Hang Brian, Babcock Lynn, Hornung Richard, Ho Mona, Pomerantz Wendy J
From the *Pediatric Emergency Medicine, Division of Emergency Medicine, Ann and Robert Lurie Children's Hospital of Chicago, Chicago, IL; and †Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center; and ‡UC Department of Pediatrics, Cincinnati, OH.
Pediatr Emerg Care. 2015 Oct;31(10):688-93. doi: 10.1097/PEC.0000000000000438.
The objective of this study was to determine if computerized neurocognitive testing (Immediate Post-Concussion Assessment and Cognitive Testing [ImPACT]) in the emergency department (ED) can be used as a prognostic tool to detect young athletes at risk of having protracted concussive symptoms.
This was a prospective cohort study of athletes aged 11 to 18 years who presented to an ED less than 24 hours after sustaining a sports-related concussion. ImPACT was administered in the ED, and performance was categorized as "poor" if the athlete had 3 (of 4) or greater low domain scores. Participants completed the Post-Concussion Symptom Scale (PCSS) in the ED and by phone at 1 and 2 weeks after injury. Athletes were symptomatic if their PCSS score was more than 6 in males and more than 8 in females.
One hundred nine patients were enrolled; 60% and 36% remained symptomatic at 1 and 2 weeks after injury, respectively. "Poor" ImPACT performance was not particularly useful in predicting athletes with protracted symptoms (at 1 week: positive predictive value, 70.8%; negative predictive value, 43.5%; at 2 weeks: positive predictive value, 47.8%; negative predictive value, 68.9%). In bivariate analysis, a higher ED PCSS score was associated with protracted symptoms (at 1 week: odds ratio, 1.1 [confidence interval, 1.0-1.1]; at 2 weeks: odds ratio, 1.0 [confidence interval, 1.0-1.1]).
Computerized neurocognitive testing in the ED has limited usefulness in predicting protracted symptoms. Total acute symptom burden may be a useful prognostic tool in the ED evaluation of concussed young athletes, yet further research is necessary.
本研究的目的是确定急诊科（ED）中的计算机化神经认知测试（即时 concussion 评估和认知测试 [ImPACT]）是否可作为一种预后工具，以检测有发生持续性 concussion 症状风险的年轻运动员。
这是一项针对 11 至 18 岁运动员的前瞻性队列研究，这些运动员在遭受与运动相关的 concussion 后不到 24 小时就诊于急诊科。在急诊科进行 ImPACT 测试，如果运动员在 4 个领域中有 3 个或更多低分数，则其表现被归类为“差”。参与者在急诊科以及受伤后 1 周和 2 周通过电话完成 concussion 后症状量表（PCSS）。如果男性的 PCSS 评分超过 6 分且女性超过 8 分，则运动员有症状。
共纳入 109 名患者；分别有 60%和 36%的患者在受伤后 1 周和 2 周仍有症状。“差”的 ImPACT 表现对于预测有持续性症状的运动员并非特别有用（第 1 周：阳性预测值，70.8%；阴性预测值，43.5%；第 2 周：阳性预测值，47.8%；阴性预测值，68.9%）。在双变量分析中，较高的急诊科 PCSS 评分与持续性症状相关（第 1 周：比值比，1.1 [置信区间，1.0 - 1.1]；第 2 周：比值比，1.0 [置信区间，1.0 - 1.1]）。
急诊科的计算机化神经认知测试在预测持续性症状方面作用有限。急性症状总负担可能是急诊科评估 concussion 年轻运动员时有用的预后工具，但仍需进一步研究。
