University of Pittsburgh Medical Center, Center for Sports Medicine,3200 South Water Street, Pittsburgh, PA 15203, USA.
Am J Sports Med. 2011 Nov;39(11):2311-8. doi: 10.1177/0363546511410655. Epub 2011 Jun 28.
There has been increasing attention and understanding of sport-related concussions. Recent studies show that neurocognitive testing and symptom clusters may predict protracted recovery in concussed athletes. On-field signs and symptoms have not been examined empirically as possible predictors of protracted recovery.
This study was undertaken to determine which on-field signs and symptoms were predictive of a protracted (≥21 days) versus rapid (≤7 days) recovery after a sports-related concussion. On-field signs and symptoms included confusion, loss of consciousness, posttraumatic amnesia, retrograde amnesia, imbalance, dizziness, visual problems, personality changes, fatigue, sensitivity to light/noise, numbness, and vomiting.
Cohort study (prognosis); Level of evidence, 2.
The sample included 107 male high school football athletes who completed computerized neurocognitive testing within an average 2.4 days after injury, and who were followed until returned to play as determined by neuropsychologists using international clinical concussion management guidelines. Athletes were then grouped into rapid (≤7 days, n = 62) or protracted (≥21 days, n = 36) recovery time groups. The presence of on-field signs and symptoms was determined at the time of injury by trained sports medicine professionals (i.e., ATC [certified athletic trainer], team physician). A series of odds ratios with χ(2) analyses and subsequent logistic regression were used to determine which on-field signs and symptoms were associated with an increased risk for a protracted recovery.
Dizziness at the time of injury was associated with a 6.34 odds ratio (95% confidence interval = 1.34-29.91, χ(2) = 5.44, P = .02) of a protracted recovery from concussion. Surprisingly, the remaining on-field signs and symptoms were not associated with an increased risk of protracted recovery in the current study.
Assessment of on-field dizziness may help identify high school athletes at risk for a protracted recovery. Such information will improve prognostic information and allow clinicians to manage and treat concussion more effectively in these at-risk athletes.
人们对与运动相关的脑震荡越来越关注，也越来越了解。最近的研究表明，神经认知测试和症状群可能预测脑震荡运动员的恢复时间延长。然而，目前尚未有研究对现场症状和体征作为可能的延长性恢复预测因素进行实证检验。
本研究旨在确定哪些现场症状和体征可能预测与运动相关的脑震荡后恢复时间延长（≥21 天）或快速（≤7 天）。现场症状和体征包括意识模糊、失去意识、创伤后遗忘、逆行性遗忘、平衡失调、头晕、视力问题、人格改变、疲劳、对光/噪音敏感、麻木和呕吐。
队列研究（预后）；证据水平，2 级。
该样本包括 107 名男性高中足球运动员，他们在受伤后平均 2.4 天内完成了计算机化神经认知测试，并根据神经心理学家使用国际临床脑震荡管理指南确定的标准，一直随访至重返赛场。然后，根据恢复时间将运动员分为快速（≤7 天，n=62）或延长（≥21 天，n=36）恢复组。受伤时由经过培训的运动医学专业人员（即 ATC[认证的运动训练师]、队医）确定现场症状和体征的存在。使用卡方检验和随后的逻辑回归分析比值比，以确定哪些现场症状和体征与延长性恢复风险增加相关。
受伤时的头晕与脑震荡延长恢复的 6.34 倍风险比（95%置信区间为 1.34-29.91，χ2=5.44，P=0.02）相关。令人惊讶的是，在当前研究中，其余现场症状和体征与延长性恢复风险增加无关。
评估现场头晕可能有助于识别有延长性恢复风险的高中生运动员。此类信息将改善预后信息，并使临床医生能够在这些高危运动员中更有效地管理和治疗脑震荡。
