Convergence insufficiency as a predictor of poor prognosis after acute mild traumatic brain injury.

IF 2 Q2 EMERGENCY MEDICINE
Kavya Devani, Neera Kapoor, Latha Ganti
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Abstract

Background: Mild traumatic brain injury (mTBI) is becoming a more common emergency department (ED) presentation. Towards this end, many types of testing in the acute setting are being investigated. One of these is screening for convergence insufficiency (CI) symptoms. These are common problems reported by patients with mTBI, but such oculomotor testing is rarely performed in the ED.

Objective: To assess the feasibility of convergence insufficiency screening in the ED and investigate whether CI is associated with adverse events such as post-concussive symptoms or hospital admission.

Methods: Written informed consent was obtained from patients age 18 years or older who experienced a mild head injury from any mechanism resulting in an mTBI. Patients underwent screening for CI symptoms using a standardized instrument of 15 questions, known as the convergence insufficiency symptom survey (CISS), with responses based on the Likert scale. These data were correlated to outcomes of hospital admission, occurrence of post-concussive symptoms, and 30-day hospital re-admission.

Results: A total of 116 patients were prospectively enrolled, of which 58 were male. The median age was 31 years, with a range of 18 to 95 years of age. The median CISS score was 13, with an interquartile range (IQR) of 6 to 21 and an overall range of 0 to 53. Females presented with a median CISS score of 14, which was higher compared to the male median score of 10. The higher the CISS score, the more likely the patient was to be admitted to the hospital (p = 0.0378), develop symptoms of post-concussive syndrome at 30-day follow up (p = 0.0322), and be readmitted within 30 days (p = 0.0098).

Conclusions: Screening for CI symptoms using the CISS can be a solid adjunct in the evaluation of mTBI in the ED. The CISS is easy and fast to administer, and it is a useful tool to stratify patients in terms of who is at the highest risk of developing complications related to the mTBI.

辐辏障碍是急性轻度脑外伤后预后不良的预测因素。
背景:轻度创伤性脑损伤(mTBI)在急诊科(ED)中越来越常见。为此,急诊室正在研究多种类型的测试。其中之一就是筛查辐辏功能不全(CI)症状。这些症状是 mTBI 患者报告的常见问题,但在急诊科很少进行此类眼球运动测试:目的:评估在急诊室进行辐辏不全筛查的可行性,并调查辐辏不全是否与撞击后症状或入院等不良事件有关:方法:年满 18 周岁、因任何原因导致轻度颅脑损伤的患者均需获得书面知情同意。患者使用由 15 个问题组成的标准化工具进行 CI 症状筛查,该工具被称为会聚功能不全症状调查 (CISS),根据李克特量表进行回答。这些数据与入院治疗结果、震颤后症状的出现以及 30 天内的再次入院治疗结果相关联:共有 116 名患者进行了前瞻性登记,其中 58 人为男性。中位年龄为 31 岁,从 18 岁到 95 岁不等。CISS评分中位数为13分,四分位数间距(IQR)为6至21分,总分范围为0至53分。女性的 CISS 中位数为 14 分,高于男性的 10 分。CISS 分数越高,患者越有可能入院治疗(p = 0.0378),在 30 天的随访中出现震后综合征症状(p = 0.0322),并在 30 天内再次入院治疗(p = 0.0098):结论:使用 CISS 筛查 CI 症状可作为急诊室评估 mTBI 的可靠辅助手段。CISS 的操作简单快捷,是对患者进行分层的有用工具,可用于确定哪些患者出现与 mTBI 相关的并发症的风险最高。
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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
63
审稿时长
13 weeks
期刊介绍: The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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