Gardner Andrew J, Howell David R, Iverson Grant L
Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, Newcastle, NSW, Australia.
Sports Med Open. 2018 Jan 12;4(1):5. doi: 10.1186/s40798-017-0117-9.
Video review has been introduced in many professional sports worldwide to help recognize concussions. However, to date, there has been very little research on the accuracy of using video analysis to identify signs of concussion and the various combinations of observed signs.
The objective of the study is to determine the accuracy of combinations of clinical signs of concussion identified using video analysis to identify concussions in the National Rugby League (NRL). Incidences of players using of the concussion interchange rule (CIR) (n = 156), including those where athletes were diagnosed with a concussion (n = 60), were used to calculate sensitivity and specificity of various combinations of concussion signs (unresponsiveness, slow to get up, clutching/shaking head, gait ataxia, vacant stare, and apparent seizure) and their independent association with an eventual diagnosis of concussion.
Using video analysis, players who were diagnosed with a concussion showed a significantly greater total number of signs at the time of injury (mean = 3.4, SD = 1.3) than those who were removed from play but not diagnosed with a concussion (mean = 3.0, SD = 0.9 signs; p = .046). Players who did not return to play during the same game demonstrated a significantly greater number of total signs than those who did return to play in the same game following CIR activation (mean = 3.4, SD = 1.2 versus mean = 2.9, SD = 0.9; p = 0.002). The most common combination of signs that was observed was clutching/shaking the head and slowness in getting up (17.3%). The sensitivity of the total number of signs observed decreased as the number of signs increased (range = 0.13-0.62), while the specificity increased as more signs were observed (range = 0.29-0.90). Most of the combinations of different observed signs at the time of potential injury were highly specific (> 0.80), but not sensitive to an eventual diagnosis of concussion. When considering all potential predictor variables in a logistic regression model, anticipating the oncoming collision (OR = 3.92, 95% CI = 1.28-12.03), fewer number of defenders involved in the tackle (OR = 0.58, 95% CI = 0.36-0.92), and the presence of a blank or vacant stare (OR = 2.97, 95% CI = 1.26-7.01) were each significantly associated with concussion diagnoses.
The use of video review in the NRL is challenging, but being aware of the combinations of possible concussion signs and the likelihood that various presentations result in a concussion diagnosis can provide a useful addition to sideline concussion identification and removal from play decisions.
视频回放已在全球许多职业体育项目中引入，以帮助识别脑震荡。然而，迄今为止，关于使用视频分析来识别脑震荡迹象以及观察到的各种迹象组合的准确性的研究非常少。
本研究的目的是确定使用视频分析识别国家橄榄球联盟（NRL）中脑震荡的临床迹象组合的准确性。使用脑震荡换人规则（CIR）的球员发生率（n = 156），包括那些被诊断为脑震荡的运动员（n = 60），来计算各种脑震荡迹象组合（无反应、起身缓慢、抓挠/摇头、步态共济失调、茫然凝视和明显癫痫发作）的敏感性和特异性，以及它们与最终脑震荡诊断的独立关联。
通过视频分析，被诊断为脑震荡的球员在受伤时显示出的迹象总数（平均 = 3.4，标准差 = 1.3）显著高于那些被换下场但未被诊断为脑震荡的球员（平均 = 3.0，标准差 = 0.9个迹象；p = 0.046）。在同一场比赛中未重返赛场的球员显示出的总迹象数显著多于在CIR激活后在同一场比赛中重返赛场的球员（平均 = 3.4，标准差 = 1.2 与平均 = 2.9，标准差 = 0.9；p = 0.002）。观察到的最常见的迹象组合是抓挠/摇头和起身缓慢（17.3%）。观察到的迹象总数的敏感性随着迹象数量的增加而降低（范围 = 0.13 - 0.62），而特异性随着观察到的迹象增多而增加（范围 = 0.29 - 0.90）。在潜在受伤时观察到的不同迹象的大多数组合具有高度特异性（> 0.80），但对最终的脑震荡诊断不敏感。在逻辑回归模型中考虑所有潜在预测变量时，预期即将到来的碰撞（OR = 3.92，95% CI = 1.28 - 12.03）、参与擒抱的防守球员数量较少（OR = 于 = 0.58，95% CI = 0.36 - 0.92）以及茫然或空洞的凝视（OR = 2.97，95% CI = 1.26 - 7.01）均与脑震荡诊断显著相关。
在NRL中使用视频回放具有挑战性，但了解可能的脑震荡迹象组合以及各种表现导致脑震荡诊断的可能性，可为场边脑震荡识别和做出换下场决定提供有益补充。
