从2001年到2012年，与儿童相关的运动和娱乐相关脑损伤（TBI）的急诊科就诊率增加了一倍以上。In 2012, over 329,000 children and adolescents in the US have received medical treatment for TBI。当我们考虑大量个人可能不寻求医疗服务时，这种统计数字变得更加令人不安。TBI显然是公共卫生的关注，并引起了公众，媒体，体育社区和医疗保健专业人员的关注。
Secondary to this attention, an increasing amount of literature examining the lingering effects of previous concussion(s) now exists; however, this literature frequently demonstrates mixed results. Unfortunately, the existing research also frequently contains insufficient sample sizes, lack of stringent inclusion/exclusion criteria, absence of case matching, and/or mixing of sexes in the groups examined. In our recent study, we attempted to address these limitations by utilizing a large sample database of over 26,000 athletes aged 10 to 19 years, extensive inclusion and exclusion criteria, and a case match design. Participants were grouped according to sex and number of previous self-reported concussions and then case matched on age, sex, and body mass index (BMI).
使用单向方差分析来检查脑震荡组对报告的症状和对立即脑震荡后评估和认知测试（Impact®）神经认知电池复合材料的总体差异。对于男性或女性的任何神经认知谱（例如，口头记忆，视觉记忆和反应时间），未发现主题间的主要效果；然而，结果表明，随着自我报告的先前脑震荡的数量增加，男性参与者报告了头晕，雾化，集中困难和记忆问题的症状显着增加。对于女性参与者，没有发现类似的趋势。
Despite this, our finding that male adolescents with a self-reported history of concussions are suffering from greater daily discomfort than their non-concussed peers is a cause for concern. While it is not clear why a similar trend was not observed in females, several possible explanations exist, including: male athletes are known to underreport symptoms and are less likely to be diagnosed with a concussion unless relatively severe or higher number of symptoms are present; males endorsing more symptoms may also be more likely to connect their experiences to a higher number of past concussions; males are more likely to engage in sports associated with increased violent and aggressive acts (e.g., football and wrestling); and previous research suggesting estrogen and progesterone are neuroprotective and may aid in recovery post-concussion (ROOD，Duvdevani，Braswell和Stein，1994年;Stein & Hoffman, 2003). Additionally, our findings appear to contradict a significant portion of the existing literature that did not utilize stringent inclusion and exclusionary criteria, had insufficient sample sizes, and mixed sexes in the groups examined. Consequently, it becomes more likely that these studies’ findings may at least be partially explained by confounding variables (e.g., differences among males and female participants as well as psychiatric diagnoses affecting symptoms reported and neurocognitive performance). Due to the role confounding factors may be playing in the existing research’s results, we recommend use of caution when interpreting and generalizing research that utilizes a relatively lenient inclusion and exclusion criteria (e.g., mixing of sexes and not screening for learning disorder diagnoses and ADHD) and insufficient sample sizes.
虽然我们的结果并未表明脑震荡后持久的神经认知变化，但重要的是要注意Impact®可能缺乏衡量认知慢性变化的必要敏感性和特异性。Moreover, it is also important to note that the information we analyzed was obtained by self-report. As a result, our study does not allow for an inference of causation between concussion history and persistent neurocognitive impairment or post-concussive symptoms. Despite this, our results did provide evidence of persistent negative subjective effects that correlate with number of self-reported concussions, suggesting future research in this area is warranted.
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