Kruse Adam J, Nugent Andrew S, Peterson Andrew R
Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
Department of Emergency Medicine, The University of Iowa, Iowa City, IA, USA.
Open Access Emerg Med. 2018 Sep 26;10:113-121. doi: 10.2147/OAEM.S165995. eCollection 2018.
Traumatic brain injury (TBI) is a significant cause of death and disability in the United States. Many patients with TBI are initially treated in the emergency department (ED), but there is no evidence-based method of detecting or grading TBI in patients who have normal structural neuroimaging. This study aims to evaluate the validity of two common sideline concussion tests. The Concussion Symptom Severity Score (CSSS) and modified Balance Error Scoring System (mBESS) tests are well-validated sideline tests for concussion, but have not been validated in the setting of non-sport-related concussion, in settings other than the sideline or athletic training room or in moderate or severe TBI.
One hundred forty-eight subjects who had sustained a TBI within the previous 72 hours and 53 healthy control subjects were enrolled. CSSS and mBESS were administered. Clinical outcomes were followed up prospectively.
The CSSS was collected in 147 TBI subjects but only 51 TBI subjects were able to complete the mBESS. The CSSS was collected for all 53 control subjects, and the mBESS was completed for 51 control subjects. The mean CSSS for TBI and control subjects was 32.25 and 2.70, respectively ( < 0.001). The average mBESS for TBI and control subjects was 7.43 and 7.20, respectively ( = 0.82). CSSS greater than 5.17 was 93.43% sensitive and 69.84% specific for TBI.
The mBESS is poorly tolerated and, among those who can complete the test, not sensitive to TBI in the ED. The CSSS is both sensitive to TBI and well tolerated.
创伤性脑损伤（TBI）是美国死亡和残疾的重要原因。许多TBI患者最初在急诊科（ED）接受治疗，但对于结构神经影像学正常的患者，尚无基于证据的TBI检测或分级方法。本研究旨在评估两种常见的场边脑震荡测试的有效性。脑震荡症状严重程度评分（CSSS）和改良平衡误差评分系统（mBESS）测试是经过充分验证的场边脑震荡测试，但尚未在非运动相关脑震荡的情况下、场边或运动训练室以外的环境中或中度或重度TBI中得到验证。
纳入148名在过去72小时内发生TBI的受试者和53名健康对照受试者。进行CSSS和mBESS测试。对临床结果进行前瞻性随访。
147名TBI受试者收集了CSSS，但只有51名TBI受试者能够完成mBESS。所有53名对照受试者均收集了CSSS，51名对照受试者完成了mBESS。TBI和对照受试者的平均CSSS分别为32.25和2.70（<0.001）。TBI和对照受试者的平均mBESS分别为7.43和7.20（=0.82）。CSSS大于5.17对TBI的敏感性为93.43%，特异性为69.84%。
mBESS耐受性差，在能够完成测试的患者中，对急诊科的TBI不敏感。CSSS对TBI既敏感又耐受性良好。
