目的:脑震荡后症状问卷(PCSQs)通常用于脑震荡患者评估,然而,目前尚不清楚症状亚型的患病率是否取决于损伤机制(MOI).这些亚型可以定义为认知,寰枕/颈椎,自主性,balance,低能量/疲劳/睡眠,情绪变化,眼睛,和躯体。使用定量处理这些亚型的机构PCSQ,这项回顾性研究旨在深入了解运动相关(SR)和非运动相关(NSR)损伤在亚型症状学方面的差异.
方法:2009年12月至2020年1月,在美国I级创伤中心附属脑震荡诊所接受治疗的格拉斯哥昏迷评分(GCS)评分≥13和≥16岁的连续脑震荡患者符合入选条件。作者提取了MOI的数据,合并症,习惯,先前受伤,和PCSQ结果。然后进行协方差的多变量分析以确定亚型评分和MOI之间的相关性,同时考虑协变量。
结果:在应用纳入和排除标准后剩下的194例患者中,分析包括SR组中的91例患者,包括54例(59%)男性,平均±SD(范围)年龄为20.9±7.3(16-58)岁;NSR组中的103例患者,包括38例(37%)男性,平均年龄为39.2±14.8(17-71)岁.人口统计学特征在组间差异显著。在认知方面,与NSR损伤组相比,SR损伤组的估计边缘平均得分显着降低(P<0.001),自主神经(p<0.000),平衡(p<0.025),能量(p<0.006),情绪(p<0.000),和总分(p<0.001)亚型。多变量测试确定了导致组间亚型评分差异的三种合并症:偏头痛(p<0.012),眩晕(p<0.004),和焦虑(p<0.038)。对于(但不限于)抑郁症的其余合并症,没有发现显着结果,神经精神疾病,癫痫发作,晕厥,睡眠障碍,或者没有。
结论:研究结果表明,通过NSR损伤持续脑震荡的患者表现出更严重的症状,但脑震荡亚型频率与SR脑震荡相似。这表明与脑震荡亚型组成相比,MOI可能与症状严重程度更密切相关,尽管需要对MOI有更明确控制的更多患者群体来进一步阐明这些主张.
OBJECTIVE: Postconcussive symptom questionnaires (PCSQs) are often used in
concussion patient assessment, yet there is a lack of knowledge as to whether symptom subtype prevalence is dependent on the mechanism of injury (MOI). These subtypes can be defined as cognitive, atlanto-occipital/cervical spine, autonomic, balance, low energy/fatigue/sleep, emotional changes, eyes, and somatic. Using an institutional PCSQ that quantitatively addressed these subtypes, this retrospective
study aimed to provide insight into differences in subtype symptomatology between sports-related (SR) and non-sports-related (NSR) injuries.
METHODS: Consecutive
concussion patients with Glasgow Coma Scale (GCS) score ≥ 13 and ≥ 16 years of age who were treated at a
concussion clinic affiliated with an academic level I trauma center in the United States between December 2009 and January 2020 were eligible for inclusion. The authors extracted data on MOI, comorbidities, habits, prior injuries, and PCSQ results. Multivariate analysis of covariance was then conducted to determine the correlations between subtype scores and MOI while considering covariates.
RESULTS: Of the 194 patients remaining after applying inclusion and exclusion criteria, analysis included 91 patients in the SR group consisting of 54 (59%) males with mean ± SD (range) age of 20.9 ± 7.3 (16-58) years and 103 patients in the NSR group consisting of 38 (37%) males with mean age of 39.2 ± 14.8 (17-71) years. Demographic characteristics differed significantly between groups. Estimated marginal mean scores were significantly lower in the SR injury group compared to the NSR injury group (with comparing main effects) for the cognitive (p < 0.001), autonomic (p < 0.000), balance (p < 0.025), energy (p < 0.006), emotional (p < 0.000), and total score (p < 0.001) subtypes. Multivariate tests identified three comorbidities that contributed to differences in subtype scores between groups: migraines (p < 0.012), vertigo (p < 0.004), and anxiety (p < 0.038). No significant results were found for the remaining comorbidities of (but not limited to) depression, neuropsychiatric disorders, seizures, syncope, sleep disorder, or none.
CONCLUSIONS: The findings indicate that patients who sustain a concussion via an NSR injury present with more severe symptoms but similar concussion subtype frequency as those presenting with SR
concussion. This suggests that the MOI may correlate more closely to symptom severity than concussion subtype composition, although larger patient populations with more definitive control of MOI are needed to further elucidate these claims.