目的:本研究的目的是对运动相关脑震荡(SRC)的现场和球场侧评估进行德尔菲共识。
方法:回答了第1轮和第2轮的开放式问题。前两轮的结果用于开发第三轮的李克特式问卷。如果在第3轮对某一项目的协议<80%,如果小组成员在共识之外,或者>30%的人都不同意/不同意回应,结果转入第四轮。协议和共识的水平被定义为90%。
结果:意识丧失(LOC)或疑似LOC,运动不协调/共济失调,平衡扰动,困惑/迷失方向,记忆障碍/健忘症,视力模糊/光敏感度,烦躁,含糊不清的讲话,慢反应时间,躺着一动不动,头晕,头痛/头部压力,在没有保护作用的情况下坠落到地面,受到打击后缓慢起床,昏昏欲睡的外观和姿势/癫痫发作是SRC的临床体征,表明已退出游戏。视频评估是有帮助的,但不应该取代临床判断。LOC/无响应,颈椎损伤的迹象,怀疑其他骨折(颅骨/上颌骨),癫痫发作,格拉斯哥昏迷评分(GCS)<14和神经系统检查异常是住院的指征。只有当没有SRC的临床体征时,才应考虑恢复播放(RTP)。每个可疑的脑震荡都应转诊给有经验的医生。
结论:85%的提示脑震荡的临床体征达成共识。现场和球场侧评估应包括对机制的观察,临床检查和颈椎评估。在需要从比赛中删除的19个标志和红旗中,74%的人达成了共识。正常的临床检查和HIA没有脑震荡的迹象允许RTP。视频评估对于专业游戏应该是强制性的,但不应取代临床决策。SCAT,VOMS,HIA和Maddocks问题是有用的工具。指南对非健康专业人员有帮助。
To perform a Delphi consensus for on-field and pitch-side assessment of sports-related concussion (SRC).
Open-ended questions in rounds 1 and 2 were answered. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤80% for an item, if panel members were outside consensus, or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%.
Loss of consciousness (LOC) or suspected LOC, motor incoordination/ataxia, balance disturbance, confusion/disorientation, memory disturbance/amnesia, blurred vision/light sensitivity, irritability, slurred speech, slow reaction time, lying motionless, dizziness, headaches/pressure in the head, falling to the ground with no protective action, slow to get up after a hit, dazed look, and posturing/seizures were clinical signs of SRC and indicate removal from play. Video assessment is helpful but should not replace clinical judgment. LOC/unresponsiveness, signs of cervical spine injury, suspicion of other fractures (skull/maxillo-facial), seizures, Glasgow Coma Scale score <14 and abnormal neurologic examination findings are indications for hospitalization. Return to play should only be considered when no clinical signs of SRC are present. Every suspected concussion should be referred to an experienced physician.
Consensus was achieved for 85% of the clinical signs indicating concussion. On-field and pitch-side assessment should include the observation of the mechanism, a clinical examination, and cervical spine assessment. Of the 19 signs and red flags requiring removal from play, consensus was reached for 74%. Normal clinical examination and HIA with no signs of concussion allow return to play. Video assessment should be mandatory for professional games but should not replace clinical decision-making. Sports Concussion Assessment Tool, Glasgow Coma Scale, vestibular/ocular motor screening, Head Injury Assessment Criteria 1, and Maddocks questions are useful tools. Guidelines are helpful for non-health professionals.
Level V, expert opinion.