Wang Eric X, Hwang Calvin E, Nguyen Jessica N, Segovia Nicole A, Abrams Geoffrey D, Kussman Andrea
Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA.
Am J Sports Med. 2022 May;50(6):1695-1701. doi: 10.1177/03635465221083646. Epub 2022 Mar 22.
Prognosticating recovery times for individual athletes with a concussion remains a challenge for health care providers. Several preinjury and postinjury factors have been proposed to be predictive of prolonged return-to-play (RTP) times, but the data in this area are still sparse.
This study aimed to identify risk factors associated with prolonged recovery times and determine which are most predictive of prolonged recovery times in a head-to-head comparison.
Case-control study; Level of evidence, 3.
All concussions occurring between September 2017 and August 2020 at a single National Collegiate Athletic Association Division I institution were reviewed and included in this study. Preinjury modifiers including age, sex, sport, concussion history, and past medical problems were collected from the electronic medical records. Postinjury modifiers analyzed included initial and follow-up Sport Concussion Assessment Tool 5th Edition scores, vestibular evaluation findings, and eye tracking results.
A total of 159 athletes and 187 concussion cases were included. Preinjury factors that were correlated with prolonged RTP times included a history of concussions ( = .015), a history of migraines ( = .013), and whether an athlete participated in an individual sport ( = .009). Postinjury factors correlated with prolonged RTP times included the total number ( = .020) and severity ( = .023) of symptoms as well as abnormal Vestibular Ocular Motor Screening findings ( = .002). Overall, 6 different symptoms (balance problems, difficulty concentrating, light sensitivity, drowsiness, fatigue/low energy, and difficulty remembering) were significantly correlated with prolonged RTP times. The study also found that the number and severity of symptoms were additive in a dose-dependent fashion. On multivariable analysis of all these factors, a history of concussions was found to be the most predictive of prolonged RTP times, while participation in an individual sport had the largest effect on recovery times.
Several preinjury and postinjury risk factors were identified as being correlated with prolonged recovery times. Many of these risk factors were also found to be additive in nature. This information provides clinicians with a valuable tool in prognosticating and estimating recovery times for athletes. The study also revealed that athletes participating in individual sports had longer RTP times compared with athletes in team sports, which is a novel finding that requires further research.
对个体脑震荡运动员的恢复时间进行预后评估，对医疗保健提供者来说仍是一项挑战。已有多项伤前和伤后因素被认为可预测较长的重返比赛（RTP）时间，但该领域的数据仍然稀少。
本研究旨在确定与较长恢复时间相关的风险因素，并在直接比较中确定哪些因素对较长恢复时间最具预测性。
病例对照研究；证据等级，3级。
回顾并纳入了2017年9月至2020年8月期间在一所美国国家大学体育协会第一分区机构发生的所有脑震荡病例。从电子病历中收集伤前因素，包括年龄、性别、运动项目、脑震荡史和既往病史。分析的伤后因素包括初始和随访的《运动脑震荡评估工具第5版》评分、前庭评估结果和眼动追踪结果。
共纳入159名运动员和187例脑震荡病例。与较长RTP时间相关的伤前因素包括脑震荡史（P = 0.015）、偏头痛史（P = 0.013）以及运动员是否参加个人运动项目（P = 0.009）。与较长RTP时间相关的伤后因素包括症状总数（P = 0.020）和严重程度（P = 0.023）以及前庭眼动筛查结果异常（P = 0.002）。总体而言，6种不同症状（平衡问题、注意力不集中、对光敏感、嗜睡、疲劳/精力不足和记忆困难）与较长RTP时间显著相关。研究还发现，症状的数量和严重程度呈剂量依赖性累加。对所有这些因素进行多变量分析时，发现脑震荡史对较长RTP时间最具预测性，而参加个人运动项目对恢复时间的影响最大。
确定了几个与较长恢复时间相关的伤前和伤后风险因素。还发现其中许多风险因素本质上具有累加性。这些信息为临床医生提供了一个预测和估计运动员恢复时间的宝贵工具。该研究还表明，与团队运动运动员相比，参加个人运动项目的运动员RTP时间更长，这是一个需要进一步研究的新发现。
