Streicher Nicholas S, Popovich Michael, Almeida Andrea, Alsalaheen Bara, Ichesco Ingrid K, Freeman Jeremiah, Lorincz Matt, Eckner James T
Department of Neurology (NSS, MP, AA, IKI, ML, JTE), University of Michigan, Ann Arbor; Department of Neurology (NSS), Georgetown University, Washington, DC; Department of Physical Therapy (BA), University of Michigan-Flint; and Sports Medicine and Physical Therapy (JF), University of Michigan, Ann Arbor.
Neurol Clin Pract. 2024 Jun;14(3):e200284. doi: 10.1212/CPJ.0000000000200284. Epub 2024 Apr 30.
Physical examination findings in athletes with sport-related concussion (SRC) are not well described in the literature. The objective of this study was to describe physical examination findings during the first month following concussion in athletes, with a focus on the effect of sex, age, and time since injury.
This was a retrospective electronic medical record (EMR) review of physical examination findings in 500 patients aged 6-24 who were initially seen within 15 days of SRC at a multidisciplinary outpatient academic concussion clinic between 2017 and 2019. A standardized concussion examination built in the EMR recorded mental status, cranial nerve, vestibulo-ocular motor screen, and balance findings for all patients. The primary outcome was the frequency of abnormal examination findings during the first 30 days postinjury, which was further analyzed by sex, age, and time since injury using mixed logistic regression models.
The most common abnormal examination findings overall were eyes-closed single-leg stance, vestibular-ocular reflex, visual motion sensitivity, the neck examination, and eyes-closed tandem stance. Abnormal findings were more frequent in female athletes for vestibular ocular reflex and visual motion sensitivity. The frequency of abnormal findings increased with age for vestibulo-ocular reflex, visual motion sensitivity, the neck examination, convergence testing, and eyes-open single-leg stance, whereas abnormalities decreased in frequency with age for eyes-open tandem stance and tandem gait. The frequency of abnormal findings generally decreased with time over the first 4 weeks following injury.
A comprehensive physical examination is pivotal for evaluation of athletes with concussion. These findings highlight high-yield components of the concussion examination and support use of these examination components as injury markers. Future work should investigate associations between physical examination findings and postconcussion symptoms and recovery outcomes.
This retrospective cohort study provides Class IV evidence that neurologic examination with specifically designed clinical tests are helpful for diagnosis of traumatic brain injury in young athletes at age 6-24.
与运动相关的脑震荡（SRC）运动员的体格检查结果在文献中描述不足。本研究的目的是描述运动员脑震荡后第一个月的体格检查结果，重点关注性别、年龄和受伤时间的影响。
这是一项对500名年龄在6至24岁之间的患者进行的回顾性电子病历（EMR）审查，这些患者于2017年至2019年间在一家多学科门诊学术性脑震荡诊所首次就诊，就诊时间在SRC后15天内。电子病历中内置的标准化脑震荡检查记录了所有患者的精神状态、颅神经、前庭眼动筛查和平衡检查结果。主要结局是受伤后30天内异常检查结果的频率，使用混合逻辑回归模型按性别、年龄和受伤时间进一步分析。
总体上最常见的异常检查结果是闭眼单腿站立、前庭眼反射、视觉运动敏感性、颈部检查和闭眼串联站立。在前庭眼反射和视觉运动敏感性方面，女性运动员的异常结果更为常见。在前庭眼反射、视觉运动敏感性、颈部检查、集合试验和睁眼单腿站立方面，异常结果的频率随年龄增加而增加，而在睁眼串联站立和串联步态方面，异常频率随年龄降低。受伤后前4周内，异常结果的频率通常随时间下降。
全面的体格检查对于脑震荡运动员的评估至关重要。这些发现突出了脑震荡检查的高收益组成部分，并支持将这些检查组成部分用作损伤标志物。未来的工作应研究体格检查结果与脑震荡后症状及恢复结局之间的关联。
这项回顾性队列研究提供了IV级证据，即通过专门设计的临床测试进行的神经系统检查有助于诊断6至24岁年轻运动员的创伤性脑损伤。
