The Mind Research Network/Lovelace Biomedical and Environmental Research Institute, Albuquerque, New Mexico (Drs Mayer, Stephenson, Hanlon, and Phillips, Messrs Wertz, Dodd, and Shaff, and Mss Robertson-Benta and Pabbathi Reddy); Departments of Psychiatry and Behavioral Sciences (Dr Mayer), Psychology (Drs Mayer and Campbell), Neurology (Drs Mayer and Phillips), and Emergency Medicine (Mr Oglesbee and Dr Park), University of New Mexico, Albuquerque; Department of Epidemiology and Biostatistics, University of Arizona, Tucson (Dr Bedrick); Center for Injury Research and Prevention, Department of Pediatrics (Drs Master, Grady, and Arbogast), and Division of Orthopedic Surgery (Drs Master and Grady), The Children's Hospital of Philadelphia, Philadelphia; Department of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada (Dr Zemek); Department of Psychology (Dr Yeates), Alberta Children's Hospital Research Institute (Dr Yeates), and Hotchkiss Brain Institute (Dr Yeates), University of Calgary, Calgary, Alberta, Canada; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee (Dr Meier); Departments of Cell Biology, Neurobiology and Anatomy (Dr Meier) and Biomedical Engineering (Dr Meier), Medical College of Wisconsin, Milwaukee; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts (Dr Mannix); and UBMD Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine, University at Buffalo, Buffalo, New York (Dr Leddy).
J Head Trauma Rehabil. 2020 Jul/Aug;35(4):270-278. doi: 10.1097/HTR.0000000000000560.
To evaluate diagnostic/prognostic implications of neurosensory testing during the subacute stage in patients with pediatric mild traumatic brain injury (pmTBI).
Recruitment from pediatric emergency department and urgent care clinics, assessment in a controlled environment.
In total, 146 pmTBI patients evaluated 7.4 ± 2.3 days and approximately 4 months postinjury; 104 age/sex-matched healthy controls (HCs) at equivalent time points.
Prospective cohort study.
Neurosensory examination based on sequence of 10 established tests of vestibular-ocular, oculomotor, vestibulospinal, and visual functioning.
The amount of symptom provocation (positive change from pretest symptomatology) was significantly increased in pmTBI relative to HCs on every subtest 1 week postinjury, as were deficits in monocular accommodative amplitude and King-Devick Test errors. However, symptom provocation did not meaningfully alter diagnostic sensitivity/specificity relative to more easily obtained pretest symptom ratings. Evidence of clinically significant symptom provocation 1 week postinjury improved sensitivity (Δ = +12.9%) of identifying patients with persistent postconcussive symptoms 4 months postinjury on an independent symptom measure.
The diagnostic sensitivity/specificity of neurosensory testing in acutely concussed youth may be limited at 1 week postinjury as a function of natural recovery occurring in most emergency department cohorts. Neurosensory screening may have greater utility for identifying patients who experience delayed recovery.
评估儿科轻度创伤性脑损伤（pmTBI）患者亚急性期神经感觉测试的诊断/预后意义。
在儿科急诊和紧急护理诊所招募，在受控环境中进行评估。
共有 146 名 pmTBI 患者在受伤后 7.4 ± 2.3 天和大约 4 个月进行评估；104 名年龄/性别匹配的健康对照者（HCs）在相同时间点。
前瞻性队列研究。
基于前庭眼、眼动、前庭脊髓和视觉功能的 10 项既定测试序列进行神经感觉检查。
与 HCs 相比，pmTBI 患者在受伤后第 1 周的每个子测试中都表现出明显更多的症状诱发（与术前症状相比出现阳性变化），并且单眼调节幅度和 King-Devick 测试错误也存在缺陷。然而，与更容易获得的术前症状评分相比，症状诱发并没有显著改变诊断的敏感性/特异性。受伤后第 1 周出现明显的临床症状诱发，可提高在独立症状评估中识别 4 个月后持续出现脑震荡后症状患者的敏感性（Δ=+12.9%）。
在急性脑震荡的青少年中，神经感觉测试的诊断敏感性/特异性可能在受伤后第 1 周受到限制，因为大多数急诊队列中的自然恢复都会发生。神经感觉筛查可能更有助于识别延迟恢复的患者。
