Concussion Symptom Profiles Among Child, Adolescent, and Young Adult Athletes
Concussion Symptom Profiles Among Child, Adolescent, and Young Adult Athletes
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DOI：
10.1097/jsm.0000000000000629
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发表时间：
2019-09-01
影响因子：
2.7
通讯作者：
Meehan, William P., III
中科院分区：
文献类型：
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作者：
Howell, David R.;Kriz, Peter;Meehan, William P., III
目的：(1)研究年龄如何影响脑震荡后的初始症状表现；(2)确定特定的症状特征是否与脑震荡后症状的持续时间有关，以及它们是否因年龄组而异。设计：共有689例患者(7-12岁儿童占20%，13-18岁青少年占69%，19-30岁青少年占11%)在伤后21天内确诊为脑震荡。患者完成震荡后症状量表(PCSS)，并进行跟踪，直到他们不再需要护理。单位：两个专科护理运动性脑震荡的临床实习。主要观察指标：获得总体PCSS评分，以及躯体症状、前庭眼部症状、认知症状、睡眠症状和情绪症状的严重程度评分。我们还计算了总的症状持续时间。结果：在症状域中没有发现年龄或性别关联的年龄的显著主效应。女性的躯体症状严重程度高于男性(9.8+/-6.7比8.1+/-6.7；P=0.03)。对于7~12岁的患者，躯体症状的严重程度[β系数=1.57，95%可信区间(CI)1.47~1.67]和认知症状的严重程度(β系数=2.50，95%CI，2.32~2.68)与脑震荡症状的持续时间有关。在青少年中，总症状持续时间越长，躯体症状(β系数=1.25，95%CI，0.34~2.15)和前庭-眼部症状(β系数=2.36，95%CI，1.49~3.23)越严重。结论：在脑震荡后21天内，各年龄段的症状报告行为似乎是相似的，但症状特征与症状缓解时间之间的关系因年龄而异。虽然总体症状分级对确定临床路径是有益的，但症状域的使用可能提供一种有益的方法来确定脑震荡后儿童和青少年之间不同的个性化患者护理。
Objectives: (1) To examine how age influences initial symptom presentation following concussion; and (2) to determine whether specific symptomprofiles are associated with duration of postconcussion symptoms, andwhether they vary by age group. Design: A total of 689 patients (20% children 7-12 years of age, 69% adolescents 13-18 years of age, and 11% young adults 19-30 years of age) were seen and diagnosed with a concussion within 21 days after injury. Patients completed the Post-Concussion Symptom Scale (PCSS) and were followed until they no longer required care. Setting: Two specialty care sport concussion clinical practices. Main outcome measures: Overall PCSS score was obtained, as well as severity ratings from somatic, vestibular-ocular, cognitive, sleep, and emotional symptomdomains. We also calculated total symptomduration time. Results: No significantmain effect of age, or age by sex associations were identified among the symptomdomains. Females endorsed a higher somatic symptomseverity rating than males (9.8 +/- 6.7 vs 8.1 +/- 6.7; P=0.03). For patients between 7 and 12 years of age, higher somatic [beta-coefficient = 1.57, 95% confidence interval (CI), 1.47-1.67] and cognitive (beta-coefficient = 2.50, 95% CI, 2.32-2.68) symptom severities were associated with longer duration of concussion symptoms. Among adolescents, longer total symptom duration was associated with more severe somatic (beta-coefficient = 1.25, 95% CI, 0.34-2.15) and vestibular-ocular (beta-coefficient = 2.36, 95% CI, 1.49-3.23) symptoms. Conclusions: Within 21 days after concussion, symptom-reporting behavior seems to be similar across the age spectrum, but the relationship between symptom profiles and time to symptomresolution varies by age. Although overall symptomratings are beneficial in determining clinical pathways, symptom domain use may provide a beneficial method to determine individualized patient care that differs between children and adolescents after concussion.