运动性头部损伤中头部计算机断层扫描阳性结果：这些运动员能否重返赛场？

Positive Head Computed Tomography Findings in the Setting of Sport Head Injuries: Can These Athletes Return-to-Play?

机构信息

Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville , Tennessee , USA.

Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA.

出版信息

Neurosurgery. 2023 Oct 1;93(4):773-781. doi: 10.1227/neu.0000000000002520. Epub 2023 May 11.

DOI:10.1227/neu.0000000000002520

PMID:37166195

Abstract

BACKGROUND

The literature on athletes with positive head computed tomography (HCT) findings in the setting of sport head injuries remains sparse.

OBJECTIVE

To report the proportions of athletes with a positive HCT and compare acute injury characteristics and recovery between those with and without a positive HCT.

METHODS

A retrospective, single-institution, cohort study was performed with all athletes aged 12 to 23 years seen at a regional concussion center from 11/2017 to 04/2022. The cohort was dichotomized into positive vs negative HCT (controls). Acute injury characteristics (ie, loss of consciousness and amnesia) and recovery, as measured by days to return-to-learn (RTL), symptom resolution, and return-to-play (RTP) were compared. χ 2 and Mann-Whitney U tests were performed.

RESULTS

Of 2061 athletes, 226 (11.0%) received an HCT and 9 (4.0%) had positive findings. HCT findings included 4 (44.4%) subdural hematomas, 1 (11.1%) epidural hematoma, 2 (22.2%) facial fractures, 1 (11.1%) soft tissue contusion, and 1 (11.1%) cavernous malformation. All 9 (100.0%) athletes were treated nonoperatively and successfully returned-to-play at a median (IQR) of 73.0 (55.0-82.0) days. No differences in loss of consciousness or amnesia were seen between positive HCT group and controls. The Mann-Whitney U test showed differences in RTL (17.0 vs 4.0 days; U = 45.0, P = .016) and RTP (73.0 vs 27.0 days; U = 47.5, P = .007) but not in symptom resolution. Our subanalysis showed no differences across all recovery metrics between acute hemorrhages and controls.

CONCLUSION

Among athletes seen at a regional concussion center who underwent an acute HCT, positive findings were seen in 4%. Although athletes with a positive HCT had longer RTL and RTP, symptom resolution was similar between those with a positive and negative HCT. All athletes with a positive HCT successfully returned to play. Despite a more conservative approach to athletes with a positive HCT, clinical outcomes are similar between those with and without a positive HCT.

摘要

背景

在运动性头部损伤的情况下，头部计算机断层扫描（HCT）阳性的运动员的文献仍然很少。

目的

报告 HCT 阳性运动员的比例，并比较 HCT 阳性和阴性运动员的急性损伤特征和恢复情况。

方法

对 2017 年 11 月至 2022 年 4 月在一个区域性脑震荡中心就诊的所有 12 至 23 岁的运动员进行回顾性、单机构队列研究。该队列分为 HCT 阳性（对照组）和 HCT 阴性。比较急性损伤特征（即意识丧失和遗忘）和恢复情况，以返回学习（RTL）天数、症状缓解和重返运动（RTP）来衡量。采用 χ 2 和曼-惠特尼 U 检验。

结果

在 2061 名运动员中，226 名（11.0%）接受了 HCT 检查，9 名（4.0%）结果阳性。HCT 检查结果包括 4 名（44.4%）硬膜下血肿、1 名（11.1%）硬膜外血肿、2 名（22.2%）面部骨折、1 名（11.1%）软组织挫伤和 1 名（11.1%）海绵状血管畸形。所有 9 名（100.0%）运动员均接受非手术治疗，并在中位数（IQR）73.0（55.0-82.0）天内成功重返赛场。阳性 HCT 组和对照组在意识丧失或遗忘方面无差异。曼-惠特尼 U 检验显示 RTL（17.0 与 4.0 天；U = 45.0，P =.016）和 RTP（73.0 与 27.0 天；U = 47.5，P =.007）有差异，但症状缓解无差异。我们的亚分析显示，在所有恢复指标上，急性出血与对照组之间无差异。

结论

在接受急性 HCT 的区域性脑震荡中心就诊的运动员中，阳性发现占 4%。尽管 HCT 阳性的运动员 RTL 和 RTP 较长，但 HCT 阳性和阴性运动员的症状缓解情况相似。所有 HCT 阳性的运动员均成功重返赛场。尽管对 HCT 阳性的运动员采取了更为保守的方法，但 HCT 阳性和阴性运动员的临床结局相似。