Departments of Orthopaedic Surgery (Drs Oyekan, Trbovich, Shaw, Collins, Lee, and Kontos) and Physical Therapy (Dr Schneider), University of Pittsburgh, Pittsburgh, Pennsylvania; Pittsburgh Ortho Spine Research Group, University of Pittsburgh, Pittsburgh, Pennsylvania (Drs Oyekan, Shaw, and Lee); Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Eagle); and UPMC Sports Medicine Concussion Program, Pittsburgh, Pennsylvania (Drs Trbovich, Collins, and Kontos).
J Head Trauma Rehabil. 2023;38(6):417-424. doi: 10.1097/HTR.0000000000000866. Epub 2023 Feb 28.
To examine the frequency and association of neck pain symptoms in patients with a concussion.
Three-hundred and thirty-one consecutively enrolled patients aged 9 to 68 years with a diagnosed concussion 1 to 384 days post-injury were enrolled at a concussion clinic from a single integrated healthcare system in Western Pennsylvania between 2019 and 2021.
Retrospective cohort analysis of prospectively collected concussion screening tool intake survey responses and clinical outcomes data. The primary outcome was self-reported neck pain or difficulty with neck movement on the Concussion Clinical Profiles Screening (CP Screen) tool, recovery time, and incidence of treatment referral. Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) composite scores, Vestibular/Ocular Motor Screening (VOMS) item scores, type and severity of neck symptoms, mechanism of injury, time from injury to clinic presentation, medical history, and concussion symptom profile were secondary outcomes.
Of the 306 consecutively enrolled eligible patients in the registry, 145 (47%) reported neck pain, 68 (22.2%) reported difficulty moving their neck, and 146 (47.7%) reported either symptom. A total of 47 (15.4%) participants reported more severe neck symptoms, and this group took longer to recover (40 ± 27 days) than those not reporting neck symptoms (30 ± 28 days; U = 8316, P < .001). Stepwise logistic regression predicting more severe neck symptoms was significant (Nagelkerke R2 = 0.174, χ 2 = 9.315, P = .316) with older age ( P = .019) and mechanism of injury including motor vehicle collisions (MVCs) ( P = .047) and falls ( P = .044) as risk factors. MVCs and falls were associated with over 4 times and 2 times greater risk, respectively, for reporting more severe neck symptoms.
Neck pain and stiffness symptoms are common in patients with a concussion following high-energy mechanisms of injury including MVCs or falls from height. These symptoms are associated with prolonged recovery. Providers should evaluate neck symptoms and consider targeted treatment strategies to limit their effects in patients with a concussion.
探讨患者脑震荡后颈部疼痛症状的发生频率及相关性。
2019 年至 2021 年，在宾夕法尼亚州西部的一家综合性医疗保健系统的脑震荡诊所，连续纳入了 331 名年龄在 9 至 68 岁之间、受伤后 1 至 384 天被诊断为脑震荡的连续入组患者。
对前瞻性收集的脑震荡筛查工具摄入调查回复和临床结果数据进行回顾性队列分析。主要结局是自我报告的颈部疼痛或颈部运动困难，使用脑震荡临床特征筛查（CP Screen）工具，康复时间和治疗转介发生率。即时脑震荡评估和认知测试（ImPACT）综合评分、前庭/眼动筛查（VOMS）项目评分、颈部症状的类型和严重程度、损伤机制、从受伤到就诊的时间、病史和脑震荡症状特征为次要结局。
在登记处连续纳入的 306 名符合条件的患者中，145 名（47%）报告颈部疼痛，68 名（22.2%）报告颈部活动困难，146 名（47.7%）报告有上述任何症状。共有 47 名（15.4%）参与者报告颈部症状更严重，这组患者的康复时间（40 ± 27 天）长于无颈部症状组（30 ± 28 天；U = 8316，P <.001）。逐步逻辑回归预测更严重的颈部症状具有统计学意义（Nagelkerke R2 = 0.174，χ 2 = 9.315，P =.316），其危险因素包括年龄较大（P =.019）和损伤机制，包括机动车碰撞（MVC）（P =.047）和跌倒（P =.044）。MVC 和跌倒分别与报告更严重颈部症状的风险增加 4 倍和 2 倍相关。
高能量损伤机制（包括 MVC 或高处坠落伤）后的脑震荡患者常有颈部疼痛和僵硬症状。这些症状与康复时间延长有关。医务人员应评估颈部症状并考虑采用针对性治疗策略，以限制脑震荡患者的症状影响。
