3Vanderbilt University School of Medicine, Nashville, Tennessee.
1Department of Neurological Surgery, Vanderbilt University Medical Center, Vanderbilt Sports Concussion Center, Nashville.
Neurosurg Focus. 2024 Jul;57(1):E10. doi: 10.3171/2024.4.FOCUS24160.
Psychological symptoms following a sport-related concussion may affect recovery in adolescent athletes. Therefore, the aims of this study were to 1) describe the proportion of athletes with acute psychological symptoms, 2) identify potential predictors of higher initial psychological symptoms, and 3) determine whether psychological symptoms affect recovery in a cohort of concussed high school athletes.
A retrospective cohort study of high school athletes (14-18 years of age) who sustained a sport-related concussion from November 2017 to April 2022 and presented to a multidisciplinary concussion center was performed. The main independent variable was psychological symptom cluster score, calculated by summing the four affective symptoms on the initial Post-Concussion Symptom Scale (PCSS) (i.e., irritability, sadness, nervousness, feeling more emotional). The psychological symptom ratio was defined as the ratio of the psychological symptom cluster score divided by the total initial PCSS score. The outcomes included time to return to learn (RTL), symptom resolution, and time to return to play (RTP). Univariable and multivariable regressions were performed to adjust for demographic factors and health history.
A total of 431 athletes (58.0% female, mean age 16.2 ± 1.3 years) were included. Nearly half of the sample (45%) reported at least one psychological symptom, with a mean psychological symptom cluster score of 4.2 ± 5.2 and psychological symptom cluster ratio of 0.10 ± 0.11. Irritability was the most commonly endorsed psychological symptom (38.1%), followed by feeling more emotional (30.2%), nervousness (25.3%), and sadness (22.0%). Multivariable regression showed that female sex (B = 2.15, 95% CI 0.91-3.39; p < 0.001), loss of consciousness (B = 1.91, 95% CI 0.11-3.72; p = 0.037), retrograde/anterograde amnesia (B = 1.66, 95% CI 0.20-3.11; p = 0.026), and psychological history (B = 2.96, 95% CI 1.25-4.70; p < 0.001) predicted an increased psychological symptom cluster score. Female sex (B = 0.03, 95% CI 0.00-0.06; p = 0.031) and psychological history (B = 0.06, 95% CI 0.02-0.10; p = 0.002) predicted an increased psychological symptom ratio. Multivariable linear regression showed that both higher psychological symptom cluster score and ratio were associated with longer times to RTL, symptom resolution, and RTP.
In a cohort of high school athletes, 45% reported at least one psychological symptom, with irritability being most common. Female sex, loss of consciousness, amnesia, and a psychological history were significantly associated with an increased psychological symptom cluster score. Higher psychological symptom cluster score and psychological symptom ratio independently predicted longer recovery. These results reinforce the notion that psychological symptoms after concussion are common and may negatively impact recovery.
运动相关性脑震荡后出现的心理症状可能会影响青少年运动员的康复。因此，本研究的目的是：1）描述有急性心理症状的运动员的比例；2）确定潜在的更高初始心理症状的预测因素；3）确定心理症状是否会影响一组患有脑震荡的高中生运动员的康复。
对 2017 年 11 月至 2022 年 4 月期间因运动相关脑震荡并到多学科脑震荡中心就诊的 14-18 岁高中生运动员进行了回顾性队列研究。主要的独立变量是心理症状群评分，通过将初始脑震荡后症状量表（PCSS）上的四个情感症状（即易怒、悲伤、紧张、感觉更情绪化）相加来计算。心理症状比定义为心理症状群评分除以初始 PCSS 总评分的比值。结局包括重返学习时间（RTL）、症状缓解和重返运动时间（RTP）。进行了单变量和多变量回归分析，以调整人口统计学因素和健康史。
共纳入了 431 名运动员（58.0%为女性，平均年龄 16.2 ± 1.3 岁）。将近一半的样本（45%）报告至少有一种心理症状，心理症状群评分平均为 4.2 ± 5.2，心理症状群比为 0.10 ± 0.11。最常见的心理症状是易怒（38.1%），其次是感觉更情绪化（30.2%）、紧张（25.3%）和悲伤（22.0%）。多变量回归显示，女性（B=2.15，95%CI 0.91-3.39；p<0.001）、意识丧失（B=1.91，95%CI 0.11-3.72；p=0.037）、逆行/顺行性遗忘症（B=1.66，95%CI 0.20-3.11；p=0.026）和心理病史（B=2.96，95%CI 1.25-4.70；p<0.001）预测心理症状群评分增加。女性（B=0.03，95%CI 0.00-0.06；p=0.031）和心理病史（B=0.06，95%CI 0.02-0.10；p=0.002）预测心理症状比增加。多变量线性回归显示，较高的心理症状群评分和比与 RTL、症状缓解和 RTP 的恢复时间延长相关。
在一组高中生运动员中，45%的运动员报告至少有一种心理症状，其中易怒最常见。女性、意识丧失、遗忘症和心理病史与心理症状群评分增加显著相关。较高的心理症状群评分和心理症状比独立预测康复时间延长。这些结果强化了脑震荡后出现心理症状很常见并可能会对康复产生负面影响的观点。
