Sufrinko Alicia M, Marchetti Gregory F, Cohen Paul E, Elbin R J, Re Valentina, Kontos Anthony P
UPMC Sports Medicine Concussion Program, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
John G. Rangos Sr. School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA.
Am J Sports Med. 2017 Apr;45(5):1187-1194. doi: 10.1177/0363546516685061. Epub 2017 Feb 13.
A sport-related concussion (SRC) is a heterogeneous injury that requires a multifaceted and comprehensive approach for diagnosis and management, including symptom reports, vestibular/ocular motor assessments, and neurocognitive testing.
To determine which acute (eg, within 7 days) vestibular, ocular motor, neurocognitive, and symptom impairments predict the duration of recovery after an SRC.
Cohort study (prognosis); Level of evidence, 2.
Sixty-nine patients with a mean age of 15.3 ± 1.9 years completed a neurocognitive, vestibular/ocular motor, and symptom assessment within 7 days of a diagnosed concussion. Patients were grouped by recovery time: ≤14 days (n = 27, 39.1%), 15-29 days (n = 25, 36.2%), and 30-90 days (n = 17, 24.6%). Multinomial regression was used to identify the best subset of predictors associated with prolonged recovery relative to ≤14 days.
Acute visual motor speed and cognitive-migraine-fatigue symptoms were associated with an increased likelihood of recovery times of 30-90 days and 15-29 days relative to a recovery time of ≤14 days. A model with visual motor speed and cognitive-migraine-fatigue symptoms within the first 7 days of an SRC was 87% accurate at identifying patients with a recovery time of 30-90 days.
The current study identified cognitive-migraine-fatigue symptoms and visual motor speed as the most robust predictors of protracted recovery after an SRC according to the Post-concussion Symptom Scale, Immediate Post-concussion Assessment and Cognitive Testing, and Vestibular/Ocular Motor Screening (VOMS). While VOMS components were sensitive in identifying a concussion, they were not robust predictors for recovery. Clinicians may consider particular patterns of performance on clinical measures when providing treatment recommendations and discussing anticipated recovery with patients.
与运动相关的脑震荡（SRC）是一种异质性损伤，需要采用多方面、综合性的方法进行诊断和管理，包括症状报告、前庭/眼动评估以及神经认知测试。
确定哪些急性（如7天内）前庭、眼动、神经认知和症状损伤可预测SRC后的恢复持续时间。
队列研究（预后）；证据等级，2级。
69名平均年龄为15.3±1.9岁的患者在确诊脑震荡后7天内完成了神经认知、前庭/眼动和症状评估。患者按恢复时间分组：≤14天（n = 27，39.1%）、15 - 29天（n = 25，36.2%）和30 - 90天（n = 17，24.6%）。采用多项回归分析来确定相对于≤14天的恢复时间，与恢复时间延长相关的最佳预测指标子集。
相对于恢复时间≤14天，急性视觉运动速度和认知性偏头痛 - 疲劳症状与恢复时间为30 - 90天和15 - 29天的可能性增加相关。一个包含SRC后前7天视觉运动速度和认知性偏头痛 - 疲劳症状的模型在识别恢复时间为30 - 90天的患者时准确率为87%。
根据脑震荡后症状量表、脑震荡后即刻评估和认知测试以及前庭/眼动筛查（VOMS），本研究确定认知性偏头痛 - 疲劳症状和视觉运动速度是SRC后恢复延迟的最有力预测指标。虽然VOMS各组成部分在识别脑震荡方面很敏感，但它们不是恢复的有力预测指标。临床医生在提供治疗建议并与患者讨论预期恢复情况时，可考虑临床测量的特定表现模式。
