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‘Subconcussive’ is a dangerous misnomer: hits of greater magnitude than concussive impacts may not cause symptoms
British Journal of Sports Medicine ( IF 18.4 ) Pub Date : 2024-05-07 , DOI: 10.1136/bjsports-2023-107413
Christopher J Nowinski , Hye Chang Rhim , Ann C McKee , Ross D Zafonte , David W Dodick , Robert C Cantu , Daniel H Daneshvar

Concussion is a traumatic brain injury (TBI) defined by the presence of transient signs and symptoms related to alterations in brain function due to biomechanical force.1 2 However, not every such force results in acute signs or symptoms, and recent research seeks to better understand the sequelae of both forces and injuries that are subclinical. The term ‘subconcussive’ has emerged to refer to both subclinical head acceleration events (HAEs) and injuries (as defined by clinical, biomarker and/or neuroimaging changes). We believe that this term can be misleading in both instances and should be replaced. When referring to impacts, the prefix ‘sub’ implies lower magnitude HAEs than those that cause a diagnosed concussion. However, sensor studies show that many HAEs are associated with greater head acceleration than impacts that result in a diagnosed concussion. We suggest replacing subconcussive with the more agnostic term ‘non-concussive’. When referring to injuries, the term subconcussive is a contradiction. If a concussion is a TBI, a subconcussive event implies no injury occurred. However, impacts that do not result in diagnosed concussions are sometimes associated with evidence of neurological injury, including functional changes that do not meet criteria for concussive symptoms, biomarker changes and structural changes evident on neuroimaging.3 There is increasing evidence that these injuries are associated with long-term sequelae.4 5 Researchers are misusing ‘subconcussive’ when referring to these injuries without overt clinical signs or symptoms. For the reasons detailed below, we suggest replacing subconcussive when referring to injury with ‘subclinical TBI’. With the arrival of football helmet accelerometers, researchers hoped to identify HAE magnitude thresholds that would characterise concussion. Unfortunately, there is no such threshold. A study of 319 college football players reported that peak linear and rotational accelerations were not correlated with symptom frequency, severity score or any symptom.6 In …

中文翻译:

“亚脑震荡”是一个危险的误称:比脑震荡更大的撞击可能不会引起症状

脑震荡是一种创伤性脑损伤 (TBI),其定义是出现与生物力学力导致的脑功能改变相关的短暂体征和症状。1 2 然而,并非每种此类力都会导致急性体征或症状,最近的研究寻求更好地解决这一问题。了解亚临床外力和损伤的后遗症。 “亚脑震荡”一词指的是亚临床头部加速事件 (HAE) 和损伤(根据临床、生物标志物和/或神经影像变化定义)。我们认为这个术语在这两种情况下都可能产生误导,应该被替换。当提及撞击时,前缀“sub”意味着 HAE 的震级低于导致诊断为脑震荡的 HAE。然而,传感器研究表明,与导致诊断为脑震荡的撞击相比,许多 HAE 与更大的头部加速度相关。我们建议用更不可知的术语“非脑震荡”代替“亚脑震荡”。当提到伤害时,“亚脑震荡”一词是一个矛盾。如果脑震荡属于 TBI,则亚脑震荡事件意味着没有发生伤害。然而,不会导致诊断为脑震荡的撞击有时与神经损伤的证据相关,包括不符合脑震荡症状标准的功能变化、生物标志物变化和神经影像学上明显的结构变化。3越来越多的证据表明这些损伤与脑震荡相关。 4 5 研究人员在提及这些没有明显临床体征或症状的损伤时误用了“亚脑震荡”。由于下文详述的原因,我们建议在提及损伤时用“亚临床 TBI”代替“亚震荡”。随着橄榄球头盔加速度计的出现,研究人员希望确定表征脑震荡的 HAE 幅度阈值。不幸的是,没有这样的门槛。一项针对 319 名大学橄榄球运动员的研究报告称,峰值线性加速度和旋转加速度与症状频率、严重程度评分或任何症状均不相关。6 在……
更新日期:2024-05-07
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