Hannah Theodore C, Kalagara Roshini, Ali Muhammad, Schupper Alexander J, Li Adam Y, Spiera Zachary, Marayati Naoum Fares, Quinones Addison, Asfaw Zerubabbel K, Vasan Vikram, Hrabarchuk Eugene I, McCarthy Lily, Gometz Alex, Lovell Mark, Choudhri Tanvir
1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York.
2Physical Medicine and Rehabilitation, Concussion Management of New York, New York, New York; and.
J Neurosurg Pediatr. 2022 Jul 29;30(4):369-377. doi: 10.3171/2022.6.PEDS22127. Print 2022 Oct 1.
Concussion incidence is known to be highest in children and adolescents; however, there is conflicting evidence about the effect of age on concussion risk and recovery within the adolescent age range. The heterogeneity of results may be partially due to the use of age groupings based on convenience, making comparisons across studies difficult. This study evaluated the independent effect of age on concussion incidence, severity, and recovery in student-athletes aged 12-18 years using cluster analysis to define groupings.
Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) scores of 11,403 baseline tests and 4922 postinjury tests were used to calculate the incidence rates for adolescent student-athletes grouped into 3 age bands (12-13, 14-15, and 16-18 years of age) on the basis of clustering analysis. The recently created Severity Index was used to compare concussion severity between groups. Follow-up tests for subjects who sustained a concussion were used to evaluate recovery time. The chi-square test and 1-way ANOVA were used to compare differences in demographic characteristics and concussion incidence, severity, and recovery. Multivariable logistic and linear regressions were used to evaluate the independent effects of age on concussion incidence and severity, respectively. Multivariable Cox hazard regression was used to evaluate differences in recovery time. Further analyses were conducted to directly compare findings across studies on the basis of the age groupings used in prior studies.
Multivariable regression analyses demonstrated that the 14- to 15-year-old age group had a significantly higher concussion incidence than both the 12- to 13-year-old (14- to 15-year-old group vs 12- to 13-year-old group, OR 1.57, 95% CI 1.16-2.17, p = 0.005) and 16- to 18-year-old (16- to 18-year-old group vs 14- to 15-year-old group, OR 0.79, 95% CI 0.69-0.91, p = 0.0008) age groups. There was no difference in incidence between the 12- to 13-year-old and 16- to 18-year-old groups (16- to 18-year group vs 12- to 13-year group, OR 1.26, 95% CI 0.93-1.72, p = 0.15). There were also no differences in concussion severity or recovery between any groups.
This study found that concussion incidence was higher during mid-adolescence than early and late adolescence, suggesting a U-shaped relationship between age and concussion risk over the course of adolescence. Age had no independent effect on concussion severity or recovery in the 12- to 13-, 14- to 15-, and 16- to 18-year-old groups. Further analysis of the various age groups revealed that results may vary significantly with minor changes to groupings, which may explain the divergent results in the current literature on this topic. Thus, caution should be taken when interpreting the results of this and all similar studies, especially when groupings are based on convenience.
已知儿童和青少年的脑震荡发生率最高；然而，关于年龄对青少年年龄范围内脑震荡风险和恢复的影响，存在相互矛盾的证据。结果的异质性可能部分归因于基于便利性进行年龄分组，这使得跨研究比较变得困难。本研究使用聚类分析来定义分组，评估年龄对12至18岁学生运动员脑震荡发生率、严重程度和恢复的独立影响。
使用11403次基线测试和4922次伤后测试的即时脑震荡后评估和认知测试（ImPACT）分数，根据聚类分析将青少年学生运动员分为3个年龄组（12至13岁、14至15岁和16至18岁）来计算发生率。最近创建的严重程度指数用于比较组间脑震荡严重程度。对发生脑震荡的受试者进行随访测试以评估恢复时间。卡方检验和单因素方差分析用于比较人口统计学特征以及脑震荡发生率、严重程度和恢复情况的差异。多变量逻辑回归和线性回归分别用于评估年龄对脑震荡发生率和严重程度的独立影响。多变量Cox风险回归用于评估恢复时间的差异。基于先前研究中使用的年龄分组进行进一步分析，以直接比较各研究的结果。
多变量回归分析表明，14至15岁年龄组的脑震荡发生率显著高于12至13岁组（14至15岁组与12至13岁组相比，比值比[OR]为1.57，95%置信区间[CI]为1.16 - 2.17，p = 0.005）和16至18岁组（1对16至18岁组与14至15岁组相比，OR为0.79，95%CI为0.69 - 0.91，p = 0.0008）。12至13岁组和16至18岁组之间的发生率没有差异（16至18岁组与12至13岁组相比，OR为1.26，95%CI为0.93 - 1.72，p = 0.15）。任何组之间的脑震荡严重程度或恢复情况也没有差异。
本研究发现，青春期中期的脑震荡发生率高于青春期早期和晚期，表明在青春期过程中年龄与脑震荡风险之间呈U形关系。年龄对12至13岁、14至15岁和16至18岁组的脑震荡严重程度或恢复没有独立影响。对各个年龄组的进一步分析表明，分组的微小变化可能会导致结果有显著差异，这可能解释了当前关于该主题的文献中存在的不同结果。因此，在解释本研究及所有类似研究的结果时应谨慎，尤其是当分组基于便利性时。
