University Orthopedic Center Concussion Care Clinic, State College, Pennsylvania, USA.
Department of Psychology, University of Missouri - Kansas City, Missouri, USA.
Br J Sports Med. 2018 Sep;52(17):1149-1154. doi: 10.1136/bjsports-2016-097090. Epub 2017 Apr 4.
Early identification and evaluation of concussions is critical. We examined the utility of using visible signs (VS) of concussion in predicting subsequent diagnosis of concussion in NHL players.
VS of concussion were identified through video review. Coders were trained to detect and record specific visual signs while viewing videos of NHL regular season games. 2460 games were reviewed by at least two independent coders across two seasons. The reliability, sensitivity and specificity of these VS were examined.
VS were reliably coded with inter-rater agreement rates ranging from 73% to 98.9%. 1215 VS were identified in 861 events that occurred in 735 games. 47% of diagnosed concussions were associated with a VS but 53% of diagnosed concussions had no VS. Of the VS, only loss of consciousness, motor incoordination, and blank/vacant look had positive likelihood ratios greater than 1, indicating a positive association with concussion diagnoses. Slow to get up and clutching of the head were observed frequently but had low positive predictive values. Sensitivity decreased and specificity increased when multiple VS occurred together.
Non-medical personnel can be trained to reliably identify events in which VS occur and to reliably identify specific VS within each of those events. VS can be useful to detect concussion early but they are not enough since more than half of physician diagnosed concussions occurred without the presence of a visual sign. The results underscore the complexity of this injury and highlight the need for comprehensive approaches to injury detection.
早期识别和评估脑震荡至关重要。我们研究了使用脑震荡的可见征象（VS）预测 NHL 球员后续脑震荡诊断的效用。
通过视频回顾确定脑震荡的 VS。编码员接受培训，以便在观看 NHL 常规赛视频时发现和记录特定的视觉征象。在两个赛季中，至少有两名独立编码员审查了 2460 场比赛。检查了这些 VS 的可靠性、敏感性和特异性。
VS 的编码具有较高的可靠性，组内一致性率为 73%至 98.9%。在 735 场比赛中的 861 次事件中发现了 1215 个 VS。47%的确诊脑震荡与 VS 相关，但 53%的确诊脑震荡没有 VS。在 VS 中，只有意识丧失、运动不协调和茫然/茫然的表情具有大于 1 的正似然比，表明与脑震荡诊断存在正相关。起身缓慢和抓头的情况虽然经常发生，但阳性预测值较低。当多个 VS 同时发生时，敏感性降低，特异性增加。
非医疗人员可以接受培训，以可靠地识别发生 VS 的事件，并可靠地识别这些事件中的特定 VS。VS 可以帮助早期发现脑震荡，但还不够，因为超过一半的医生诊断的脑震荡在没有视觉迹象的情况下发生。结果强调了这种损伤的复杂性，并突出了需要采用综合方法进行损伤检测。
