6至12岁儿童脑震荡恢复过程：来自一家跨学科康复诊所的经验
The Course of Concussion Recovery in Children 6-12 Years of Age: Experience From an Interdisciplinary Rehabilitation Clinic.
作者信息
Risen Sarah R, Reesman Jennifer, Yenokyan Gayane, Slomine Beth S, Suskauer Stacy J
机构信息
Kennedy Krieger Institute and Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD; current affiliation: Pediatric Neurology and Developmental Medicine, Baylor College of Medicine and Texas Children's Hospital(∗).
Kennedy Krieger Institute and Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD(†).
出版信息
PM R. 2017 Sep;9(9):874-883. doi: 10.1016/j.pmrj.2016.12.005. Epub 2017 Jan 8.
BACKGROUND
Current concussion evidence is derived largely from teenagers and adults. Concussion in younger children occurs within the context of neuromaturation, with differing age-based pathophysiological responses to injury. Therefore, our current understanding of concussion in older children and adults is unlikely to directly apply to younger children.
OBJECTIVE
To describe patient variables, clinical course, and factors associated with time to discharge from concussion care in children 6-12 years of age with concussion treated in an interdisciplinary rehabilitation-based concussion clinic.
DESIGN
Retrospective chart review.
SETTING
Interdisciplinary concussion clinic at an academically affiliated rehabilitation center.
PATIENTS
Children aged 6-12 years (n = 105; mean 10.8 years of age, 70% male) seen within 60 days of concussive injury.
MAIN OUTCOME MEASUREMENTS
Descriptive statistics explored demographic, injury, and clinical features. The primary outcome measure, time to discharge from concussion care, was estimated with survival-analysis methods based on the date of discharge from the clinic. Multivariate models were used to examine factors associated with longer time to discharge.
RESULTS
Median time to discharge was 34 days postinjury (range 5-192 days); 75% of children were discharged within 60 days of injury. A minority reported persisting symptoms at discharge. Younger age and increased symptom burden at initial evaluation predicted longer time to discharge.
CONCLUSIONS
Although children 6-12 years old treated in a specialty concussion clinic show variability in time to discharge from concussion care, most were discharged within 2 months after injury. Risk factors for prolonged recovery, such as younger age and greater symptom burden at initial visit, can be used when counseling families and planning interventions. There may be varying contributions, including psychosocial stressors, to ongoing symptoms in children who experience persisting symptoms after other concussion-related concerns have resolved. Future work focused on the subset of children who report persisting symptoms will be useful for developing an evidence base related to their care.
LEVEL OF EVIDENCE
II.
背景
目前关于脑震荡的证据主要来自青少年和成年人。年幼儿童的脑震荡发生在神经成熟的背景下，对损伤的病理生理反应因年龄而异。因此，我们目前对大龄儿童和成年人脑震荡的理解不太可能直接适用于年幼儿童。
目的
描述在一家以康复为基础的跨学科脑震荡诊所接受治疗的6至12岁脑震荡儿童的患者变量、临床病程以及与从脑震荡护理中出院时间相关的因素。
设计
回顾性病历审查。
地点
一家学术附属康复中心的跨学科脑震荡诊所。
患者
在脑震荡损伤后60天内就诊的6至12岁儿童（n = 105；平均年龄10.8岁，70%为男性）。
主要观察指标
描述性统计分析探讨了人口统计学、损伤和临床特征。主要观察指标，即从脑震荡护理中出院的时间，采用基于出院日期的生存分析方法进行估计。使用多变量模型检查与出院时间延长相关的因素。
结果
受伤后出院的中位时间为34天（范围5 - 192天）；75%的儿童在受伤后60天内出院。少数儿童在出院时报告仍有症状。年龄较小以及初始评估时症状负担较重预示着出院时间较长。
结论
尽管在专科脑震荡诊所接受治疗的6至12岁儿童从脑震荡护理中出院的时间存在差异，但大多数在受伤后2个月内出院。在为家庭提供咨询和规划干预措施时，可以考虑延长康复时间的风险因素，如年龄较小和初次就诊时症状负担较重。在其他与脑震荡相关的问题解决后仍有持续症状的儿童中，包括心理社会压力源在内的各种因素可能对持续症状有不同的影响。未来针对报告有持续症状的儿童亚组开展的研究，将有助于建立与他们的护理相关的证据基础。
证据级别
二级。
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