Eagle Shawn R, Puligilla Anish, Fazio-Sumrok Vanessa, Kegel Nathan, Collins Michael W, Kontos Anthony P
J Neurosurg Pediatr. 2020 Apr 24;26(2):165-170. doi: 10.3171/2020.2.PEDS2025. Print 2020 Aug 1.
No studies to date have investigated the role of early clinical care in time to recovery from concussion in a pediatric population. The purpose of this study was to investigate the role of clinic presentation timing (≤ 7 days [early] compared to 8-20 days [late] from injury) in concussion assessment performance and risk for prolonged recovery (> 30 days) in pediatric concussion.
This study is a retrospective cross-sectional study from a concussion clinic between April 2016 and January 2019, including 218 children and adolescents with diagnosed concussion, separated based on clinic presentation timing following injury: early (≤ 7 days) and late (8-20 days). Outcomes were recovery time, Postconcussion Symptom Scale (PCSS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Vestibular/Ocular Motor Screen (VOMS), and demographics, medical history, and injury information. A general linear model and chi-square analyses were used to assess differences between early and late presentation, along with logistic regression, to predict prolonged recovery (> 30 days).
Those with early presentation reported higher symptoms on VOMS subtests (79%-85%) compared to those with late presentation (61%-78%), with the exception of near-point of convergence distance and visual motion sensitivity (VMS). The strongest predictor of prolonged recovery was number of days to first clinic visit (OR 9.8). Positive VMS (OR 5.18), history of headache/migraine (OR 4.02), and PCSS score (OR 1.04) were also predictive of prolonged recovery.
Despite patients in the early presentation group presenting with more positive VOMS scores, the early presentation group recovered sooner than patients in the late presentation group. Even after controlling for vestibular dysfunction, history of headache or migraine, and total symptom severity, days to first visit remained the most robust predictor of recovery > 30 days. These findings suggest that early, specialized medical care and intervention for children and adolescents with recent concussion is associated with normal recovery time. Clinicians should educate children and parents on the potential importance of early treatment to improve the odds of positive outcomes following concussion.
迄今为止，尚无研究调查早期临床护理在儿科人群脑震荡恢复时间方面的作用。本研究的目的是调查临床就诊时间（受伤后≤7天[早期]与8 - 20天[晚期]）在儿科脑震荡评估表现及恢复时间延长（>30天）风险中的作用。
本研究是一项回顾性横断面研究，研究对象为2016年4月至2019年1月期间一家脑震荡诊所的218名诊断为脑震荡的儿童和青少年，根据受伤后的临床就诊时间分为：早期（≤7天）和晚期（8 - 20天）。观察指标包括恢复时间、脑震荡后症状量表（PCSS）、即刻脑震荡评估与认知测试（ImPACT）、前庭/眼动筛查（VOMS），以及人口统计学、病史和损伤信息。采用一般线性模型和卡方分析评估早期和晚期就诊之间的差异，并采用逻辑回归预测恢复时间延长（>30天）的情况。
与晚期就诊者（61% - 78%）相比，早期就诊者在VOMS子测试中报告的症状更多（79% - 85%），但集合近点距离和视觉运动敏感度（VMS）除外。恢复时间延长的最强预测因素是首次就诊天数（比值比9.8）。阳性VMS（比值比5.18）、头痛/偏头痛病史（比值比4.02）和PCSS评分（比值比1.04）也可预测恢复时间延长。
尽管早期就诊组患者的VOMS评分更阳性，但早期就诊组比晚期就诊组恢复得更快。即使在控制了前庭功能障碍、头痛或偏头痛病史以及总症状严重程度之后，首次就诊天数仍然是恢复时间>30天的最有力预测因素。这些发现表明，对近期发生脑震荡的儿童和青少年进行早期、专业的医疗护理和干预与正常恢复时间相关。临床医生应向儿童和家长宣传早期治疗对于提高脑震荡后获得良好预后几率的潜在重要性。
