be predictive of but may underestimate time to complete recovery, which may be better estimated with computerized cognitive testing.