Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland.
Br J Sports Med. 2017 Jun;51(11):903-918. doi: 10.1136/bjsports-2016-097403.
Sport-related concussion (SRC) is a clinical diagnosis made after a sport-related head trauma. Inconsistency exists regarding appropriate methods for assessing SRC, which focus largely on symptom-scores, neurocognitive functioning and postural stability.
Systematic literature review.
MEDLINE, EMBASE, PsycINFO, Cochrane-DSR, Cochrane CRCT, CINAHL, SPORTDiscus (accessed July 9, 2016).
Original (prospective) studies reporting on postinjury assessment in a clinical setting and evaluation of diagnostic tools within 2 weeks after an SRC.
Forty-six studies covering 3284 athletes were included out of 2170 articles. Only the prospective studies were considered for final analysis (n=33; 2416 athletes). Concussion diagnosis was typically made on the sideline by an (certified) athletic trainer (55.0%), mainly on the basis of results from a symptom-based questionnaire. Clinical domains affected included cognitive, vestibular and headache/migraine. Headache, fatigue, difficulty concentrating and dizziness were the symptoms most frequently reported. Neurocognitive testing was used in 30/33 studies (90.9%), whereas balance was assessed in 9/33 studies (27.3%).
SUMMARY/CONCLUSIONS: The overall quality of the studies was considered low. The absence of an objective, gold standard criterion makes the accurate diagnosis of SRC challenging. Current approaches tend to emphasise cognition, symptom assessment and postural stability with less of a focus on other domains of functioning. We propose that the clinical assessment of SRC should be symptom based and interdisciplinary. Whenever possible, the SRC assessment should incorporate neurological, vestibular, ocular motor, visual, neurocognitive, psychological and cervical aspects.
运动相关性脑震荡（SRC）是在与运动相关的头部创伤后做出的临床诊断。在评估 SRC 的适当方法方面存在不一致之处，这些方法主要集中在症状评分、神经认知功能和姿势稳定性上。
系统文献综述。
MEDLINE、EMBASE、PsycINFO、Cochrane-DSR、Cochrane CRCT、CINAHL、SPORTDiscus（2016 年 7 月 9 日访问）。
在临床环境中报告受伤后评估并在 SRC 后 2 周内评估诊断工具的原始（前瞻性）研究。
从 2170 篇文章中纳入了 46 项涵盖 3284 名运动员的研究。只有前瞻性研究才被认为是最终分析（n=33；2416 名运动员）。脑震荡的诊断通常由（认证的）运动训练员在场边做出（55.0%），主要基于基于症状的问卷的结果。受影响的临床领域包括认知、前庭和头痛/偏头痛。最常报告的症状是头痛、疲劳、注意力集中困难和头晕。30/33 项研究（90.9%）使用了神经认知测试，9/33 项研究（27.3%）评估了平衡。
总结/结论：研究的总体质量被认为较低。缺乏客观的、金标准的标准使得 SRC 的准确诊断具有挑战性。目前的方法往往强调认知、症状评估和姿势稳定性，而较少关注其他功能领域。我们建议 SRC 的临床评估应基于症状并采用多学科方法。只要有可能，SRC 评估应包括神经、前庭、眼动、视觉、神经认知、心理和颈椎方面。
