Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Br J Sports Med. 2017 Jun;51(12):919-929. doi: 10.1136/bjsports-2016-097447. Epub 2017 Apr 28.
To conduct a systematic review of published literature on advanced neuroimaging, fluid biomarkers and genetic testing in the assessment of sport-related concussion (SRC).
Computerised searches of Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus and Cochrane Library from 1 January 2000 to 31 December 2016 were done. There were 3222 articles identified.
In addition to medical subject heading terms, a study was included if (1) published in English, (2) represented original research, (3) involved human research, (4) pertained to SRC and (5) involved data from neuroimaging, fluid biomarkers or genetic testing collected within 6 months of injury. Ninety-eight studies qualified for review (76 neuroimaging, 16 biomarkers and 6 genetic testing).
Separate reviews were conducted for neuroimaging, biomarkers and genetic testing. A standardised data extraction tool was used to document study design, population, tests employed and key findings. Reviewers used a modified quality assessment of studies of diagnostic accuracy studies (QUADAS-2) tool to rate the risk of bias, and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to rate the overall level of evidence for each search.
Results from the three respective reviews are compiled in separate tables and an interpretive summary of the findings is provided.
Advanced neuroimaging, fluid biomarkers and genetic testing are important research tools, but require further validation to determine their ultimate clinical utility in the evaluation of SRC. Future research efforts should address current gaps that limit clinical translation. Ultimately, research on neurobiological and genetic aspects of SRC is predicted to have major translational significance to evidence-based approaches to clinical management of SRC, much like applied clinical research has had over the past 20 years.
对已发表的关于运动相关性脑震荡（SRC）评估的高级神经影像学、液体生物标志物和基因检测的文献进行系统回顾。
计算机检索 2000 年 1 月 1 日至 2016 年 12 月 31 日 Medline、PubMed、Cumulative Index to Nursing and Allied Health Literature（CINAHL）、PsycINFO、Scopus 和 Cochrane Library，共检出 3222 篇文献。
除了医学主题词外，还纳入了以下研究：（1）发表于英文文献，（2）为原始研究，（3）涉及人体研究，（4）与 SRC 相关，（5）涉及神经影像学、液体生物标志物或基因检测的数据，且这些数据均在损伤后 6 个月内收集。有 98 项研究符合纳入标准（76 项神经影像学研究，16 项生物标志物研究，6 项基因检测研究）。
分别对神经影像学、生物标志物和基因检测进行综述。使用标准化数据提取工具记录研究设计、人群、所使用的检测方法以及主要发现。评价者使用改良的诊断准确性研究质量评估工具（QUADAS-2）来评估偏倚风险，使用改良的推荐分级的评估、制定与评价（GRADE）系统来评估每个检索的总体证据水平。
分别对三个独立的综述结果进行汇总，并提供了对研究结果的解释性总结。
高级神经影像学、液体生物标志物和基因检测是重要的研究工具，但需要进一步验证，以确定它们在 SRC 评估中的最终临床应用价值。未来的研究工作应解决限制其临床转化的当前差距。最终，SRC 的神经生物学和遗传学方面的研究预计将对基于证据的 SRC 临床管理方法产生重大的转化意义，就像过去 20 年应用临床研究所产生的影响一样。
