"Playing Through It'': Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery
"Playing Through It'': Delayed Reporting and Removal From Athletic Activity After Concussion Predicts Prolonged Recovery
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DOI：
10.4085/1062-6050-51.5.02
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发表时间：
2016-04-01
影响因子：
3.3
通讯作者：
Bauer, Russell M.
中科院分区：
文献类型：
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作者：
Asken, Breton M.;McCrea, Michael A.;Bauer, Russell M.
内容：临床前研究已经证明，在脑震荡后立即出现脆弱性窗口，其中持续的活动和刺激可能会损害或延长神经行为恢复。然而，这一概念尚未量化在人类population.Objective：为了研究延迟报告和从运动活动中恢复时间脑震荡后删除的效果。设计：横断面研究。设置：一个国家大学体育协会分部I大学。患者或其他参与者：研究分析了2008年至2015年期间发生运动相关脑震荡的97名运动员（年龄= 20.4 ± 1.3岁）。运动员被分组为立即从活动中移除（I-RFA）或延迟从活动中移除（D-RFA）。主要结果测量：错过的天数定义为脑震荡引起的事件和恢复接触之间的天数。RFA组和长期（8天或更长时间）与正常（7天或更短时间）恢复之间的关联也analysed.Results：50（51.5%）的97名运动员没有立即报告脑震荡症状。D-RFA运动员平均比I-RFA运动员多缺席4.9天。即使在控制了性别、脑震荡史、学习障碍或注意力缺陷/多动障碍诊断、诊断的心理障碍和急性症状严重程度后，特定RFA组的成员资格也能预测错过的天数（R-2变化= 0.097，β = 0.319，P = 0.002）。D-RFA运动员恢复时间延长的可能性约为2.2倍与I-RFA运动员相比（8天或更长时间）（chi（2）= 10.268，P = 0.001，phi = 0.325）。没有立即报告脑震荡症状并继续参加体育活动的运动员比立即报告的运动员恢复时间更长症状，并立即从活动中删除。在脑震荡后立即继续参加体育活动可能会使已经受伤的大脑暴露于复杂的神经病理生理过程。
Context: Preclinical research has demonstrated a window of vulnerability in the immediate aftermath of concussion wherein continued activity and stimulation can impair or prolong neurobehavioral recovery. However, this concept has not been quantified in a human population.Objective: To examine the effect of delayed reporting and removal from athletic activity after concussion on recovery time.Design: Cross-sectional study.Setting: A National Collegiate Athletic Association Division I university.Patients or Other Participants: Ninety-seven athletes who sustained a sport-related concussion between 2008 and 2015 were analyzed (age = 20.4 +/- 1.3 years). Athletes were grouped as immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA).Main Outcome Measure(s): Days missed was defined as the number of days between the concussion-causing event and clearance for return to contact. Associations between RFA group and prolonged (8 or more days') versus normal (7 or fewer days') recovery were also analyzed.Results: Fifty (51.5%) of the 97 athletes did not immediately report concussion symptoms. The D-RFA athletes averaged 4.9 more days missed than the I-RFA athletes. Membership in the specific RFA group predicted days missed even after controlling for sex, concussion history, learning disability or attention-deficit/hyperactivity disorder diagnosis, diagnosed psychological disorder, and acute symptom severity (R-2 change = 0.097, beta = .319, P = .002). The D-RFA athletes were approximately 2.2 times more likely to have a prolonged recovery (8 or more days) compared with the I-RFA athletes (chi(2) = 10.268, P = .001, phi = 0.325).Conclusions: Athletes who do not immediately report symptoms of a concussion and continue to participate in athletic activity are at risk for longer recoveries than athletes who immediately report symptoms and are immediately removed from activity. Continuing to participate in athletic activity during the immediate aftermath of a concussion potentially exposes the already injured brain to compounded neuropathophysiologic processes.