Examining the Sensitivity of the 2023 American Congress of Rehabilitation Medicine's Diagnostic Criteria for Mild Traumatic Brain Injury Using a Sport-Related Concussion Sample.
Avi N Albert, Anthony E Bishay, Olivia Shaffer, Kristen L Williams, Samuel Fitch, Scott L Zuckerman, Douglas P Terry
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引用次数: 0
Abstract
Objective: To (1) retrospectively apply the updated American Congress of Rehabilitation Medicine (ACRM) mild traumatic brain injury (mTBI) criteria to a cohort of high school athletes previously diagnosed with sport-related concussion (SRC) using prior clinical definitions, and (2) compare demographics, medical history, and recovery outcomes between those who met the full mTBI criteria versus those classified as suspected mTBI.
Setting: Outpatient Specialty Concussion Clinic.
Participants: In total, 181 concussed athletes aged 14 to 18 years were presented to clinic within 72 hours of injury. All were diagnosed with SRC by a certified athletic trainer or physician using the Concussion in Sport Group definition, which defines SRC as any traumatic blow to the head/body causing neurologic symptoms.
Design: Retrospective cohort study.
Main measures: Participants were classified as having a full or suspected mTBI based on the ACRM 2023 criteria. Full mTBIs required: (1) a plausible mechanism and either (2a) a clinical sign (eg, amnesia, loss of consciousness), or (2b) at least 2 symptoms plus a clinical examination finding. Suspected mTBIs had a plausible mechanism and at least 2 symptoms or at least 2 examination findings. Groups were compared across demographics, medical history, and recovery metrics (return-to-learn, symptom resolution, return-to-play).
Results: Of the 181 patients (mean age 16.3 ± 1.3 years; 35.9% female), 114 (63.0%) met the definition for a full mTBI, whereas 67 (37.0%) had a suspected mTBI. Significant differences included higher rates of family migraine history (24.8% vs 7.7%, P = .019) and on-field evaluations (50.4% vs 38.5%, P < .001) in the full group. No significant differences in return-to-learn (median [Mdn]: 4.0 vs 3.0), symptom resolution (Mdn: 11.0 vs 12.5), or return-to-play (Mdn: 15.0 vs 14.5) were noted (P > .05).
Conclusion: Among high school athletes with SRC, most met the updated full ACRM mTBI criteria, with the rest meeting the suspected mTBI criteria. Results suggest high sensitivity for the ACRM definition for diverse concussion presentations.
目的：(1)回顾性应用最新的美国康复医学大会（ACRM）轻度创伤性脑损伤（mTBI）标准，对一组先前根据临床定义诊断为运动相关脑震荡（SRC）的高中运动员进行研究；(2)比较符合完全mTBI标准的运动员与疑似mTBI患者的人口统计学、病史和恢复结果。单位：脑震荡专科门诊。参与者：共有181名14至18岁的脑震荡运动员在受伤后72小时内就诊。所有患者均由经过认证的运动教练或医生根据运动组的脑震荡定义诊断为SRC，该定义将SRC定义为头部/身体的任何创伤性打击导致神经系统症状。设计：回顾性队列研究。主要措施：参与者根据ACRM 2023标准被分类为完全或疑似mTBI。完整的mtbi要求：(1)合理的机制和（2a）临床症状（如健忘症、意识丧失），或（2b）至少2种症状加上临床检查发现。疑似mtbi有一个合理的机制和至少2个症状或至少2个检查结果。对各组进行人口统计学、病史和恢复指标（重返学习、症状缓解、重返比赛）的比较。结果：181例患者（平均年龄16.3±1.3岁，女性占35.9%）中，114例（63.0%）符合完全mTBI的定义，67例（37.0%）有疑似mTBI。显著差异包括较高的家族偏头痛病史（24.8% vs 7.7%, P = 0.019）和现场评估（50.4% vs 38.5%, P = 0.05）。结论：在患有SRC的高中运动员中，大多数符合最新的完整ACRM mTBI标准，其余符合疑似mTBI标准。结果表明ACRM定义对不同的脑震荡表现有很高的敏感性。
期刊介绍：
The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America (BIAA).
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