Olson Ashley, Ellis Michael J, Selci Erin, Russell Kelly
Max Rady College of Medicine Sciences, University of Manitoba, Winnipeg, MB, Canada.
Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
Front Neurol. 2020 Apr 3;11:220. doi: 10.3389/fneur.2020.00220. eCollection 2020.
(1) To examine the prevalence of delayed symptom onset (DSO) among pediatric sport-related concussion (SRC) patients as well as the effect of symptom onset on initial symptom severity, length of recovery, and development of delayed recovery; (2) to evaluate the impact of symptom onset on sideline management. We conducted a prospective study of pediatric SRC patients (<20 years of age) evaluated at a multi-disciplinary concussion program. Patients underwent initial medical assessment by a single neurosurgeon and a structured interview by a research assistant. Patients were classified as experiencing early symptom onset (symptom onset <15 min from the time of the suspected injury; ESO) or DSO (≥15 min from the time of the suspected injury). A total of 144 SRC patients (61.1% male; mean age 14.6 years, SD 1.8) evaluated a median of 5.0 days (IQR 4.0, 9.0) post-injury were included in the study. Among these patients, 120 (83.3%) reported experiencing ESO while 24 (16.7%) experienced DSO following injury. Among those that experienced DSO the median length of time from the suspected injury to symptom onset was 60.0 min (IQR 20.0, 720.0). No significant differences were observed in symptom severity at initial medical assessment (median Post-Concussion Symptom Scale score 20.0 vs. 18.0, = 0.35), length of physician-document clinical recovery (median 22.0 vs. 24.0 days; = 0.46) or the proportion of those who developed delayed physician-documented clinical recovery (34.4 vs. 42.1%, = 0.52) among patients with ESO or DSO. Patients who reported experiencing ESO were significantly more likely to be immediately removed from play at the time of their suspected injury compared to those who experienced DSO (71.6% vs. 29.2%; < 0.0001). This study suggests that an important proportion of children and adolescents who sustain an acute SRC experience DSO. DSO is associated with lower rates of immediate removal from play at the time of suspected injury. Secondary study findings highlight the need for improved sport stakeholder concussion education and standardized concussion protocols that mandate the immediate and permanent removal of all youth with a suspected concussion until they undergo medical assessment.
(1) 研究儿科运动相关性脑震荡（SRC）患者中延迟症状发作（DSO）的患病率，以及症状发作对初始症状严重程度、恢复时间和延迟恢复发展的影响；(2) 评估症状发作对赛场边管理的影响。我们对在一个多学科脑震荡项目中接受评估的儿科SRC患者（<20岁）进行了一项前瞻性研究。患者由一名神经外科医生进行初始医学评估，并由一名研究助理进行结构化访谈。患者被分类为经历早期症状发作（症状发作距离疑似受伤时间<15分钟；ESO）或DSO（距离疑似受伤时间≥15分钟）。共有144例SRC患者（61.1%为男性；平均年龄14.6岁，标准差1.8）纳入研究，他们在受伤后中位5.0天（四分位间距4.0，9.0）接受评估。在这些患者中，120例（83.3%）报告经历ESO，而24例（16.7%）在受伤后经历DSO。在经历DSO的患者中，从疑似受伤到症状发作的中位时间为60.0分钟（四分位间距20.0，720.0）。在初始医学评估时，ESO或DSO患者在症状严重程度（脑震荡后症状量表中位评分20.0对18.0，P = 0.35）、医生记录的临床恢复时间（中位22.0对24.0天；P = 0.46）或出现延迟医生记录的临床恢复的患者比例（34.4%对42.1%，P = 0.52）方面均未观察到显著差异。与经历DSO的患者相比，报告经历ESO的患者在疑似受伤时更有可能立即被禁止参赛（71.6%对29.2%；P < 0.0001）。这项研究表明，遭受急性SRC的儿童和青少年中有相当一部分经历DSO。DSO与疑似受伤时立即被禁止参赛的比例较低有关。次要研究结果强调需要改善体育利益相关者的脑震荡教育以及标准化的脑震荡协议，这些协议要求立即并永久禁止所有疑似脑震荡的青少年参赛，直到他们接受医学评估。
