McIntosh Samantha J, Vergeer Melanie H, Galarneau Jean-Michel, Eliason Paul H, Debert Chantel T
Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
JAMA Netw Open. 2025 Jun 2;8(6):e2516619. doi: 10.1001/jamanetworkopen.2025.16619.
IMPORTANCE: Up to 30% of individuals who sustain a mild traumatic brain injury (mTBI) develop persisting symptoms after concussion (PSAC). Identifying acute risk factors for PSAC can enhance clinical care in adults with concussion. OBJECTIVE: To evaluate summary odds ratio (OR) estimates for acute factors associated with PSAC in adults with mTBI. DATA SOURCES: For this systematic review and meta-analysis, a systematic search of Ovid MEDLINE, Embase, PsycINFO, CINAHL, SPORTDiscus, and the Cochrane Central Register of Clinical Trials (studies published from 1970 to February 15, 2024) and backward reference searching was performed on February 15, 2024. Search terms were mTBI, concussion, prognostic variables, predictors, and PSAC. STUDY SELECTION: Peer-reviewed studies in English that reported clinical factors collected within 1 month (≤28 days) of injury and associated with poor outcome, specifically PSAC, more than 1 month after concussion were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. DATA EXTRACTION AND SYNTHESIS: Independent extraction and quality assessment were performed by 2 author reviewers. Study characteristics and ORs were extracted using the Modified Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prognostic Factor Studies. Risk of bias was assessed using the Quality in Prognostic Studies tool. Three-level meta-analytic models examined factors associated with PSAC 1, 3, and 6 months after mTBI. MAIN OUTCOMES AND MEASURES: Adjusted OR (AOR) estimates for the association of acute clinical measures with PSAC. RESULTS: Thirty-four studies were reviewed; data were extracted from 15 studies (44.1%) included in the meta-analysis (592 406 adults with concussion; mean age, 29.3 years [range, 16-89 years]; 57.8% male). Acute concentration difficulty was associated with greatest odds of PSAC across all time points (AOR, 3.43 [95% CI, 1.85-6.36]). Medical history of anxiety and/or depression or of sleep disorders (AOR, 2.47 [95% CI, 1.62-3.78]) and clinical signs (loss of consciousness and amnesia; AOR, 1.90 [95% CI, 1.28-2.84]) were associated with increased odds of PSAC across all time points. At 1 month (AOR, 3.12 [95% CI, 1.43-6.82]) and 6 months (AOR, 26.81 [95% CI, 3.42-210.06]), difficulty concentrating was associated with greatest odds of PSAC, while medical history of anxiety and/or depression or of sleep disorders was associated with greatest odds of PSAC at 3 months (AOR, 2.92 [95% CI, 1.39-6.14]). CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, acute cognitive symptoms, medical history of anxiety and/or depression or of sleep disorders, and the presence of clinical signs (loss of consciousness and amnesia) were the factors associated with greatest odds of PSAC in adults across all time points. The findings suggest that evaluating specific acute symptoms and signs may contribute to the prognosis of PSAC in adults.
重要性：高达30%的轻度创伤性脑损伤（mTBI）患者在脑震荡后会出现持续症状（PSAC）。识别PSAC的急性风险因素可以改善成人脑震荡患者的临床护理。 目的：评估mTBI成人中与PSAC相关的急性因素的汇总比值比（OR）估计值。 数据来源：对于本系统评价和荟萃分析，于2024年2月15日对Ovid MEDLINE、Embase、PsycINFO、CINAHL、SPORTDiscus和Cochrane临床试验中心注册库（1970年至2024年2月15日发表的研究）进行了系统检索，并进行了逆向参考文献检索。检索词为mTBI、脑震荡、预后变量、预测因素和PSAC。 研究选择：纳入了英文的同行评审研究，这些研究报告了在受伤后1个月（≤28天）内收集的临床因素，且与脑震荡后1个月以上的不良结局（特别是PSAC）相关。遵循系统评价和荟萃分析的首选报告项目指南。 数据提取与合成：由2名作者评审员进行独立提取和质量评估。使用改良的预后因素研究系统评价的关键评估和数据提取清单提取研究特征和OR值。使用预后研究质量工具评估偏倚风险。三级荟萃分析模型研究了mTBI后1、3和6个月与PSAC相关的因素。 主要结局和指标：急性临床指标与PSAC关联的调整后OR（AOR）估计值。 结果：共审查了34项研究；从荟萃分析纳入的15项研究（44.1%）中提取了数据（592406名成人脑震荡患者；平均年龄29.3岁[范围16 - 89岁]；57.8%为男性）。在所有时间点，急性注意力不集中与PSAC的最高几率相关（AOR，3.43[95%CI，1.85 - 6.36]）。焦虑和/或抑郁病史或睡眠障碍病史（AOR，2.47[95%CI，1.62 - 3.78]）以及临床体征（意识丧失和失忆；AOR，1.90[95%CI，1.28 - 2.84]）在所有时间点均与PSAC几率增加相关。在1个月时（AOR，3.12[95%CI，1.43 - 6.82]）和6个月时（AOR，26.81[95%CI，3.42 - 210.06]），注意力不集中与PSAC的最高几率相关，而焦虑和/或抑郁病史或睡眠障碍病史在3个月时与PSAC的最高几率相关（AOR，2.92[95%CI，1.39 - 6.14]）。 结论与意义：在本系统评价和荟萃分析中，急性认知症状、焦虑和/或抑郁病史或睡眠障碍病史以及临床体征（意识丧失和失忆）是所有时间点成人PSAC几率最高相关的因素。研究结果表明，评估特定的急性症状和体征可能有助于预测成人PSAC的预后。
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