From the Department of Neurosurgery.
Medical College of Wisconsin.
Pediatr Emerg Care. 2022 Apr 1;38(4):e1185-e1191. doi: 10.1097/PEC.0000000000002544.
The aims of the study were (1) to determine the frequency of neck pain in patients diagnosed with mild traumatic brain injury (mTBI) or concussion in a pediatric level 1 trauma center emergency department (ED), (2) to identify variables associated with neck pain in this population, and (3) to report on aspects of care received in the ED including imaging and medication use.
This is a retrospective chart review of 652 patients presenting to a pediatric ED with diagnosis of concussion/mTBI. Charts were reviewed for the following information: baseline demographic information, mechanism of injury, cause of mTBI, presence or absence of neck pain, point tenderness in the neck on physical examination, and whether the patient followed up within our health system in the 6 months after injury. Charts were also reviewed for other concussion-related symptoms, medication given in the ED, imaging performed in the ED, cervical spine clearance in the ED, and referrals made. For those patients who did have follow-up appointments within our system, additional chart review was performed to determine whether they sought follow-up treatment for symptoms related to concussion/neck pain and the duration of follow-up. Statistical analyses focused on the prevalence of neck pain in the sample. We subsequently explored the degree to which neck pain was associated with other collected variables.
Of 652 patients, 90 (13.8%) reported neck pain. Acceleration/deceleration injury and motor vehicle accident were predictive of neck pain. Neck pain was less common in those reporting nausea and vomiting. Direct impact of the head against an object was associated with reduced odds of neck pain, but after adjusting for other variables, this was no longer statistically significant. Patients with neck pain were older than those without neck pain. Patients with neck pain were more likely to receive ibuprofen or morphine and undergo imaging of the spine. They were also more likely to receive a referral and follow-up with neurosurgery. There was no significant difference between groups with respect to concussion-related follow-up visits or follow-up visits to a dedicated concussion clinic.
Neck pain is a common symptom in pediatric patients with mTBI, although it was more likely in older patients and those presenting with acceleration/deceleration mechanisms. Although patients with neck pain were more likely to receive a referral and follow-up with neurosurgery, they were not more likely to have concussion-related follow-up visits. Indeed, most patients had no follow-up visits related to their concussion, which supports the notion that concussion is a self-limiting condition.
本研究的目的是：(1)确定在小儿一级创伤中心急诊科诊断为轻度创伤性脑损伤(mTBI)或脑震荡的患者中颈部疼痛的频率；(2)确定该人群中与颈部疼痛相关的变量；(3)报告急诊科的治疗情况，包括影像学检查和药物使用。
这是对在小儿急诊科就诊并诊断为脑震荡/mTBI 的 652 名患者的回顾性图表审查。对图表进行了以下信息的审查：基线人口统计学信息、损伤机制、mTBI 的原因、是否存在颈部疼痛、体格检查时颈部的压痛点以及患者在受伤后 6 个月内是否在我们的健康系统内进行了随访。还审查了其他与脑震荡相关的症状、急诊科给予的药物、急诊科进行的影像学检查、急诊科颈椎清除术和转介情况。对于那些在我们的系统内进行了随访预约的患者，还进行了额外的图表审查，以确定他们是否因脑震荡/颈部疼痛相关症状寻求了随访治疗以及随访的持续时间。统计分析主要集中在样本中颈部疼痛的流行程度上。随后，我们探讨了颈部疼痛与其他收集变量的关联程度。
在 652 名患者中，有 90 名(13.8%)报告有颈部疼痛。加速/减速损伤和机动车事故与颈部疼痛相关。报告恶心和呕吐的患者颈部疼痛较少见。头部直接撞击物体与颈部疼痛的几率降低相关，但在调整其他变量后，这不再具有统计学意义。有颈部疼痛的患者比没有颈部疼痛的患者年龄更大。有颈部疼痛的患者更有可能接受布洛芬或吗啡治疗，并进行脊柱影像学检查。他们也更有可能获得转诊并接受神经外科随访。两组在与脑震荡相关的随访或专门的脑震荡诊所的随访方面无显著差异。
颈部疼痛是 mTBI 患儿的常见症状，尽管在年龄较大的患者和有加速/减速机制的患者中更为常见。尽管有颈部疼痛的患者更有可能获得转诊并接受神经外科随访，但他们更有可能出现与脑震荡相关的随访。事实上，大多数患者都没有与脑震荡相关的随访，这支持脑震荡是一种自限性疾病的观点。
