Department of Orthopedics, University of Colorado School of Medicine, USA.
Sports Medicine Center, Children's Hospital of Colorado, USA.
J Sci Med Sport. 2022 Jun;25(6):455-459. doi: 10.1016/j.jsams.2022.01.010. Epub 2022 Feb 4.
To examine the utility of a multimodal assessment battery of self-reported dizziness, clinician obtained postural stability, and symptom severity ratings within 14 days of concussion to predict symptom resolution time among children and adolescents.
Prospective cohort.
Patients ages 6-18 years completed evaluation ≤14 days post-concussion, including self-reported symptom severity using the Post-Concussion Symptom Inventory (PCSI) and postural stability assessments. We grouped patients as dizzy or not dizzy based on the difference in current and pre-injury PSCI dizziness ratings: difference between current and pre-injury dizziness ≥3 = dizzy; difference <3 = not dizzy. We evaluated postural stability using modified Balance Error Scoring System (mBESS) and tandem gait (TG). Our primary outcome was time from concussion to symptom resolution. Using a univariable Cox proportional hazard model, we examined the association between dizziness and symptom resolution time. We then used a multivariable Cox proportional hazard model to adjust for potential confounding variables.
We examined 89 patients and grouped each as dizzy (n = 34; age = 14.7 ± 2.7 years; 7.1 ± 3.4 days post-injury; symptom resolution time = 40.8 ± 5.7 days) or not dizzy (n = 55; age = 14.4 ± 2.3 years; 7.2 ± 3.1 days post-injury; symptom resolution time = 23.3 ± 3.2 days). Upon univariable examination, dizziness was independently associated with increased symptom resolution time (Hazard Ratio [HR] = 0.49; 95%CI: 0.28, 0.83; p = 0.009). After adjusting for potential confounders (total symptom severity, mBESS tandem stance errors, TG time, loss of consciousness), only symptom severity change was associated with symptom resolution time (HR = 0.98; 95%CI: 0.96, 0.997; p = 0.025).
Total symptom severity assessed within 14 days of concussion, but not dizziness or postural stability, was significantly associated with symptom resolution time among children and adolescents following concussion.
通过使用 14 天内报告的头晕、临床医生获得的姿势稳定性和症状严重程度评定的多模式评估组合，来预测儿童和青少年脑震荡后症状缓解时间，以检验其在临床中的实用性。
前瞻性队列研究。
6-18 岁患者在脑震荡后≤14 天内完成评估，包括使用脑震荡后症状问卷（Post-Concussion Symptom Inventory，PCSI）报告的症状严重程度和姿势稳定性评估。我们根据当前和受伤前 PCSI 头晕评分的差异将患者分为头晕或不头晕：当前和受伤前头晕评分的差异≥3=头晕；差异<3=不头晕。我们使用改良平衡错误评分系统（modified Balance Error Scoring System，mBESS）和 tandem gait（TG）评估姿势稳定性。我们的主要结局是从脑震荡到症状缓解的时间。使用单变量 Cox 比例风险模型，我们检查了头晕与症状缓解时间之间的关联。然后，我们使用多变量 Cox 比例风险模型来调整潜在的混杂变量。
我们共检查了 89 名患者，根据头晕情况将每组分为头晕（n=34；年龄 14.7±2.7 岁；受伤后 7.1±3.4 天；症状缓解时间 40.8±5.7 天）或不头晕（n=55；年龄 14.4±2.3 岁；受伤后 7.2±3.1 天；症状缓解时间 23.3±3.2 天）。单变量检查发现，头晕与症状缓解时间延长独立相关（风险比[Hazard Ratio，HR]为 0.49；95%置信区间：0.28，0.83；p=0.009）。在调整潜在混杂因素（总症状严重程度、mBESS 并足站立错误、TG 时间、意识丧失）后，仅症状严重程度变化与症状缓解时间相关（HR=0.98；95%置信区间：0.96，0.997；p=0.025）。
脑震荡后 14 天内评估的总症状严重程度，但不是头晕或姿势稳定性，与儿童和青少年脑震荡后症状缓解时间显著相关。
