Howell David R, Potter Morgan N, Kirkwood Michael W, Wilson Pamela E, Provance Aaron J, Wilson Julie C
1Sports Medicine Center and.
2Department of Orthopedics and.
J Neurosurg Pediatr. 2019 Jul 1;24(1):54-61. doi: 10.3171/2018.11.PEDS18626. Epub 2019 Apr 16.
The goal of this study was to determine which variables assessed during an initial clinical evaluation for concussion are independently associated with time until symptom resolution among pediatric patients.
Data collected from a prospective clinical registry of pediatric patients with concussion were analyzed. The primary outcome variable was time from injury until symptom resolution. Predictor variables assessed within 10 days after injury included preinjury factors, Health and Behavior Inventory scores, headache severity, and balance, vestibular, and oculomotor test performances. The researchers used univariate Cox proportional models to identify potential predictors of symptom resolution time and constructed a multivariate Cox proportional hazards model in which total duration of concussion symptoms remained the outcome variable.
The sample consisted of 351 patients (33% female, mean age 14.6 ± 2.2 years, evaluated 5.6 ± 2.6 days after concussion). Univariate Cox proportional hazards models indicated that several variables were associated with a longer duration of symptoms, including headache severity (hazard ratio [HR] 0.90 [95% CI 0.85-0.96]), headache frequency (HR 0.83 [95% CI 0.71-0.96]), confusion (HR 0.79 [95% CI 0.69-0.92]), forgetfulness (HR 0.79 [95% CI 0.68-0.92]), attention difficulties (HR 0.83 [95% CI 0.72-0.96]), trouble remembering (HR 0.84 [95% CI 0.72-0.98]), getting tired often (HR 0.86 [95% CI 0.76-0.97]), getting tired easily (HR 0.86 [95% CI 0.76-0.98]), dizziness (HR 0.86 [95% CI 0.75-0.99]), and abnormal performance on the Romberg test (HR 0.59 [95% CI 0.40-0.85]). A multivariate Cox proportional hazards model indicated that an abnormal performance on the Romberg test was independently associated with a longer duration of symptoms (HR 0.65 [95% CI 0.44-0.98]; p = 0.038).
For children and adolescents evaluated within 10 days after receiving a concussion, abnormal performance on the Romberg test was independently associated with a longer duration of symptoms during recovery. In line with findings of other recent studies investigating predictors of symptom resolution, postural stability tests may provide useful prognostic information for sports medicine clinicians.
本研究的目的是确定在儿童脑震荡初始临床评估期间评估的哪些变量与症状缓解时间独立相关。
分析了从儿童脑震荡前瞻性临床登记处收集的数据。主要结局变量是从受伤到症状缓解的时间。受伤后10天内评估的预测变量包括受伤前因素、健康与行为量表得分、头痛严重程度以及平衡、前庭和动眼神经测试表现。研究人员使用单变量Cox比例模型来识别症状缓解时间的潜在预测因素，并构建了一个多变量Cox比例风险模型，其中脑震荡症状的总持续时间仍然是结局变量。
样本包括351名患者（33%为女性，平均年龄14.6±2.2岁，脑震荡后5.6±2.6天接受评估）。单变量Cox比例风险模型表明，几个变量与症状持续时间较长相关，包括头痛严重程度（风险比[HR]0.90[95%置信区间0.85 - 0.96]）、头痛频率（HR 0.83[95%置信区间0.71 - 0.96]）、意识模糊（HR 0.79[95%置信区间0.69 - 0.92]）、健忘（HR 0.79[95%置信区间0.68 - 0.92]）、注意力困难（HR 0.83[95%置信区间0.72 - 0.96]）、记忆障碍（HR 0.84[95%置信区间0.72 - 0.98]）、经常疲劳（HR 0.86[95%置信区间0.76 - 0.97]）、容易疲劳（HR 0.86[95%置信区间0.76 - 0.98]）、头晕（HR 0.86[95%置信区间0.75 - 0.99]）以及罗姆伯格试验表现异常（HR 0.59[95%置信区间0.40 - 0.85]）。多变量Cox比例风险模型表明，罗姆伯格试验表现异常与症状持续时间较长独立相关（HR 0.65[95%置信区间0.44 - 0.98]；p = 0.038）。
对于在脑震荡后10天内接受评估的儿童和青少年，罗姆伯格试验表现异常与恢复期间症状持续时间较长独立相关。与其他近期研究调查症状缓解预测因素的结果一致，姿势稳定性测试可能为运动医学临床医生提供有用的预后信息。
