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Association of Time Since Injury to the First Clinic Visit With Recovery Following Concussion.
JAMA Neurology ( IF 20.4 ) Pub Date : 2020-04-01 , DOI: 10.1001/jamaneurol.2019.4552
Anthony P Kontos 1, 2 , Kendra Jorgensen-Wagers 3, 4 , Alicia M Trbovich 1, 2 , Nathan Ernst 1, 2 , Kouros Emami 1, 2 , Brandon Gillie 5 , Jonathan French 1, 2 , Cyndi Holland 1, 2 , R J Elbin 6 , Michael W Collins 1, 2
Affiliation  

Importance Recovery after concussion varies, with adolescents taking longer (approximately 30 days) than adults. Many factors have been reported to influence recovery, including preinjury factors, perceptions about recovery, comorbid conditions, and sex. However, 1 factor that may play a role in recovery but has received little attention from researchers is the timeliness of clinical evaluation and care. Objective To investigate the association of time since injury with initiation of clinical care on recovery time following concussion. Design, Setting, and Participants This retrospective, cross-sectional study was conducted in a sports medicine clinic between August 2016 and March 2018. Eligible participants were aged 12 to 22 years and had a diagnosed, symptomatic concussion; patients were excluded if recovery data were incomplete. Participants were divided into 2 groups: those seen within 7 days of the injury (early) vs between 8 and 20 days of the injury (late). Data were analyzed between June 2019 and August 2019. Exposures Time from injury (concussion) to initiation of clinical care. Main Outcomes and Measures Recovery time; testing with the Post-Concussion Symptom Scale, Immediate Post-Concussion Assessment and Cognitive Testing, and Vestibular/Ocular Motor Screening instruments; demographic factors, medical history, and injury information. Results A total of 416 individuals were eligible, and 254 (61.1%) were excluded, leaving 162 (38.9%) in analyses. The early group (98 patients) and late group (64 patients) did not differ in age (mean [SD] age, early, 15.3 [1.6] years; late, 15.4 [1.6] years), number of female patients (early, 51 of 98 [52.0%]; late, 40 of 64 [62.5%]), or other demographic, medical history, or injury information. The groups also were similar on symptom severity, cognitive, ocular, and vestibular outcomes at the first clinic visit. Results from a logistical regression supported being in the late group (adjusted odds ratio, 5.8 [95% CI, 1.9-17.6]; P = .001) and visual motion sensitivity symptoms greater than 2 (adjusted odds ratio, 4.5 [95% CI, 1.1-18.0]; P = .04) as factors significantly associated with recovery time. Conclusions and Relevance Findings suggest that earlier initiation of clinical care is associated with faster recovery after concussion. Other factors may also influence recovery time. Further research is needed to determine the role of active rehabilitation and treatment strategies, as well as demographic factors, medical history, and injury characteristics on the current findings.

中文翻译:


从受伤到第一次就诊的时间与脑震荡后恢复的关系。



重要性 脑震荡后的恢复各不相同,青少年比成人需要更长的时间(大约 30 天)。据报道,许多因素会影响康复,包括受伤前因素、对康复的看法、合并症和性别。然而,临床评估和护理的及时性是可能对康复发挥作用但很少受到研究人员关注的因素之一。目的 调查受伤后的时间与开始临床护理与脑震荡后恢复时间的关系。设计、背景和参与者 这项回顾性横断面研究于 2016 年 8 月至 2018 年 3 月在运动医学诊所进行。符合条件的参与者年龄在 12 至 22 岁之间,患有诊断出的有症状的脑震荡;如果恢复数据不完整,患者将被排除。参与者被分为 2 组:受伤后 7 天内(早期)和受伤后 8 至 20 天内(晚期)。对 2019 年 6 月至 2019 年 8 月期间的数据进行了分析。 暴露 从受伤(脑震荡)到开始临床护理的时间。主要成果和措施 恢复时间;使用脑震荡后症状量表、脑震荡后立即评估和认知测试以及前庭/眼运动筛查仪器进行测试;人口因素、病史和受伤信息。结果 共有 416 人符合资格,254 人(61.1%)被排除,留下 162 人(38.9%)进行分析。早期组(98 名患者)和晚期组(64 名患者)在年龄(平均 [SD] 年龄,早期,15.3 [1.6] 岁;晚期,15.4 [1.6] 岁)、女性患者数量(早期、 98 人中的 51 人 [52.0%];迟到,64 人中的 40 人 [62.5%]),或其他人口统计、病史或受伤信息。 首次就诊时,各组在症状严重程度、认知、眼部和前庭结果方面也相似。逻辑回归结果支持晚期组(调整后的比值比,5.8 [95% CI,1.9-17.6];P = .001)和视觉运动敏感性症状大于 2(调整后的比值比,4.5 [95% CI,1.9-17.6];P = .001) ,1.1-18.0];P = .04)作为与恢复时间显着相关的因素。结论和相关性研究结果表明,早期开始临床护理与脑震荡后更快的恢复有关。其他因素也可能影响恢复时间。需要进一步研究来确定积极康复和治疗策略的作用,以及人口因素、病史和损伤特征对当前研究结果的影响。
更新日期:2020-04-01
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