University of Pittsburgh Medical Center Concussion Program, Pittsburgh, PA.
University of Pittsburgh Medical Center Rehabilitation Institute, Pittsburgh, PA.
J Pediatr. 2024 May;268:113927. doi: 10.1016/j.jpeds.2024.113927. Epub 2024 Feb 1.
To determine which components from a multidomain assessment best predict protracted recovery in pediatric patients with a concussion.
A prospective cohort of patients aged 5-9 years who presented within 21 days of concussion to a specialty clinic were categorized into normal (≤30 days) and protracted (>30 days) recovery. Participants provided demographic and medical history information, and completed the Child Sport Concussion Assessment Tool-5 symptom report and balance assessment, the Vestibular/Ocular Motor Screen-Child (VOMS-C), and the Pediatric Immediate Post-concussion Assessment and Cognitive Testing. Univariate logistic regressions (LR) were used to inform a follow-up forward stepwise LR to identify the best predictors of protracted recovery. Receiver operating characteristic analysis of the area under the curve (AUC) was used to identify which predictors retained from the LR model best discriminated recovery.
The final sample included 68 patients (7.52 ± 2.3 years; 56% male), 36 (52.9%) with normal and 32 (47.1%) with protracted recovery. Results of the LR to identify protracted recovery were significant (P < .001) and accounted for 39% of the variance. The model accurately classified 78% of patients, with days to first clinic visit (OR, 1.2; 95% CI, 1.1-1.4; P = .003) and positive VOMS-C findings (OR, 8.32; 95% CI, 2.4-28.8; P < .001) as significant predictors. A receiver operating characteristic analysis of the AUC of this 2-factor model discriminated protracted from normal recovery (AUC, 0.82; 95% CI, 0.71-0.92; P < .001).
Days to first clinic visit and positive findings on the VOMS-C were the most robust predictors of protracted recovery after concussion in young pediatric patients.
确定多维评估中的哪些成分最能预测患有脑震荡的儿科患者的恢复时间延长。
本前瞻性队列研究纳入了在专门诊所就诊的 5-9 岁脑震荡患者，分为正常（≤30 天）和延长（>30 天）恢复组。参与者提供了人口统计学和病史信息，并完成了儿童运动性脑震荡评估工具-5 症状报告和平衡评估、前庭/眼动筛查-儿童（VOMS-C）和儿童即时脑震荡后评估和认知测试。单变量逻辑回归（LR）用于确定后续逐步 LR 的最佳预测因素。曲线下面积（AUC）的接收器操作特征分析用于确定 LR 模型中保留的最佳预测因素。
最终样本包括 68 名患者（7.52±2.3 岁；56%为男性），36 名（52.9%）为正常恢复，32 名（47.1%）为延长恢复。LR 识别延长恢复的结果具有统计学意义（P<0.001），占方差的 39%。该模型准确地对 78%的患者进行分类，就诊的第 1 天（OR，1.2；95%CI，1.1-1.4；P=0.003）和 VOMS-C 阳性发现（OR，8.32；95%CI，2.4-28.8；P<0.001）是显著的预测因素。该 2 因素模型的 AUC 接收器操作特征分析区分了延长和正常恢复（AUC，0.82；95%CI，0.71-0.92；P<0.001）。
就诊的第 1 天和 VOMS-C 的阳性发现是预测年轻儿科患者脑震荡后恢复时间延长的最有力的预测因素。
