Erlanger David, Kaushik Tanya, Cantu Robert, Barth Jeffrey T, Broshek Donna K, Freeman Jason R, Webbe Frank M
Department of Neuroscience and Education, Columbia University, New York, New York, USA.
J Neurosurg. 2003 Mar;98(3):477-84. doi: 10.3171/jns.2003.98.3.0477.
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.
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.
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.
目前的脑震荡分级系统和重返赛场指南几乎没有实证支持。因此，作者研究了脑震荡的特征、症状以及脑震荡病史与脑震荡严重程度的三个指标（即时症状数量、初次随访检查时的症状数量和症状持续时间）之间的关系，以建立脑震荡分级的实证基础。
47名遭受脑震荡的运动员接受了基于互联网的神经认知测试的不同版本，直到他们的表现相对于基线水平处于正常范围内。作为综合脑震荡管理方案的一部分，还获取了受伤当天在赛场边以及随访检查时观察者报告和自我报告症状的评估。虽然意识丧失（LOC）是损伤初始严重程度的一个有用指标，但它与脑震荡严重程度的其他指标（包括症状持续时间）并无关联。在随访检查中报告有记忆问题的运动员总体上有更多症状，这些症状持续时间更长，并且在受伤后约48小时进行的神经认知测试中的得分显著下降。神经认知测试得分的这种下降与症状持续时间的增加显著相关。脑震荡病史与症状数量和持续时间无关。
本文首次记录了脑震荡后症状缓解临床过程的实证指标。脑震荡后24小时出现的自我报告的记忆问题是与运动相关脑震荡严重程度的有力指标，并且在确定运动员准备好重返比赛时应作为主要考虑因素。神经认知测试得分下降是与症状持续时间显著相关的唯一客观指标。短暂的意识丧失和脑震荡病史都不是脑震荡后症状持续时间的有用预测指标。
