*Department of Medical Informatics and Clinical Epidemiology and ‖Center for Spoken Language Understanding, Oregon Health & Science University, Portland, Oregon; ‡Brain Trauma Foundation, New York, New York; §Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; ¶Department of Emergency Medicine and; ‡‡Departments of Psychiatry and Neurology, Icahn School of Medicine at Mount Sinai, New York, New York #Department of Psychology, Portland State University, Portland, Oregon; **US Army Combat Casualty Care Research Program, US Army Medical Research and Materiel Command, Fort Detrick, Maryland.
Neurosurgery. 2014 Sep;75 Suppl 1:S3-15. doi: 10.1227/NEU.0000000000000433.
Currently, there is no evidence-based definition for concussion that is being uniformly applied in clinical and research settings.
To conduct a systematic review of the highest-quality literature about concussion and to assemble evidence about the prevalence and associations of key indicators of concussion. The goal was to establish an evidence-based foundation from which to derive, in future work, a definition, diagnostic criteria, and prognostic indicators for concussion.
Key questions were developed, and an electronic literature search from 1980 to 2012 was conducted to acquire evidence about the prevalence of and associations among signs, symptoms, and neurologic and cognitive deficits in samples of individuals exposed to potential concussive events. Included studies were assessed for potential for bias and confound and rated as high, medium, or low potential for bias and confound. Those rated as high were excluded from the analysis. Studies were further triaged on the basis of whether the definition of a case of concussion was exclusive or inclusive; only those with wide, inclusive case definitions were used in the analysis. Finally, only studies reporting data collected at fixed time points were used. For a study to be included in the conclusions, it was required that the presence of any particular sign, symptom, or deficit be reported in at least 2 independent samples.
From 5437 abstracts, 1362 full-text publications were reviewed, of which 231 studies were included in the final library. Twenty-six met all criteria required to be used in the analysis, and of those, 11 independent samples from 8 publications directly contributed data to conclusions. Prevalent and consistent indicators of concussion are (1) observed and documented disorientation or confusion immediately after the event, (2) impaired balance within 1 day after injury, (3) slower reaction time within 2 days after injury, and/or (4) impaired verbal learning and memory within 2 days after injury.
The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations, derived from the strongest evidence in the published literature. The product is an evidence-based foundation from which to develop diagnostic criteria and prognostic indicators.
目前，在临床和研究环境中，尚无统一应用的基于证据的脑震荡定义。
对最高质量的脑震荡文献进行系统回顾，并汇集有关脑震荡的主要指标的患病率和关联的证据。目的是从已发表的文献中获取证据，为今后制定脑震荡的定义、诊断标准和预后指标奠定基础。
制定了关键问题，并进行了 1980 年至 2012 年的电子文献检索，以获取有关在潜在脑震荡事件暴露个体样本中，体征、症状以及神经和认知缺陷的患病率和关联的证据。纳入的研究进行了偏倚和混杂的潜在风险评估，并被评为高、中或低偏倚和混杂风险。那些被评为高风险的研究被排除在分析之外。进一步根据脑震荡病例的定义是排他性还是包容性对研究进行分类；只有具有广泛包容性病例定义的研究才用于分析。最后，只使用报告固定时间点数据的研究。一项研究要包含在结论中，必须至少有 2 个独立样本报告存在任何特定的体征、症状或缺陷。
从 5437 篇摘要中，共回顾了 1362 篇全文出版物，其中 231 篇研究被纳入最终文库。26 项研究符合用于分析的所有标准，其中 8 项出版物的 11 个独立样本直接提供了数据。脑震荡的常见且一致的指标是：（1）事件后立即观察到并记录的定向力或意识模糊；（2）受伤后 1 天内平衡受损；（3）受伤后 2 天内反应时间较慢；以及/或（4）受伤后 2 天内言语学习和记忆受损。
这项系统回顾的结果确定了一致性和普遍性的脑震荡指标及其关联，这些结果来自已发表文献中最强的证据。其产物是一个基于证据的基础，可用于制定诊断标准和预后指标。
