Boutis Kathy, Gravel Jocelyn, Freedman Stephen B, Craig William, Tang Ken, DeMatteo Carol A, Dubrovsky Alexander Sasha, Beer Darcy, Burns Emma, Sangha Gurinder, Zemek Roger
Division of Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.
Division of Emergency Medicine, CHU Sainte-Justine and Université de Montréal, Montréal, Québec, Canada.
J Emerg Med. 2018 Jun;54(6):757-765. doi: 10.1016/j.jemermed.2018.02.041. Epub 2018 Apr 21.
The accurate identification of children with a concussion by emergency physicians is important to initiate appropriate anticipatory guidance and management.
We compared the frequency of persistent concussion symptoms in children who were provided the diagnosis of concussion by an emergency physician versus those who met Berlin/Zurich international criteria for this diagnosis. We also determined the clinical variables independently associated with a physician-diagnosed concussion.
This was a planned secondary analysis of a prospective, multicenter cohort study. Participants were 5-17 years of age and met the Zurich/Berlin International Consensus Statement criteria for concussion.
There were 2946 enrolled children. In those with physician-diagnosed concussion vs. no concussion, the frequency of persistent symptoms was 62.5% vs. 38.8% (p < 0.0001) at 1 week, 46.3% vs. 25.8% (p < 0.0001) at 2 weeks, and 33.0% vs. 23.0% (p < 0.0001) at 4 weeks. Of those meeting international criteria, 2340 (79.4%) were diagnosed with a concussion by an emergency physician and 12 variables were associated with this diagnosis. Five had an odds ratio (OR) > 1.5: older age (13-17 vs. 5-7 years, OR 2.9), longer time to presentation (≥16 vs. <16 h, OR 2.1), nausea (OR 1.7), sport mechanism (OR 1.7), and amnesia (OR 1.6).
Relative to international criteria, the more selective assignment of concussion by emergency physicians was associated with a greater frequency of persistent concussion symptoms. In addition, while most children meeting international criteria for concussion were also provided this diagnosis for concussion by an emergency physician, the presence of 5 specific variables made this diagnosis more likely.
急诊医生准确识别脑震荡患儿对于启动适当的预期指导和管理至关重要。
我们比较了由急诊医生诊断为脑震荡的儿童与符合柏林/苏黎世国际脑震荡诊断标准的儿童中持续性脑震荡症状的发生频率。我们还确定了与医生诊断的脑震荡独立相关的临床变量。
这是一项对前瞻性多中心队列研究的计划二次分析。参与者年龄在5至17岁之间，符合苏黎世/柏林国际共识声明的脑震荡标准。
共纳入2946名儿童。在医生诊断为脑震荡与未诊断为脑震荡的儿童中，1周时持续性症状的发生率分别为62.5%和38.8%（p<0.0001），2周时分别为46.3%和25.8%（p<0.0001），4周时分别为33.0%和23.0%（p<0.0001）。在符合国际标准的儿童中，2340名（79.4%）被急诊医生诊断为脑震荡，12个变量与该诊断相关。其中5个变量的比值比（OR）>1.5：年龄较大（13 - 17岁与5 - 7岁，OR 2.9）、就诊时间较长（≥16小时与<16小时，OR 2.1）、恶心（OR 1.7）、运动损伤机制（OR 1.7）和失忆（OR 1.6）。
相对于国际标准，急诊医生对脑震荡的诊断更为严格，这与持续性脑震荡症状的更高发生率相关。此外，虽然大多数符合国际脑震荡标准的儿童也被急诊医生诊断为脑震荡，但存在5个特定变量会使这种诊断更有可能。
