University of Rochester, Rochester, New York (Mr Stephen, Mss Hasman, Goldenberg, and Mr Merchant-Borna, and Dr Bazarian); Indiana University, Bloomington (Dr Kawata); and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts (Dr Mannix).
J Head Trauma Rehabil. 2022;37(5):318-325. doi: 10.1097/HTR.0000000000000767. Epub 2022 Mar 15.
To summarize the evidence linking contact sports-related repetitive head impacts (RHIs) and short-term declines in neurologic function.
A scoping review following the guidelines in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and searching 3 databases (PubMed, EMBASE, and Web of Science) was performed. Peer-reviewed research articles were eligible for inclusion if they were full-length English language articles published between 1999 and 2019 examining athletes between the ages of 14 and 40 years exposed to RHIs, and reporting cognitive, vestibular, and/or oculomotor outcomes within 4 weeks of last head hit exposure.
Fifty-two articles met criteria for review: 14 reported oculomotor outcomes, 23 reported vestibular outcomes, and 36 reported cognitive function. Short-term RHI-related declines in neurologic function were reported in 42.9% of oculomotor studies, in 20.8% of vestibular studies, and in 33.3% of cognitive studies. Most of the 52 studies involved American football, soccer, or ice hockey athletes at the collegiate ( n = 23) or high school ( n = 14) level. Twenty-four (46%) studies involved only male athletes. Wearable sensors were used to measure RHIs in 24 studies (46%), while RHIs were not measured in 26 studies (50%). In addition, many studies failed to control for attention-deficit/hyperactivity disorder/learning disability and/or concussion history.
The results of this scoping review suggest that the evidence linking RHIs to short-term declines in neurologic function is relatively sparse and lacking in methodological rigor. Although most studies failed to find a link, those that did were more likely to use objective measures of RHIs and to control for confounders. More careful trial design may be needed to definitively establish a causal link between RHIs and short-term neurologic dysfunction.
总结与接触性运动相关的重复性头部撞击（RHI）和短期神经功能下降相关的证据。
根据系统评价和荟萃分析扩展的首选报告项目（PRISMA-ScR）指南进行了范围综述，并在 3 个数据库（PubMed、EMBASE 和 Web of Science）中进行了搜索。符合纳入标准的同行评审研究文章必须是在 1999 年至 2019 年期间发表的、以年龄在 14 至 40 岁之间的、暴露于 RHI 的运动员为研究对象的、且在末次头部撞击后 4 周内报告认知、前庭和/或眼动结果的英文全文文章。
52 篇文章符合审查标准：14 篇报告眼动结果，23 篇报告前庭结果，36 篇报告认知功能。42.9%的眼动研究、20.8%的前庭研究和 33.3%的认知研究报告了短期 RHI 相关的神经功能下降。52 项研究中，大多数涉及美式橄榄球、足球或冰球运动员，包括大学（n=23）或高中（n=14）水平。24 项（46%）研究仅涉及男性运动员。24 项研究（46%）使用可穿戴传感器测量 RHI，而 26 项研究（50%）未测量 RHI。此外，许多研究未能控制注意力缺陷/多动障碍/学习障碍和/或脑震荡史。
本范围综述的结果表明，将 RHI 与短期神经功能下降联系起来的证据相对较少，且缺乏方法学严谨性。尽管大多数研究都没有发现联系，但那些确实发现联系的研究更有可能使用 RHI 的客观测量方法，并控制混杂因素。可能需要更仔细的试验设计来明确确定 RHI 与短期神经功能障碍之间的因果关系。
