Kontos Anthony P, Elbin R J, Sufrinko Alicia, Marchetti Gregory, Holland Cyndi L, Collins Michael W
Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania (Drs Kontos, Sufrinko, and Collins); UPMC Sports Concussion Program, Pittsburgh, Pennsylvania (Drs Kontos, Sufrinko, and Collins and Ms Holland); Department of Health, Human Performance and Recreation/Office of Sports Concussion Research, University of Arkansas, Fayetteville (Dr Elbin); and Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania (Dr Marchetti).
J Head Trauma Rehabil. 2019 Nov/Dec;34(6):394-401. doi: 10.1097/HTR.0000000000000536.
Update concussion recovery curves by considering pre- and postinjury modifying factors. Determine whether there is a dose-response for modifying factors on recovery.
Sports medicine concussion clinic.
A total of 314 athletes aged 12-23 years within 7 days of a concussion enrolled between 2015 and 2018.
Prospective cohort study.
Categorical recovery time defined as days from injury to full medical clearance for return to play per established criteria. Preinjury factors included age, gender, concussion history, and migraine history. Postinjury factors included loss of consciousness, posttraumatic amnesia, posttraumatic migraine symptoms, and high symptom burden.
Average recovery was 27.5 ± 25 days. Five factors were prognostic of recovery: (1) younger than 18 years, (2) female, (3) history of migraine, (4) posttraumatic migraine symptoms, and (5) high symptom burden (P < .05). Recovery percentage at 21 days after injury was 96.7% for participants with 0 factor, 65.3% for those with 1 to 2, and 31.8% for those with 3 to 5-with prognostic separation in low- to high-risk groups of 62%.
Findings support a dose-response for combined pre- and postinjury factors on recovery. Both the type and quantity of modifying factors influence recovery and should be considered in prognosis and approaches to multidisciplinary care.
通过考虑损伤前后的修正因素来更新脑震荡恢复曲线。确定修正因素对恢复是否存在剂量反应。
运动医学脑震荡诊所。
2015年至2018年期间，共有314名年龄在12 - 23岁之间、脑震荡后7天内的运动员入组。
前瞻性队列研究。
分类恢复时间，定义为从受伤到根据既定标准完全获得医疗许可可重返比赛的天数。损伤前因素包括年龄、性别、脑震荡史和偏头痛史。损伤后因素包括意识丧失、创伤后遗忘、创伤后偏头痛症状和高症状负担。
平均恢复时间为27.5±25天。有五个因素可预测恢复情况：（1）年龄小于18岁，（2）女性，（3）偏头痛史，（4）创伤后偏头痛症状，（5）高症状负担（P < 0.05）。受伤后21天时，0个因素的参与者恢复率为96.7%，1至2个因素的参与者为65.3%，3至5个因素的参与者为31.8%，低风险组与高风险组的预后分离率为62%。
研究结果支持损伤前后综合因素对恢复存在剂量反应。修正因素的类型和数量均会影响恢复，在预后和多学科护理方法中均应予以考虑。
