O'Brien Michael J, Howell David R, Pepin Michael J, Meehan William P
Sports Concussion Clinic, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA.
Orthop J Sports Med. 2017 Oct 17;5(10):2325967117732516. doi: 10.1177/2325967117732516. eCollection 2017 Oct.
Current guidelines dictate a gradual exercise progression after a concussion; however, it is unclear what proportion of athletes experience a recurrence of symptoms once they are symptom free at rest. Estimating the proportion of athletes and predictors of symptom recurrence would help shape return-to-play protocols.
To determine the proportion and associated risk factors of athletes who have a recurrence of concussion symptoms with exercise after being symptom free at rest.
Case-control study; Level of evidence, 3.
Between October 1, 2009 and July 31, 2011, we studied patients from a sport concussion clinic located within a tertiary care regional children's hospital. Patients were queried at every visit using a standardized questionnaire. Our main outcome variable was recurrence of symptoms with exercise after being symptom free at rest at some point in their recovery. Cofactors included age, sex, loss of consciousness with injury, prior concussion (diagnosed and undiagnosed), Post-Concussion Symptom Scale (PCSS) score, time until clinical presentation, and duration of symptoms.
Of the 217 patients included, 25 (12%) experienced a return of symptoms. Losing consciousness at the time of injury and a longer duration between injury and clinical presentation were associated with a decreased risk of symptoms recurring with exercise. Conversely, athletes who had sustained previously undiagnosed concussions and had suffered a longer duration of symptoms at rest were at an increased risk of symptom recurrence with exercise.
Relatively few athletes who are symptom free at rest after a concussion will have a recurrence of symptoms when they resume exercise. The risk of symptoms recurring with exercise may be greater among those athletes who sustained previously undiagnosed concussions and had a longer period of symptoms at rest. The early identification of athletes who may be at risk of symptom recurrence will help mold treatment guidelines and exercise progression protocols.
当前指南规定脑震荡后应逐渐增加运动量；然而，尚不清楚无症状的运动员在恢复后进行运动时症状复发的比例。估计运动员症状复发的比例及其预测因素将有助于制定重返赛场的方案。
确定在休息时无症状的运动员在运动后出现脑震荡症状复发的比例及相关危险因素。
病例对照研究；证据等级为3级。
2009年10月1日至2011年7月31日期间，我们对一家三级医疗区域儿童医院内的运动脑震荡诊所的患者进行了研究。每次就诊时均使用标准化问卷对患者进行询问。我们的主要结局变量是在恢复过程中的某个时间点休息时无症状的运动员在运动后症状复发情况。协变量包括年龄、性别、受伤时是否失去意识、既往脑震荡（已诊断和未诊断）、脑震荡后症状量表（PCSS）评分、就诊时间以及症状持续时间。
在纳入的217例患者中，25例（12%）出现症状复发。受伤时失去意识以及受伤与就诊之间的时间间隔较长与运动后症状复发风险降低相关。相反，既往有未诊断出的脑震荡且休息时症状持续时间较长的运动员运动后症状复发风险增加。
脑震荡后休息时无症状的运动员在恢复运动时症状复发的情况相对较少。既往有未诊断出的脑震荡且休息时症状持续时间较长的运动员运动后症状复发的风险可能更高。早期识别可能有症状复发风险的运动员将有助于制定治疗指南和运动进展方案。
