Feller Christina N, Goldenberg May, Asselin Patrick D, Merchant-Borna Kian, Abar Beau, Jones Courtney Marie Cora, Mannix Rebekah, Kawata Keisuke, Bazarian Jeffrey J
University of Rochester School of Medicine and Dentistry, Rochester, New York.
Medical College of Wisconsin, Milwaukee.
JAMA Netw Open. 2021 Mar 1;4(3):e210599. doi: 10.1001/jamanetworkopen.2021.0599.
Symptom-based methods of concussion diagnosis in contact sports result in underdiagnosis and repeated head injury exposure, increasing the risk of long-term disability. Measures of neuro-ophthalmologic (NO) function have the potential to serve as objective aids, but their diagnostic utility is unknown.
To identify NO measures that accurately differentiate athletes with and without concussion.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted among athletes with and without concussion who were aged 17 to 22 years between 2016 and 2017. Eye movements and cognitive function were measured a median of 19 days after injury among patients who had an injury meeting the study definition of concussion while playing a sport (retrospectively selected from a concussion clinic), then compared with a control group of participants without concussion (enrolled from 104 noncontact collegiate athlete volunteers without prior head injury). Data analysis was conducted from November 2019 through May 2020.
Concussion.
Classification accuracy of clinically important discriminator eye-tracking (ET) metrics. Participants' eye movements were evaluated with a 12-minute ET procedure, yielding 42 metrics related to smooth pursuit eye movement (SPEM), saccades, dynamic visual acuity, and reaction time. Clinically important discriminator metrics were defined as those with significantly different group differences and area under the receiver operator characteristic curves (AUROCs) of at least 0.70.
A total of 34 participants with concussions (mean [SD] age, 19.7 [2.4] years; 20 [63%] men) and 54 participants without concussions (mean [SD] age, 20.8 [2.2] years; 31 [57%] men) completed the study. Six ET metrics (ie, simple reaction time, discriminate reaction time, discriminate visual reaction speed, choice visual reaction speed, and reaction time on 2 measures of dynamic visual acuity 2) were found to be clinically important; all were measures of reaction time, and none were related to SPEM. Combined, these 6 metrics had an AUROC of 0.90 (95% CI, 0.80-0.99), a sensitivity of 77.8%, and a specificity of 92.6%. The 6 metrics remained significant on sensitivity testing.
In this study, ET measures of slowed visual reaction time had high classification accuracy for concussion. Accurate, objective measures of NO function have the potential to improve concussion recognition and reduce the disability associated with underdiagnosis.
在接触性运动中，基于症状的脑震荡诊断方法会导致诊断不足以及运动员反复暴露于头部受伤风险中，从而增加长期残疾的风险。神经眼科（NO）功能测量有可能作为客观辅助手段，但其诊断效用尚不清楚。
确定能够准确区分有脑震荡和无脑震荡运动员的NO测量指标。
设计、地点和参与者：这项队列研究在2016年至2017年期间年龄在17至22岁的有脑震荡和无脑震荡的运动员中进行。对于在进行体育运动时受伤且符合脑震荡研究定义的患者（从脑震荡诊所中回顾性选择），在受伤后中位数19天测量其眼动和认知功能，然后与无脑震荡的对照组参与者（从104名无既往头部受伤的非接触性大学运动员志愿者中招募）进行比较。数据分析于2019年11月至2020年5月进行。
脑震荡。
具有临床重要鉴别意义的眼动追踪（ET）指标的分类准确性。通过12分钟的ET程序评估参与者的眼动，得出42项与平稳跟踪眼动（SPEM）、扫视、动态视力和反应时间相关的指标。具有临床重要鉴别意义的指标被定义为那些组间差异显著且受试者工作特征曲线下面积（AUROC）至少为0.70的指标。
共有34名脑震荡参与者（平均[标准差]年龄，19.7[2.4]岁；20名[63%]为男性）和54名无脑震荡参与者（平均[标准差]年龄，20.8[2.2]岁；31名[57%]为男性）完成了研究。发现6项ET指标（即简单反应时间、辨别反应时间、辨别视觉反应速度、选择视觉反应速度以及动态视力2项测量指标的反应时间）具有临床重要意义；所有这些都是反应时间的测量指标，且均与SPEM无关。综合起来，这6项指标的AUROC为0.90（95%CI，0.80 - 0.99），敏感性为77.8%，特异性为92.6%。这6项指标在敏感性测试中仍然具有显著性。
在本研究中，视觉反应时间减慢的ET测量指标对脑震荡具有较高的分类准确性。准确、客观的NO功能测量指标有可能改善脑震荡的识别，并减少与诊断不足相关的残疾。
