Van Pelt Kathryn L, Allred Dain, Cameron Kenneth L, Campbell Darren E, D'Lauro Christopher J, He Xuming, Houston Megan N, Johnson Brian R, Kelly Tim F, McGinty Gerald, Meehan Sean, O'Donnell Patrick G, Peck Karen Y, Svoboda Steven J, Pasquina Paul, McAllister Thomas, McCrea Michael, Broglio Steven P
NeuroTrauma Research Laboratory, University of Michigan, 401 Washtenaw Ave, Ann Arbor, MI, 48104, USA.
United States Air Force Academy, 2355 Faculty Drive, Suite 1N207, U.S. Air Force Academy, CO, 80840, USA.
Inj Epidemiol. 2019 Jan 14;6(1):1. doi: 10.1186/s40621-018-0178-3.
Concussion, or mild traumatic brain injury, is a major public health concern affecting 42 million individuals globally each year. However, little is known regarding concussion risk factors across all concussion settings as most concussion research has focused on only sport-related or military-related concussive injuries.
The current study is part of the Concussion, Assessment, Research, and Education (CARE) Consortium, a multi-site investigation on the natural history of concussion. Cadets at three participating service academies completed annual baseline assessments, which included demographics, medical history, and concussion history, along with the Sport Concussion Assessment Tool (SCAT) symptom checklist and Brief Symptom Inventory (BSI-18). Clinical and research staff recorded the date and injury setting at time of concussion. Generalized mixed models estimated concussion risk with service academy as a random effect. Since concussion was a rare event, the odds ratios were assumed to approximate relative risk.
Beginning in 2014, 10,604 (n = 2421, 22.83% female) cadets enrolled over 3 years. A total of 738 (6.96%) cadets experienced a concussion, 301 (2.84%) concussed cadets were female. Female sex and previous concussion were the most consistent estimators of concussion risk across all concussion settings. Compared to males, females had 2.02 (95% CI: 1.70-2.40) times the risk of a concussion regardless of injury setting, and greater relative risk when the concussion occurred during sport (Odds Ratio (OR): 1.38 95% CI: 1.07-1.78). Previous concussion was associated with 1.98 (95% CI: 1.65-2.37) times increased risk for any incident concussion, and the magnitude was relatively stable across all concussion settings (OR: 1.73 to 2.01). Freshman status was also associated with increased overall concussion risk, but was driven by increased risk for academy training-related concussions (OR: 8.17 95% CI: 5.87-11.37). Medical history of headaches in the past 3 months, diagnosed ADD/ADHD, and BSI-18 Somatization symptoms increased overall concussion risk.
Various demographic and medical history factors are associated with increased concussion risk. While certain factors (e.g. sex and previous concussion) are consistently associated with increased concussion risk, regardless of concussion injury setting, other factors significantly influence concussion risk within specific injury settings. Further research is required to determine whether these risk factors may aid in concussion risk reduction or prevention.
脑震荡，即轻度创伤性脑损伤，是一个重大的公共卫生问题，每年全球有4200万人受其影响。然而，对于所有脑震荡情况的风险因素知之甚少，因为大多数脑震荡研究仅关注与运动相关或与军事相关的脑震荡损伤。
本研究是脑震荡评估、研究和教育（CARE）联盟的一部分，这是一项关于脑震荡自然史的多中心调查。三所参与的军校学员完成了年度基线评估，包括人口统计学、病史和脑震荡史，以及运动脑震荡评估工具（SCAT）症状清单和简明症状量表（BSI - 18）。临床和研究人员记录了脑震荡发生时的日期和损伤情况。广义混合模型以军校为随机效应估计脑震荡风险。由于脑震荡是罕见事件，假设优势比近似相对风险。
从2014年开始，10604名（n = 2421，22.83%为女性）学员在3年期间入学。共有738名（6.96%）学员经历了脑震荡，301名（2.84%）脑震荡学员为女性。在所有脑震荡情况下，女性性别和既往脑震荡是脑震荡风险最一致的预测因素。与男性相比，无论损伤情况如何，女性发生脑震荡的风险是男性的2.02倍（95%置信区间：1.70 - 2.40），当脑震荡发生在运动期间时相对风险更高（优势比（OR）：1.38，95%置信区间：1.07 - 1.78）。既往脑震荡与任何脑震荡事件的风险增加1.98倍（95%置信区间：1.65 - 2.37）相关，并且在所有脑震荡情况下风险程度相对稳定（OR：1.73至2.01）。新生身份也与总体脑震荡风险增加相关，但主要是由于军校训练相关脑震荡风险增加（OR：8.17，95%置信区间：5.87 - 11.37）。过去3个月的头痛病史、诊断为注意力缺陷多动障碍（ADD/ADHD）以及BSI - 18躯体化症状增加了总体脑震荡风险。
各种人口统计学和病史因素与脑震荡风险增加相关。虽然某些因素（如性别和既往脑震荡）无论脑震荡损伤情况如何都始终与脑震荡风险增加相关，但其他因素在特定损伤情况下显著影响脑震荡风险。需要进一步研究以确定这些风险因素是否有助于降低或预防脑震荡风险。
