Cuff Steven, Maki Aaron, Feiss Robyn, Young Julie, Shi Junxin, Hautmann Amanda, Yang Jingzhen
Division of Sports Medicine, Nationwide Children's Hospital, Westerville, Ohio, USA
The Ohio State University College of Medicine, Columbus, Ohio, USA.
Br J Sports Med. 2022 Dec;56(23):1345-1352. doi: 10.1136/bjsports-2022-105598. Epub 2022 Sep 14.
For young patients sustaining concussion, assessing recovery is vital in determining safe return to play. Identifying risk factors may aid clinicians in recognising patients at risk for prolonged recovery. The study objective is to identify risk factors for prolonged (>28 days) and extended (>90 days) recovery (defined as symptom duration) and analyse how these risk factors differ between the two groups.
We retrospectively analysed electronic health record data (n=4937) among patients aged 10-18 years collected at Nationwide Children's Hospital Sports Medicine concussion clinics between 1 July 2012 and 30 June 2019. Data collected included patient demographics, comorbidities (eg, prior psychiatric diagnoses, prior concussions) and injury characteristics (eg, loss of consciousness, injury setting). We examined patient risk factors for prolonged (>28 days) and/or extended (>90 days) recovery using modified Poisson regression models.
Factors associated with increased risk of prolonged recovery from concussion included prior concussions (adjusted risk ratio (ARR) 1.19, 95% CI 1.02 to 1.38) for two concussions (ARR 1.36, 95% CI 1.14 to 1.61), for >3, and higher initial symptom score (ARR 2.57, 95% CI 2.34 to 2.83) for postconcussion symptom (PCS) scores 21-60 (ARR 2.89, 95% CI 2.54 to 3.29), for PCS>60. Risk factors for extended recovery included history of concussion (ARR 1.50, 95% CI 1.09 to 2.06) for two concussions (ARR 1.75, 95% CI 1.17 to 2.62), for >3 and older age (15-18 years, ARR 1.11, 95% CI 1.05 to 1.18). Additionally, comorbid attention deficit hyperactivity disorder increased risk of prolonged recovery (ARR 1.14, 95% CI 1.01 to 1.29) while anxiety increased risk for extended recovery (ARR 1.47, 95% CI 1.10 to 1.95).
Overall, risk factors for prolonged recovery differ somewhat from risk factors for extended recovery. For patients who present to clinic with concussion, mental health is an important consideration which may impact the timeline for symptom recovery.
对于遭受脑震荡的年轻患者，评估恢复情况对于确定安全重返赛场至关重要。识别风险因素可能有助于临床医生识别恢复时间延长的高危患者。本研究的目的是识别恢复时间延长（>28天）和恢复时间更长（>90天）（定义为症状持续时间）的风险因素，并分析两组之间这些风险因素的差异。
我们回顾性分析了2012年7月1日至2019年6月30日在全国儿童医院运动医学脑震荡诊所收集的10至18岁患者的电子健康记录数据（n=4937）。收集的数据包括患者人口统计学信息、合并症（如既往精神疾病诊断、既往脑震荡）和损伤特征（如意识丧失、受伤环境）。我们使用修正的泊松回归模型检查患者恢复时间延长（>28天）和/或恢复时间更长（>90天）的风险因素。
与脑震荡恢复时间延长风险增加相关的因素包括既往脑震荡（两次脑震荡的调整风险比（ARR）为1.19，95%置信区间为1.02至1.38），三次及以上脑震荡（ARR为1.36，95%置信区间为1.14至1.61），以及脑震荡后症状（PCS）评分为21-60时初始症状评分较高（ARR为2.57，95%置信区间为2.34至2.83），PCS>60时（ARR为2.89，95%置信区间为2.54至3.29）。恢复时间更长的风险因素包括脑震荡病史（两次脑震荡的ARR为1.50，95%置信区间为1.09至2.06），三次及以上脑震荡（ARR为1.75，95%置信区间为1.17至2.62）以及年龄较大（15-18岁，ARR为1.11，95%置信区间为b1.05至1.18）。此外，合并注意力缺陷多动障碍会增加恢复时间延长的风险（ARR为1.14，95%置信区间为1.01至1.29），而焦虑会增加恢复时间更长的风险（ARR为1.47，95%置信区间为1.10至1.95）。
总体而言，恢复时间延长的风险因素与恢复时间更长的风险因素略有不同。对于因脑震荡前来就诊的患者，心理健康是一个重要的考虑因素，可能会影响症状恢复的时间线。
