Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong; PICU, The Hong Kong Children's Hospital, Hong Kong.
Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
Semin Pediatr Neurol. 2019 Jul;30:117-127. doi: 10.1016/j.spen.2019.03.017. Epub 2019 Mar 26.
Concussion, also referred to as mild traumatic brain injury (MTBI), is a common pediatric condition. This article reviews global perspectives on the epidemiology, treatment, and prognosis of concussion in children. A Pubmed search was conducted using Clinical Queries with the key terms "concussion" and "mild traumatic brain injury," and the search was limited to "children." The search strategy included meta-analyses, randomized controlled trials, clinical trials, and reviews. The majority of publications were from Canada and the United States. Prevalence estimates vary widely according to case definition and studied population. Due to under-reporting and to the widely varying definitions of concussion, it is difficult to estimate how common the condition is. Common causes of concussions include sports injuries, motor vehicle collisions, bicycle accidents, falls, and assaults. Diagnosis is mainly clinical. Because concussion results from a disturbance in brain function rather than structural injury, neuroimaging studies, such as computed tomography and magnetic resonance imaging, are not routinely recommended. Treatment generally involves physical and cognitive rest, with a gradual return to activities, whereas prolonged rest may actually worsen outcomes. Helmets when bicycling, skiing, snowboarding, motor biking, placing age limits on certain types of contact sports, and encouragement of fair play are recommended to decrease the impact of head injuries but they do not prevent concussions. Overall outcomes are generally favorable. The symptoms and signs of concussion usually resolve within 10 days; most patients recover in 48-72 hours. Global perspectives on management and prognosis are lacking. Concussions or MTBIs are common childhood injuries and the prognosis is good but information is predominantly from Canada and the USA. Research in other countries in particular low and middle income countries is vital to have a global perspective on MTBI.
脑震荡，也称为轻度创伤性脑损伤（MTBI），是一种常见的儿科疾病。本文综述了全球范围内儿童脑震荡的流行病学、治疗和预后的观点。使用临床查询的 Pubmed 进行了搜索，关键词为“脑震荡”和“轻度创伤性脑损伤”，并将搜索范围限于“儿童”。搜索策略包括荟萃分析、随机对照试验、临床试验和综述。大多数出版物来自加拿大和美国。根据病例定义和研究人群的不同，患病率估计值差异很大。由于漏报和脑震荡的定义广泛不同，因此很难估计该疾病的普遍程度。脑震荡的常见原因包括运动损伤、机动车碰撞、自行车事故、跌倒和袭击。诊断主要基于临床。由于脑震荡是由于大脑功能紊乱而不是结构损伤引起的，因此通常不建议进行神经影像学研究，如计算机断层扫描和磁共振成像。治疗通常包括身体和认知休息，逐渐恢复活动，而长时间休息实际上可能会使结果恶化。建议在骑自行车、滑雪、单板滑雪、骑摩托车时戴头盔，对某些类型的接触性运动设置年龄限制，并鼓励公平竞争，以减少头部受伤的影响，但不能预防脑震荡。总体预后通常良好。脑震荡的症状和体征通常在 10 天内消退；大多数患者在 48-72 小时内恢复。缺乏关于管理和预后的全球观点。脑震荡或 MTBI 是常见的儿童损伤，预后良好，但信息主要来自加拿大和美国。特别是在低收入和中等收入国家开展研究对于全面了解 MTBI 至关重要。
