Alsalaheen Bara, Stockdale Kayla, Pechumer Dana, Broglio Steven P, Marchetti Gregory F
Department of Physical Therapy, University of Michigan, Flint.
Department of Neurology, University of Michigan, Ann Arbor.
J Athl Train. 2017 Sep;52(9):834-846. doi: 10.4085/1062-6050-52.7.05. Epub 2017 Aug 15.
Meta-analyses examining construct-specific cognitive impairment concurrently with self-reported symptoms postconcussion are sparse.
To review the literature on the effects of concussion on construct-specific neurocognitive declines and to compare them with self-reported symptoms before 1 week and between 1 and 3 weeks postconcussion.
Relevant studies in PubMed, CINAHL, and PsycINFO published from January 1, 1999 through November 30, 2015.
Studies were included if participants completed the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) before and after concussion and if test performance and Postconcussion Symptom Scale (PCSS) scores were reported at both times.
After reviewing the full texts, we extracted data from 17 studies consisting of 29 independent samples; therefore, this meta-analysis consisted of 1777 unique participants.
The Hedges g effect size (ES) was estimated. A random-effects or fixed-effects model was used based on heterogeneity findings. When heterogeneity was present, we used meta-regression to assess unexplained between-studies variance. Within the first week of injury, the ESs were small to moderate for cognitive declines, ranging from -0.43 (95% confidence interval [CI] = -0.52, -0.35) to -0.67 (95% CI = -0.77, -0.58), and large for the PCSS score (Hedges g = -0.81; 95% CI = -0.91, -0.71). After 1 week, the ESs for cognitive declines (Hedges g range = -0.25 [95% CI = -0.35, -0.15] to -0.37 [95% CI = -0.55, -0.19]) and PCSS score (Hedges g = -0.38; 95% CI = -0.53, -0.22) were also small. Within 2 weeks of injury, PCSS score and time since injury weakly moderated the cognitive ES.
When a neurocognitive test was administered within 1 week of injury, the ES was larger for self-reported symptoms than for ImPACT scores generated at the same session. After 1 week of injury, the ESs for ImPACT and PCSS scores were comparable. If the athlete reports symptoms within 1 week of injury, administering a cognitive test does not appear to offer additional information to the clinician. However, if the athlete does not report symptoms postconcussion, cognitive testing may inform the clinical management of the injury.
同时考察脑震荡后特定结构认知障碍与自我报告症状的荟萃分析较少。
回顾关于脑震荡对特定结构神经认知衰退影响的文献，并将其与脑震荡后1周内以及1至3周之间的自我报告症状进行比较。
1999年1月1日至2015年11月30日在PubMed、CINAHL和PsycINFO上发表的相关研究。
如果参与者在脑震荡前后完成了脑震荡后即刻评估和认知测试（ImPACT），并且报告了两次测试成绩和脑震荡后症状量表（PCSS）分数，则纳入研究。
在审阅全文后，我们从17项研究中提取了数据，这些研究包括29个独立样本；因此，这项荟萃分析包括1777名独特的参与者。
估计了Hedges g效应量（ES）。根据异质性结果使用随机效应或固定效应模型。当存在异质性时，我们使用元回归来评估研究间无法解释的方差。在受伤后的第一周内，认知衰退的ES为小到中度，范围从-0.43（95%置信区间[CI]=-0.52，-0.35）到-0.67（95%CI=-0.77，-0.58），而PCSS分数的ES较大（Hedges g=-0.81；95%CI=-0.91，-0.71）。1周后，认知衰退的ES（Hedges g范围=-0.25[95%CI=-0.35，-0.15]至-0.37[95%CI=-0.55，-0.19]）和PCSS分数的ES（Hedges g=-0.38；95%CI=-0.53，-0.22）也较小。在受伤后2周内，PCSS分数和受伤后的时间对认知ES有微弱的调节作用。
在受伤后1周内进行神经认知测试时，自我报告症状的ES比同一次测试中产生的ImPACT分数的ES更大。受伤1周后，ImPACT和PCSS分数的ES相当。如果运动员在受伤后1周内报告症状，进行认知测试似乎不会为临床医生提供额外信息。然而，如果运动员在脑震荡后未报告症状，认知测试可能会为损伤的临床管理提供信息。
