运动性脑震荡评估工具在住院创伤性脑损伤患者中的应用

M. Sargeant, E. Sykes, M. Saviour, A. Sawhney, E. Calzolari, J. Arthur, A. McGoldrick, B. Seemungal
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引用次数: 6

摘要

运动脑震荡评估工具第三版是一种运动筛查工具,通常用于支持头部受伤后的重返比赛决定。运动脑震荡评估工具第三版被认为是识别脑功能障碍(暗示一定程度的脑损伤);然而,运动脑震荡评估工具从未在明确的急性脑损伤患者中得到验证。在这项研究中,我们发现所有三个运动脑震荡评估工具第3版领域-症状,认知和平衡评估-在区分创伤性脑损伤患者(所有急性神经影像学异常)与健康对照时都很敏感。通过相关矩阵(Bonferroni校正),我们发现主观(症状)和客观(检查)评估之间没有相关性,例如失衡和记忆功能障碍的主诉分别与平衡和记忆功能测试的表现不相关。当放松多重比较的修正时,我们发现,在所有的运动脑震荡评估工具第三版症状中,“头部压力”的感觉具有最多的相互相关性(包括情感症状),并且绝大多数显示偏头痛的模式。综上所述,运动脑震荡评估工具第三版中的客观和主观评估相关性较差,可能表明运动脑震荡评估工具第三版中的症状不能很好地反映脑损伤,而是表明非脑损伤过程,如偏头痛。由此可见,目前流行的正统观念是,运动员在头部受伤后休息,直到他们的症状消退,因为害怕加剧脑损伤,这可能不利于他们的恢复——至少在某些情况下。需要前瞻性临床研究来评估脑震荡患者早期积极调查和治疗与休息的恢复情况,这一观点得到了最近国际共识的支持。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The utility of the Sports Concussion Assessment Tool in hospitalized traumatic brain injury patients
The Sports Concussion Assessment Tool 3rd version is a sports screening tool that is often used to support return to play decisions following a head injury. The Sports Concussion Assessment Tool 3rd version is presumed to identify brain dysfunction (implying a degree of brain injury); however, the Sports Concussion Assessment Tool has never been validated with patients with definite acute brain injury. In this study, we found that all three Sports Concussion Assessment Tool 3rd version domains – symptoms, cognitive and balance assessments – were sensitive in discriminating traumatic brain injury patients (all with abnormal acute neuroimaging) from healthy controls. Through a correlation matrix (Bonferroni corrected), we found no correlation between the subjective (symptoms) and objective (examination) Sports Concussion Assessment Tool 3rd version assessments, e.g. complaints of imbalance and memory dysfunction were not correlated, respectively, with performance on testing balance and memory function. When relaxing the correction for multiple comparisons we found that of all Sports Concussion Assessment Tool 3rd version symptoms, a feeling of ‘pressure in the head’ had the largest number of co-correlations (including affective symptoms) and overwhelmingly in a pattern indicative of migraine. Taken together, that objective and subjective assessments in the Sports Concussion Assessment Tool 3rd version are poorly correlated, could suggest that symptoms in the Sports Concussion Assessment Tool 3rd version poorly reflect brain injury but rather indicate non-brain injury processes such as migraine. It follows that the current prominent orthodoxy of resting athletes following a head injury until their symptoms settle for fear of exacerbating brain injury may be unfavourable for their recovery – at least in some cases. Prospective clinical studies would be required to assess patient recovery from concussion with early active investigation and treatment versus rest – a notion supported by recent international consensus.
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