Division of Pediatric Neurology, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Neurology. 2013 Jun 11;80(24):2250-7. doi: 10.1212/WNL.0b013e31828d57dd. Epub 2013 Mar 18.
To update the 1997 American Academy of Neurology (AAN) practice parameter regarding sports concussion, focusing on 4 questions: 1) What factors increase/decrease concussion risk? 2) What diagnostic tools identify those with concussion and those at increased risk for severe/prolonged early impairments, neurologic catastrophe, or chronic neurobehavioral impairment? 3) What clinical factors identify those at increased risk for severe/prolonged early postconcussion impairments, neurologic catastrophe, recurrent concussions, or chronic neurobehavioral impairment? 4) What interventions enhance recovery, reduce recurrent concussion risk, or diminish long-term sequelae? The complete guideline on which this summary is based is available as an online data supplement to this article.
We systematically reviewed the literature from 1955 to June 2012 for pertinent evidence. We assessed evidence for quality and synthesized into conclusions using a modified Grading of Recommendations Assessment, Development and Evaluation process. We used a modified Delphi process to develop recommendations.
Specific risk factors can increase or decrease concussion risk. Diagnostic tools to help identify individuals with concussion include graded symptom checklists, the Standardized Assessment of Concussion, neuropsychological assessments, and the Balance Error Scoring System. Ongoing clinical symptoms, concussion history, and younger age identify those at risk for postconcussion impairments. Risk factors for recurrent concussion include history of multiple concussions, particularly within 10 days after initial concussion. Risk factors for chronic neurobehavioral impairment include concussion exposure and APOE ε4 genotype. Data are insufficient to show that any intervention enhances recovery or diminishes long-term sequelae postconcussion. Practice recommendations are presented for preparticipation counseling, management of suspected concussion, and management of diagnosed concussion.
更新 1997 年美国神经病学学会（AAN）关于运动性脑震荡的实践参数，重点关注以下 4 个问题：1）哪些因素增加/减少脑震荡风险？2）哪些诊断工具可以识别脑震荡患者和那些有严重/长期早期损伤、神经灾难或慢性神经行为障碍风险的患者？3）哪些临床因素可以识别那些有严重/长期早期脑震荡后损伤、神经灾难、反复脑震荡或慢性神经行为障碍风险的患者？4）哪些干预措施可以促进康复、降低复发性脑震荡风险或减轻长期后遗症？本摘要所依据的完整指南可作为本文的在线数据补充。
我们系统地回顾了 1955 年至 2012 年 6 月的相关文献，以获取相关证据。我们评估了证据的质量，并使用改良的推荐评估、制定和评估（Grading of Recommendations Assessment, Development and Evaluation）过程综合为结论。我们使用改良的德尔菲法制定建议。
特定的危险因素可以增加或降低脑震荡的风险。有助于识别脑震荡患者的诊断工具包括分级症状检查表、标准化脑震荡评估、神经心理学评估和平衡错误评分系统。持续的临床症状、脑震荡史和年龄较小可以识别那些有脑震荡后损伤风险的患者。复发性脑震荡的危险因素包括多次脑震荡史，尤其是在初次脑震荡后 10 天内。慢性神经行为障碍的危险因素包括脑震荡暴露和 APOE ε4 基因型。目前还没有足够的数据表明任何干预措施都能促进康复或减轻脑震荡后的长期后遗症。本文提出了参加运动前咨询、疑似脑震荡管理和确诊脑震荡管理的建议。
