The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia.
Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Br J Sports Med. 2017 Jun;51(11):877-887. doi: 10.1136/bjsports-2016-097393.
Various definitions for concussion have been proposed, each having its strengths and weaknesses. We reviewed and compared current definitions and identified criteria necessary for an operational definition of sports-related concussion (SRC) in preparation of the 5th Concussion Consensus Conference (Berlin, Germany). We also assessed the role of biomechanical studies in informing an operational definition of SRC.
This is a systematic literature review.
Data sources include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Clinical Trials and SPORT Discus (accessed 14 September 2016).
Eligibility criteria were studies reporting (clinical) criteria for diagnosing SRC and studies containing SRC impact data.
Out of 1601 articles screened, 36 studies were included (2.2%), 14 reported on criteria for SRC definitions and 22 on biomechanical aspects of concussions. Six different operational definitions focusing on clinical findings and their dynamics were identified. Biomechanical studies were obtained almost exclusively on American football players. Angular and linear head accelerations linked to clinically confirmed concussions demonstrated considerable individual variation.
SUMMARY/CONCLUSIONS: SRC is a traumatic brain injury that is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces with several common features that help define its nature. Limitations identified include that the current criteria for diagnosing SRC are clinically oriented and that there is no gold/standard to assess their diagnostic properties. A future, more valid definition of SRC would better identify concussed players by demonstrating high predictive positive/negative values. Currently, the use of helmet-based systems to study the biomechanics of SRC is limited to few collision sports. New approaches need to be developed to provide objective markers for SRC.
已经提出了各种脑震荡定义，每个定义都有其优缺点。我们回顾和比较了现有的定义，并确定了运动相关性脑震荡（SRC）操作性定义所需的标准，为第 5 届脑震荡共识会议（德国柏林）做准备。我们还评估了生物力学研究在提供 SRC 操作性定义方面的作用。
这是一项系统文献回顾。
资料来源包括 MEDLINE、Embase、护理学和联合健康文献累积索引、Cochrane 临床试验中央注册和 SPORT Discus（2016 年 9 月 14 日检索）。
入选标准为报告 SRC 诊断标准的（临床）研究和包含 SRC 冲击数据的研究。
在筛选的 1601 篇文章中，有 36 篇研究被纳入（2.2%），其中 14 篇报告了 SRC 定义的标准，22 篇报告了脑震荡的生物力学方面。确定了六个不同的操作性定义，重点是临床发现及其动态。生物力学研究几乎仅在美式足球运动员中进行。与临床确诊的脑震荡相关的角加速度和线性头部加速度显示出相当大的个体差异。
总结/结论：SRC 是一种创伤性脑损伤，定义为一种受生物力学力影响的大脑复杂病理生理过程，具有几个有助于定义其性质的共同特征。已确定的局限性包括，目前用于诊断 SRC 的标准是临床导向的，没有金/标准来评估其诊断特性。未来，对 SRC 的更有效定义将通过展示高预测阳性/阴性值来更好地识别脑震荡运动员。目前，基于头盔的系统用于研究 SRC 的生物力学仅限于少数碰撞运动。需要开发新方法来为 SRC 提供客观标记。
