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Concussion Guidelines Step 2: Evidence for Subtype Classification.

التفاصيل البيبلوغرافية
العنوان: Concussion Guidelines Step 2: Evidence for Subtype Classification.
المؤلفون: Lumba-Brown A; Department of Emergency Medicine, Brain Performance Center, Stanford University, Stanford, California., Teramoto M; Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah., Bloom OJ; Carolina Sports Concussion Clinic, Cary, North Carolina., Brody D; Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland., Chesnutt J; Depts. of Family Medicine, Neurology, Orthopedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon., Clugston JR; Departments of Community Health and Family Medicine and Neurology, University of Florida, Gainesville, Florida., Collins M; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania., Gioia G; Division of Pediatric Neuropsychology, Safe Concussion Outcome Recovery & Education Program, Children's National Health System, Depts. of Pediatrics and Psychiatry & Behavioral Sciences, George Washington University School of Medicine, Rockville, Maryland., Kontos A; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.; Department of Sports Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania., Lal A; Department of Neurosurgery, Concussion and Brain Performance Center, Stanford University, Stanford, California., Sills A; Department of Neurosurgery and Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville, Tennessee., Ghajar J; Department of Neurosurgery, Brain Performance Center, Stanford University, Stanford, California.
المصدر: Neurosurgery [Neurosurgery] 2020 Jan 01; Vol. 86 (1), pp. 2-13.
نوع المنشور: Guideline; Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 7802914 Publication Model: Print Cited Medium: Internet ISSN: 1524-4040 (Electronic) Linking ISSN: 0148396X NLM ISO Abbreviation: Neurosurgery Subsets: MEDLINE
أسماء مطبوعة: Publication: 2022- : [Philadelphia] : Lippincott Williams & Wilkins, Inc.
Original Publication: Baltimore, Williams & Wilkins.
مواضيع طبية MeSH: Brain Concussion/*classification, Adult ; Child ; Evidence-Based Medicine ; Female ; Humans ; Male
مستخلص: Background: Concussion is a heterogeneous mild traumatic brain injury (mTBI) characterized by a variety of symptoms, clinical presentations, and recovery trajectories. By thematically classifying the most common concussive clinical presentations into concussion subtypes (cognitive, ocular-motor, headache/migraine, vestibular, and anxiety/mood) and associated conditions (cervical strain and sleep disturbance), we derive useful definitions amenable to future targeted treatments.
Objective: To use evidence-based methodology to characterize the 5 concussion subtypes and 2 associated conditions and report their prevalence in acute concussion patients as compared to baseline or controls within 3 d of injury.
Methods: A multidisciplinary expert workgroup was established to define the most common concussion subtypes and their associated conditions and select clinical questions related to prevalence and recovery. A literature search was conducted from January 1, 1990 to November 1, 2017. Two experts abstracted study characteristics and results independently for each article selected for inclusion. A third expert adjudicated disagreements. Separate meta-analyses were conducted to do the following: 1) examine the prevalence of each subtype/associated condition in concussion patients using a proportion, 2) assess subtype/associated conditions in concussion compared to baseline/uninjured controls using a prevalence ratio, and 3) compare the differences in symptom scores between concussion subtypes and uninjured/baseline controls using a standardized mean difference (SMD).
Results: The most prevalent concussion subtypes for pediatric and adult populations were headache/migraine (0.52; 95% CI = 0.37, 0.67) and cognitive (0.40; 95% CI = 0.25, 0.55), respectively. In pediatric patients, the prevalence of the vestibular subtype was also high (0.50; 95% CI = 0.40, 0.60). Adult patients were 4.4, 2.9, and 1.7 times more likely to demonstrate cognitive, vestibular, and anxiety/mood subtypes, respectively, as compared with their controls (P < .05). Children and adults with concussion showed significantly more cognitive symptoms than their respective controls (SMD = 0.66 and 0.24; P < .001). Furthermore, ocular-motor in adult patients (SMD = 0.72; P < .001) and vestibular symptoms in both pediatric and adult patients (SMD = 0.18 and 0.36; P < .05) were significantly worse in concussion patients than in controls.
Conclusion: Five concussion subtypes with varying prevalence within 3 d following injury are commonly seen clinically and identifiable upon systematic literature review. Sleep disturbance, a concussion-associated condition, is also common. There was insufficient information available for analysis of cervical strain. A comprehensive acute concussion assessment defines and characterizes the injury and, therefore, should incorporate evaluations of all 5 subtypes and associated conditions.
(© Congress of Neurological Surgeons 2019.)
التعليقات: Comment in: Neurosurgery. 2020 Feb 1;86(2):E222-E223. (PMID: 31515561)
Comment in: Neurosurgery. 2020 Feb 1;86(2):E224. (PMID: 31529054)
Comment in: Neurosurgery. 2020 Jan 1;86(1):E1. (PMID: 31670378)
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فهرسة مساهمة: Keywords: Concussion; head injury; meta-analysis; mild traumatic brain injury; oculomotor; subtype; systematic review; traumatic brain injury; vestibular
تواريخ الأحداث: Date Created: 20190822 Date Completed: 20200824 Latest Revision: 20231020
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC6911735
DOI: 10.1093/neuros/nyz332
PMID: 31432081
قاعدة البيانات: MEDLINE
الوصف
تدمد:1524-4040
DOI:10.1093/neuros/nyz332