Iverson Grant L, Karr Justin E, Maxwell Bruce, Zafonte Ross, Berkner Paul D, Cook Nathan E
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.
MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, United States.
Front Neurol. 2021 Feb 23;12:614648. doi: 10.3389/fneur.2021.614648. eCollection 2021.
Researchers operationalize persistent post-concussion symptoms in children and adolescents using varied definitions. Many pre-existing conditions, personal characteristics, and current health issues can affect symptom endorsement rates in the absence of, or in combination with, a recent concussion, and the use of varied definitions can lead to differences in conclusions about persistent symptoms and recovery across studies. This study examined how endorsement rates varied by 14 different operational definitions of persistent post-concussion symptoms for uninjured boys and girls with and without pre-existing or current health problems. This cross-sectional study included a large sample (age range: 11-18) of girls ( = 21,923) and boys ( = 26,556) without a recent concussion who completed the Post-Concussion Symptom Scale at preseason baseline. Endorsements rates varied substantially by definition, health history, and current health issues. The most lenient definition (i.e., a single mild symptom) was endorsed by most participants (54.5% of boys/65.3% of girls). A large portion of participants with pre-existing mental health problems (42.7% of boys/51.5% of girls), current moderate psychological distress (70.9% of boys/72.4% of girls), and insufficient sleep prior to testing (33.4% of boys/47.6% of girls) endorsed symptoms consistent with mild ICD-10 postconcussional syndrome; whereas participants with no current or prior health problems rarely met this definition (1.6% of boys/1.6% of girls). The results illustrate the tremendous variability in the case definitions of persistent symptoms and the importance of harmonizing definitions across future studies.
研究人员使用不同的定义来界定儿童和青少年持续性脑震荡后症状。许多既往存在的状况、个人特征以及当前的健康问题，在没有近期脑震荡或与近期脑震荡同时存在的情况下，都可能影响症状认可率，并且使用不同的定义可能导致各研究在关于持续性症状和恢复情况的结论上存在差异。本研究考察了对于有无既往或当前健康问题的未受伤男孩和女孩，持续性脑震荡后症状的14种不同操作性定义的认可率是如何变化的。这项横断面研究纳入了一大样本（年龄范围：11 - 18岁）的女孩（n = 21,923）和男孩（n = 26,556），他们在季前基线时完成了脑震荡后症状量表，且近期没有脑震荡。认可率因定义、健康史和当前健康问题而有很大差异。最宽松的定义（即单一轻度症状）被大多数参与者认可（男孩中的54.5%/女孩中的65.3%）。很大一部分有既往心理健康问题的参与者（男孩中的42.7%/女孩中的51.5%）、当前有中度心理困扰的参与者（男孩中的70.9%/女孩中的72.4%）以及测试前睡眠不足的参与者（男孩中的33.4%/女孩中的47.6%）认可了与轻度ICD - 10脑震荡后综合征相符的症状；而没有当前或既往健康问题的参与者很少符合这个定义（男孩中的1.6%/女孩中的1.6%）。结果表明了持续性症状病例定义的巨大变异性以及在未来研究中统一定义的重要性。
