Symptom-based assessment of the severity of a concussion
Symptom-based assessment of the severity of a concussion
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DOI：
10.3171/jns.2003.98.3.0477
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发表时间：
2003-03-01
影响因子：
4.1
通讯作者：
Webbe, FM
中科院分区：
文献类型：
--
作者：
Erlanger, D;Kaushik, T;Webbe, FM
对象。目前的脑震荡分级系统和恢复比赛指南几乎没有经验支持。因此，作者研究了脑震荡的特征和症状以及脑震荡的病史与脑震荡严重程度的三个指标——立即出现症状的次数、初次随访检查时出现症状的次数和症状持续时间的关系，以建立脑震荡分级的经验基础。47名持续脑震荡的运动员接受了一项基于互联网的神经认知测试，直到他们的表现相对于基线水平处于正常范围内。作为全面脑震荡管理方案的一部分，还对受伤当天在赛场边线上的观察员报告和自我报告的症状进行评估，并在后续检查中进行评估。虽然意识丧失（LOC）是判断损伤初始严重程度的有用指标，但它与包括症状持续时间在内的其他脑震荡严重程度指标没有相关性。在随访检查中报告记忆问题的运动员通常有更多的症状，这些症状持续时间更长，并且在受伤后大约48小时进行的神经认知测试中得分显著下降。神经认知测试得分的下降与症状持续时间的延长显著相关。脑震荡的历史与症状的数量和持续时间无关。本文代表了经验导出的指标的临床过程后脑震荡症状解决的第一个文件。脑震荡后24小时出现的自我报告的记忆问题是运动相关脑震荡严重程度的有力指标，应该是决定运动员是否准备好重返比赛的主要考虑因素。神经认知测试的下降是唯一与症状持续时间显著相关的客观测量。短暂的LOC和脑震荡史都不能有效地预测脑震荡后症状的持续时间。
Object. Current grading systems of concussion and return-to-play guidelines have little empirical support. The authors therefore examined the relationships of the characteristics and symptoms of concussion and the history of concussion to three indicators of concussion severity-number of immediate symptoms, number of symptoms at the initial follow-up examination, and duration of symptoms-to establish an empirical basis for grading concussions.Methods. Forty-seven athletes who sustained concussions were administered alternate forms of an Internet-based neurocognitive test until their performances were within normal limits relative to baseline levels. Assessments of observer-reported and self-reported symptoms at the sideline of the playing field on the day of injury, and at follow-up examinations were also obtained as part of a comprehensive concussion management protocol.Although loss of consciousness (LOC) was a useful indicator of the initial severity of the injury, it did not correlate with other indices of concussion severity, including duration of symptoms. Athletes reporting memory problems at follow-up examinations had significantly more symptoms in general, longer durations of those symptoms, and significant decreases in scores on neurocognitive tests administered approximately 48 hours postinjury. This decline of scores on neurocognitive testing was significantly associated with an increased duration of symptoms. A history of concussion was unrelated to the number and duration of symptoms.Conclusions. This paper represents the first documentation of empirically derived indicators of the clinical course of postconcussion symptom resolution. Self-reported memory problems apparent 24 hours postconcussion were robust indicators of the severity of sports-related concussion and should be a primary consideration in determining an athlete's readiness to return to competition. A decline on neurocognitive testing was the only objective measure significantly related to the duration of symptoms. Neither a brief LOC nor a history of concussion was a useful predictor of the duration of postconcussion symptoms.