MSc, McMaster University, School of Rehabilitation Science, Institute of Applied Health Sciences, Room 433, 1400 Main St West, Hamilton, Ontario, Canada L8S 1C7.
Pediatrics. 2010 Feb;125(2):327-34. doi: 10.1542/peds.2008-2720. Epub 2010 Jan 18.
The term "concussion" is frequently used in clinical records to describe a traumatic head injury; however, there are no standard definitions of this term, particularly in how it is used with children. The goals of this study were to examine the clinical correlates of the concussion diagnosis and to identify the factors that lead to the use of this term in a regional pediatric center.
Medical data were prospectively collected from 434 children with traumatic brain injury who were admitted to a Canadian children's hospital. A proportional hazards regression was used to examine the association of the concussion diagnosis and the times until discharge and school return. A classification-tree analysis modeled the clinical correlates of patients who received a concussion diagnosis.
The concussion label was significantly more likely to be applied to children with mild Glasgow Coma Scale scores of 13 to 15 (P = .03). The concussion label was strongly predictive of earlier hospital discharge (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.2-1.9; P = .003) and earlier return to school (OR: 2.4 [95% CI: 1.6-3.7]; P < .001). A diagnosis of a concussion was significantly more likely when the computed-tomography results were normal and the child had lost consciousness.
Children with mild traumatic brain injuries have an increased frequency of receiving the concussion label, although the label may also be applied to children with more-severe injuries. The concussion diagnosis is associated with important clinical outcomes. Its typical use in hospital settings likely refers to an impact-related mild brain injury, in the absence of indicators other than a loss of consciousness. Clinicians may use the concussion label because it is less alarming to parents than the term mild brain injury, with the intent of implying that the injury is transient with no significant long-term health consequences.
“脑震荡”一词常被用于临床记录以描述创伤性头部损伤；但该术语并无标准定义，尤其是在涉及儿童时。本研究旨在探讨脑震荡诊断的临床相关性，并确定导致该术语在区域性儿科中心使用的因素。
前瞻性收集加拿大一家儿童医院收治的 434 例创伤性脑损伤患儿的医疗数据。采用比例风险回归分析，研究脑震荡诊断与出院时间和返校时间的相关性。采用分类树分析，建立患者接受脑震荡诊断的临床相关性模型。
格拉斯哥昏迷量表评分为 13 至 15 分的患儿更有可能被贴上脑震荡标签（P=0.03）。脑震荡标签强烈预示着更早出院（优势比[OR]：1.5；95%置信区间[CI]：1.2-1.9；P=0.003）和更早返校（OR：2.4；95%CI：1.6-3.7；P<0.001）。当计算机断层扫描结果正常且患儿失去意识时，更有可能被诊断为脑震荡。
轻度创伤性脑损伤患儿更频繁地被贴上脑震荡标签，尽管该标签也可能被用于更严重的损伤患儿。脑震荡诊断与重要的临床结局相关。该标签在医院环境中的典型应用可能指的是与冲击相关的轻度脑损伤，除了失去意识外，没有其他指标。临床医生可能会使用脑震荡标签，因为它比轻度脑损伤的术语对家长来说不那么令人震惊，并且意味着损伤是短暂的，没有显著的长期健康后果。
