Espinoza Tamara R, Hendershot Kristopher A, Liu Brian, Knezevic Andrea, Jacobs Breanne B, Gore Russell K, Guskiewicz Kevin M, Bazarian Jeffery J, Phelps Shean E, Wright David W, LaPlaca Michelle C
Department of Emergency Medicine, Division of Emergency Neurosciences, Emory University School of Medicine, Atlanta, Georgia, USA.
Georgia Tech Research Institute (GTRI), Advanced Human Integration Branch, Atlanta, Georgia, USA.
Neurotrauma Rep. 2021 May 26;2(1):232-244. doi: 10.1089/neur.2020.0022. eCollection 2021.
Mild traumatic brain injury (mTBI) remains a diagnostic challenge and therefore strategies for objective assessment of neurological function are key to limiting long-term sequelae. Current assessment methods are not optimal in austere environments such as athletic fields; therefore, we developed an immersive tool, the Display Enhanced Testing for Cognitive Impairment and mTBI (DETECT) platform, for rapid objective neuropsychological (NP) testing. The objectives of this study were to assess the ability of DETECT to accurately identify neurocognitive deficits associated with concussion and evaluate the relationship between neurocognitive measures and subconcussive head impacts. DETECT was used over a single season of two high school and two college football teams. Study participants were instrumented with Riddell Head Impact Telemetry (HIT) sensors and a subset tested with DETECT immediately after confirmed impacts for different combinations of linear and rotational acceleration. A total of 123 athletes were enrolled and completed baseline testing. Twenty-one players were pulled from play for suspected concussion and tested with DETECT. DETECT was 86.7% sensitive (95% confidence interval [CI]: 59.5%, 98.3%) and 66.7% specific (95% CI: 22.3%, 95.7%) in correctly identifying athletes with concussions (15 of 21). Weak but significant correlations were found between complex choice response time (processing speed and divided attention) and both linear (Spearman rank correlation coefficient 0.262, = 0.02) and rotational (Spearman coefficient 0.254, = 0.03) acceleration on a subset of 76 players (113 DETECT tests) with no concussion symptoms. This study demonstrates that DETECT confers moderate to high sensitivity in identifying acute cognitive impairment and suggests that football impacts that do not result in concussion may negatively affect cognitive performance immediately following an impact. Specificity, however, was not optimal and points to the need for additional studies across multiple neurological domains. Given the need for more objective concussion screening in triage situations, DETECT may provide a solution for mTBI assessment.
轻度创伤性脑损伤（mTBI）仍然是一个诊断难题，因此客观评估神经功能的策略是限制长期后遗症的关键。在诸如运动场等严峻环境中，目前的评估方法并不理想；因此，我们开发了一种沉浸式工具，即用于认知障碍和mTBI的显示增强测试（DETECT）平台，用于快速客观的神经心理学（NP）测试。本研究的目的是评估DETECT准确识别与脑震荡相关的神经认知缺陷的能力，并评估神经认知测量与亚脑震荡头部撞击之间的关系。在两个高中和两个大学橄榄球队的一个赛季中使用了DETECT。研究参与者配备了Riddell头部撞击遥测（HIT）传感器，并且在确认线性和旋转加速度的不同组合的撞击后，立即对一个子集进行DETECT测试。共有123名运动员参加并完成了基线测试。21名球员因疑似脑震荡被换下并接受DETECT测试。DETECT在正确识别脑震荡运动员（21名中的15名）方面的敏感性为86.7%（95%置信区间[CI]：59.5%，98.3%），特异性为66.7%（95%CI：22.3%，95.7%）。在76名没有脑震荡症状的球员子集（113次DETECT测试）中，发现复杂选择反应时间（处理速度和分散注意力）与线性（斯皮尔曼等级相关系数0.262，P = 0.02）和旋转（斯皮尔曼系数0.254，P = 0.03）加速度之间存在微弱但显著的相关性。这项研究表明，DETECT在识别急性认知障碍方面具有中度至高敏感性，并表明未导致脑震荡的橄榄球撞击可能会在撞击后立即对认知表现产生负面影响。然而，特异性并不理想，这表明需要在多个神经领域进行更多研究。鉴于在分诊情况下需要更客观的脑震荡筛查，DETECT可能为mTBI评估提供一种解决方案。
