Master Christina L, Master Stephen R, Wiebe Douglas J, Storey Eileen P, Lockyer Julia E, Podolak Olivia E, Grady Matthew F
Division of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Clin J Sport Med. 2018 Mar;28(2):139-145. doi: 10.1097/JSM.0000000000000507.
Up to one-third of children with concussion have prolonged symptoms lasting beyond 4 weeks. Vision and vestibular dysfunction is common after concussion. It is unknown whether such dysfunction predicts prolonged recovery. We sought to determine which vision or vestibular problems predict prolonged recovery in children.
A retrospective cohort of pediatric patients with concussion.
A subspecialty pediatric concussion program.
PATIENTS (OR PARTICIPANTS): Four hundred thirty-two patient records were abstracted.
Presence of vision or vestibular dysfunction upon presentation to the subspecialty concussion program.
The main outcome of interest was time to clinical recovery, defined by discharge from clinical follow-up, including resolution of acute symptoms, resumption of normal physical and cognitive activity, and normalization of physical examination findings to functional levels.
Study subjects were 5 to 18 years (median = 14). A total of 378 of 432 subjects (88%) presented with vision or vestibular problems. A history of motion sickness was associated with vestibular dysfunction. Younger age, public insurance, and presence of headache were associated with later presentation for subspecialty concussion care. Vision and vestibular problems were associated within distinct clusters. Provocable symptoms with vestibulo-ocular reflex (VOR) and smooth pursuits and abnormal balance and accommodative amplitude (AA) predicted prolonged recovery time.
Vision and vestibular problems predict prolonged concussion recovery in children. A history of motion sickness may be an important premorbid factor. Public insurance status may represent problems with disparities in access to concussion care. Vision assessments in concussion must include smooth pursuits, saccades, near point of convergence (NPC), and accommodative amplitude (AA). A comprehensive, multidomain assessment is essential to predict prolonged recovery time and enable active intervention with specific school accommodations and targeted rehabilitation.
高达三分之一的脑震荡儿童会出现持续超过4周的长期症状。脑震荡后视力和前庭功能障碍很常见。尚不清楚这种功能障碍是否预示着恢复时间延长。我们试图确定哪些视力或前庭问题可预测儿童的恢复时间延长。
对儿科脑震荡患者进行回顾性队列研究。
一个儿科脑震荡专科项目。
患者（或参与者）：提取了432份患者记录。
在专科脑震荡项目就诊时是否存在视力或前庭功能障碍。
主要关注的结果是临床恢复时间，定义为临床随访结束出院，包括急性症状的缓解、正常身体和认知活动的恢复以及体格检查结果恢复到功能水平的正常化。
研究对象年龄在5至18岁（中位数 = 14岁）。432名受试者中有378名（88%）存在视力或前庭问题。晕动病史与前庭功能障碍有关。年龄较小、有公共保险以及头痛与专科脑震荡护理的就诊时间较晚有关。视力和前庭问题在不同的集群中相关。前庭眼反射（VOR）和视平稳跟踪的激发性症状以及异常平衡和调节幅度（AA）预示着恢复时间延长。
视力和前庭问题可预测儿童脑震荡恢复时间延长。晕动病史可能是一个重要的病前因素。公共保险状况可能代表了在获得脑震荡护理方面存在的差异问题。脑震荡的视力评估必须包括视平稳跟踪、扫视、集合近点（NPC）和调节幅度（AA）。全面的多领域评估对于预测恢复时间延长以及通过特定的学校适应性措施和有针对性的康复进行积极干预至关重要。
