在一个基于社区的医疗保健系统中，13年间青少年运动性脑震荡伴发颈部损伤的流行病学情况
EPIDEMIOLOGY of NECK INJURIES ACCOMPANYING SPORT CONCUSSIONS in YOUTH OVER a 13-YEAR PERIOD IN a COMMUNITY-BASED HEALTHCARE SYSTEM.
作者信息
Carmichael Joel P, Staton Elizabeth W, Blatchford Patrick J, Stevens-Lapsley Jennifer
机构信息
Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.
Department of Family Medicine, University of Colorado, Aurora, CO, USA.
出版信息
Int J Sports Phys Ther. 2019 Jun;14(3):334-344. doi: 10.26603/ijspt20190334.
BACKGROUND
The same trauma that produces concussion may also produce neck injury. The signs of concussion and neck injury are similar, and symptoms after acceleration-deceleration trauma to the head-neck complex do not accurately discriminate between them. Research on the epidemiology of neck injury among sport-concussed youth is sparse.
PURPOSE
The purpose of this study was to investigate the epidemiology of diagnosed neck injury in non-sport-related concussion (Non-SRC) versus sport-related concussion (SRC) in youth by age, sex, and sport.
STUDY DESIGN
Cross-sectional epidemiologic study.
METHODS
De-identified data from community-based electronic health records over 13 years were extracted to analyze rates and characteristics of neck injuries among non-SRCs and SRCs in youth aged five to 21. Neck injury diagnosis prevalence rates and odds ratios were calculated to estimate risk of neck injury among concussed youth, comparing non-SRCs to SRCs by age and sex.
RESULTS
Sixteen thousand, eight hundred eighty-five concussion records were extracted, of which 3,040 SRCs and 2,775 non-SRCs in youth aged five to 21 were identified by cross-filtering sport-related keywords (e.g., football, basketball, soccer, running, swimming, batting, horseback riding, skiing, etc.) with all ICD-9 and ICD-10 concussion codes. The prevalence of neck injuries diagnosed among SRCs (7.2%) was significantly different than the prevalence of neck injuries diagnosed among non-SRCs (12.1%, p < 0.000). Neck injury diagnoses were significantly more prevalent in females overall (p < 0.000) and among non-SRCs (p < 0.000). The prevalence of neck injury diagnoses was not significantly higher in concussed females versus concussed males with SRC (p = 0.164).Among youth aged five to 21 exposed to concussions, non-SRCs were more likely to be accompanied by a neck injury diagnosis than SRCs (OR 1.66; 95% CI 1.39 to 1.98; p < 0.000). Similarly, female-to-male neck injury proportion ratios were significantly higher in females in non-SRCs compared to SRCs (IPR 1.90, 95% CI 1.60 to 2.25, p < 0.000).Sports with highest prevalence of concussion differ from sports with highest prevalence of concussion-related neck injury in both sexes.
CONCLUSIONS
The overall prevalence of diagnosed neck injuries in youth was higher in non-SRCs compared to SRCs (12.1 vs. 7.2%, p < 0.001), with the highest prevalence at age 14 in both sexes. The risk of neck injury diagnosis accompanying concussion was significantly higher in females compared to males (6.1% difference; p < 0.000).
背景
造成脑震荡的同一创伤也可能导致颈部损伤。脑震荡和颈部损伤的体征相似，头部 - 颈部复合体受到加速 - 减速创伤后的症状并不能准确区分两者。关于运动性脑震荡青少年颈部损伤流行病学的研究较少。
目的
本研究旨在按年龄、性别和运动项目调查青少年非运动相关性脑震荡（Non - SRC）与运动相关性脑震荡（SRC）中确诊颈部损伤的流行病学情况。
研究设计
横断面流行病学研究。
方法
提取13年基于社区的电子健康记录中的去识别化数据，以分析5至21岁青少年非SRC和SRC中颈部损伤的发生率及特征。计算颈部损伤诊断患病率和比值比，以估计脑震荡青少年颈部损伤的风险，按年龄和性别比较非SRC和SRC。
结果
提取了16885份脑震荡记录，通过交叉筛选与运动相关的关键词（如足球、篮球、足球、跑步、游泳、击球、骑马、滑雪等）以及所有ICD - 9和ICD - 10脑震荡编码，识别出5至21岁青少年中的3040例SRC和2775例非SRC。SRC中确诊颈部损伤的患病率（7.2%）与非SRC中确诊颈部损伤的患病率（12.1%，p < 0.000）有显著差异。总体而言，女性颈部损伤诊断的患病率显著更高（p < 0.000），在非SRC中也是如此（p < 0.000）。SRC中脑震荡女性与脑震荡男性的颈部损伤诊断患病率差异不显著（p = 0.164）。在5至21岁遭受脑震荡的青少年中，非SRC比SRC更有可能伴有颈部损伤诊断（OR 1.66；95% CI 1.39至1.98；p < 0.000）。同样，非SRC中女性与男性的颈部损伤比例显著高于SRC（IPR 1.90，95% CI 1.60至2.25，p < 0.000）。男女中脑震荡患病率最高的运动与脑震荡相关颈部损伤患病率最高的运动不同。
结论
青少年中确诊颈部损伤的总体患病率在非SRC中高于SRC（12.1%对7.2%，p < 0.001），男女在14岁时患病率最高。与男性相比，女性脑震荡时颈部损伤诊断的风险显著更高（相差6.1%；p < 0.000）。
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