Gardner Andrew J, Howell David R, Levi Christopher R, Iverson Grant L
Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
Priority Research Centre for Stroke and Brain Injury, Level 5, McAuley Building, Calvary Mater Hospital, Waratah, NSW, 2298, Australia.
Sports Med Open. 2017 Aug 22;3(1):29. doi: 10.1186/s40798-017-0097-9.
Many professional sports have introduced sideline video review to help recognise concussions. The reliability and validity of identifying clinical and observable signs of concussion using video analysis has not been extensively explored. This study examined the reliability and validity of clinical signs of concussion using video analysis in the National Rugby League (NRL).
All 201 professional NRL matches from the 2014 season were reviewed to document six signs of possible concussion (unresponsiveness, slow to get up, clutching/shaking head, gait ataxia, vacant stare, and seizure).
A total of 127,062 tackles were reviewed. Getting up slowly was the most common observable sign (2240 times in the season, 1.8% of all tackles) but only 223 times where it appeared to be a possible concussion (0.2% of all tackles and 10.0% of the times it occurred). Additionally, clutching/shaking the head occurred 361 times (on 212 occasions this sign appeared to be due to a possible concussion), gait ataxia was observed 102 times, a vacant stare was noted 98 times, unresponsiveness 52 times, and a possible seizure 4 times. On 383 occasions, one or more of the observable signs were identified and deemed associated with a possible concussion. There were 175 incidences in which a player appeared to demonstrate two or more concussion signs, and 54 incidences where a player appeared to demonstrate three or more concussion signs. A total of 60 diagnosed concussions occurred, and the concussion interchange rule was activated 167 times. Intra-rater reliability (κ = 0.65-1.00) was moderate to perfect for all six video signs; however, the inter-rater reliability was not as strong (κ = 0.22-0.76). Most of the signs had relatively low sensitivity (0.18-0.75), but high specificity (0.85-1.00).
Using video replay, observable signs of concussion appear to be sensitive to concussion diagnoses when reviewing known injuries among professional rugby league players. When reviewing an entire season, however, certain signs occur very commonly and did not identify concussion. Thus, the implementation of video review in the NRL is challenging, but can provide a useful addition to sideline concussion identification and removal from play decisions.
许多职业体育项目已引入场边视频回放以帮助识别脑震荡。利用视频分析来识别脑震荡临床及可观察症状的可靠性和有效性尚未得到广泛研究。本研究在国家橄榄球联盟（NRL）中，考察了利用视频分析来判断脑震荡临床症状的可靠性和有效性。
对2014赛季的所有201场职业NRL比赛进行回顾，记录六种可能的脑震荡症状（无反应、起身缓慢、抓握/摇晃头部、步态共济失调、茫然凝视和癫痫发作）。
共审查了127,062次擒抱动作。起身缓慢是最常见的可观察症状（该赛季出现2240次，占所有擒抱动作的1.8%），但似乎可能是脑震荡的情况仅223次（占所有擒抱动作的0.2%，以及该症状出现次数的10.0%）。此外，抓握/摇晃头部出现361次（其中212次该症状似乎是由可能的脑震荡引起），观察到步态共济失调102次，茫然凝视98次，无反应52次，可能的癫痫发作4次。在383次情况中，识别出一种或多种可观察症状，并认为与可能的脑震荡相关。有175例球员似乎表现出两种或更多脑震荡症状，54例球员似乎表现出三种或更多脑震荡症状。总共发生了60例确诊脑震荡，脑震荡替换规则被激活167次。所有六种视频症状的评分者内信度（κ = 0.65 - 1.00）为中等至完美；然而，评分者间信度没那么强（κ = 0.22 - 0.76）。大多数症状的敏感性相对较低（0.18 - 0.75），但特异性较高（0.85 - 1.00）。
使用视频回放时，在审查职业橄榄球联盟球员已知损伤时，脑震荡的可观察症状似乎对脑震荡诊断敏感。然而，在审查整个赛季时，某些症状非常常见，且无法识别脑震荡。因此，在NRL中实施视频审查具有挑战性，但可为场边脑震荡识别及决定球员是否离场提供有益补充。
