Vestibulo-ocular dysfunction in pediatric sports-related concussion
Vestibulo-ocular dysfunction in pediatric sports-related concussion
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DOI：
10.3171/2015.1.peds14524
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发表时间：
2015-09-01
影响因子：
1.9
通讯作者：
Russell, Kelly
中科院分区：
文献类型：
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作者：
Ellis, Michael J.;Cordingley, Dean;Russell, Kelly
目的本研究有两个目的：1）检测儿童和青少年急性运动相关脑震荡（SRC）和脑震荡后综合征（PCS）患者中前庭-眼功能障碍（VOD）的患病率，这些儿童和青少年被转诊到多学科儿科脑震荡项目;和2）以确定VOD是否与PCS的发展有关。方法作者对所有急性肺动脉高压患者进行了回顾性分析，SRC（伤后30天或更短时间内出现）和PCS（至少1个月内出现3种或3种以上症状）在2013年9月至2014年7月期间参考了多学科儿科脑震荡项目。初步评估包括临床病史、体格检查和脑震荡后症状量表评估。还对患者进行了VOD评估，VOD定义为不止一种主观前庭和眼部主诉（头晕、视力模糊等）和不止一种客观体格检查结果（异常平滑追踪、扫视、前庭眼反射等）。结果：共101例患者（平均年龄14.2岁，SD 2.3岁;男性63例，女性38例）参加了本研究，其中急性SRC 77例（76.2%），PCS 24例（23.8%）。77例急性SRC患者中的22例（28.6%）和24例PCS患者中的15例（62.5%）符合VOD的临床标准。有VOD的急性SRC患者的症状持续时间中位数为40天（四分位距[IQR] 28.5-54天），而无VOD的患者为21天（IQR 13-32天）（p = 0.0001）。有统计学意义上的增加调整后的几率发展PCS急性SRC患者VOD相比，那些没有VOD（调整OR 4.10; 95%CI 1.04-16.16）。结论VOD的证据是检测到一个显着比例的儿童和青少年急性SRC和PCS谁被称为多学科儿科脑震荡程序。在该儿科急性SRC队列中，该临床特征是随后发生PCS的重要风险因素。
OBJECT The objective of this study was 2-fold: 1) to examine the prevalence of vestibulo-ocular dysfunction (VOD) among children-and adolescents with acute sports-related concussion (SRC) and postconcussion syndrome (PCS) who were referred to a multidisciplinary pediatric concussion program; and 2) to determine if VOD is associated with the development of PCS in this cohort.METHODS The authors conducted a retrospective review of all patients with acute SRC (presenting 30 days or less postinjury) and PCS (3 or more symptoms for at least 1 month) referred to a multidisciplinary pediatric concussion program between September 2013 and July 2014. Initial assessment included clinical history, physical examination, and Post-Concussion Symptom Scale assessment. Patients were also assessed for VOD, which was defined as more than one subjective vestibular and oculomotor complaint (dizziness, blurred vision, and so on) and more than one objective physical examination finding (abnormal smooth pursuits, saccades, vestibulo-ocular reflex, and so on). This study was approved by the local institutional ethics review board.RESULTS A total of 101 patients (mean age 14.2 years, SD 2.3 years; 63 male and 38 female patients) participated, including 77 (76.2%) with acute SRC and 24(23.8%) with PCS. Twenty-two of the 77 patients (28.6%) with acute SRC and 15 of the 24 (62.5%) with PCS met the clinical criteria for VOD. The median duration of symptoms was 40 days (interquartile range [IQR] 28.5-54 days) for patients with acute SRC who had VOD compared with 21 days (IQR 13-32 days) for those without VOD (p = 0.0001). There was a statistically significant increase in the adjusted odds of developing PCS among patients with acute SRC who had VOD compared with those without VOD (adjusted OR 4.10; 95% CI 1.04-16.16).CONCLUSIONS Evidence of VOD was detected in a significant proportion of children and adolescents with acute SRC and PCS who were referred to a multidisciplinary pediatric concussion program. This clinical feature was a significant risk factor for the subsequent development of PCS in this pediatric acute SRC cohort.