JAMA. 1999 Sep 8;282(10):974-83.
To provide biomedical researchers and clinicians with information regarding and recommendations for effective rehabilitation measures for persons who have experienced a traumatic brain injury (TBI).
A nonfederal, nonadvocate, 16-member panel representing the fields of neuropsychology, neurology, psychiatry, behavioral medicine, family medicine, pediatrics, physical medicine and rehabilitation, speech and hearing, occupational therapy, nursing, epidemiology, biostatistics, and the public. In addition, 31 experts from these same fields presented data to the panel and a conference audience of 883 members of the public. The conference consisted of (1) presentations by investigators working in areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussions that were part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and part of the third. Primary sponsors of the conference were the National Institute of Child Health and Human Development and the National Institutes of Health Office of Medical Applications of Research.
The literature was searched through MEDLINE for articles from January 1988 through August 1998 and an extensive bibliography of 2563 references was provided to the panel and the conference audience. Experts prepared abstracts for their conference presentations with relevant citations from the literature. The panel prepared a compendium of evidence, including a patient contribution and reports from federal agencies. Scientific evidence was given precedence over clinical anecdotal experience.
The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented during the open forum (October 26-28, 1998) and in the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the Internet immediately following its release at the conference and was updated with the panel's final revisions.
Traumatic brain injury results principally from vehicular incidents, falls, acts of violence, and sports injuries and is more than twice as likely to occur in men as in women. The estimated incidence rate is 100 per 100000 persons, with 52000 annual deaths. The highest incidence is among persons aged 15 to 24 years and 75 years or older, with a less striking peak in incidence in children aged 5 years or younger. Since TBI may result in lifelong impairment of physical, cognitive, and psychosocial functioning and prevalence is estimated at 2.5 million to 6.5 million individuals, TBI is a disorder of major public health significance. Mild TBI is significantly underdiagnosed and the likely societal burden is therefore even greater. Given the large toll of TBI and absence of a cure, prevention is of paramount importance. However, the focus of this conference was the evaluation of rehabilitative measures for the cognitive and behavioral consequences of TBI. Evidence supports the use of certain cognitive and behavioral rehabilitation strategies for individuals with TBI. This research needs to be replicated in larger, more definitive clinical trials and, thus, funding for research on TBI needs to be increased.
为生物医学研究人员和临床医生提供有关创伤性脑损伤（TBI）患者有效康复措施的信息及建议。
一个由16名成员组成的非联邦、无党派小组，成员代表神经心理学、神经病学、精神病学、行为医学、家庭医学、儿科学、物理医学与康复学、言语与听力、职业治疗、护理学、流行病学、生物统计学以及公众等领域。此外，来自这些领域的31位专家向该小组及883名公众组成的会议听众提供了数据。会议包括：（1）在为期两天的公开会议期间，由从事与共识问题相关领域研究的调查人员进行的陈述；（2）公开讨论期间会议参与者提出的问题和陈述，公开讨论是公开会议的一部分；（3）小组在第二天剩余时间和第三天部分时间进行的闭门审议。会议的主要赞助商是国家儿童健康与人类发展研究所和美国国立卫生研究院医学应用研究办公室。
通过MEDLINE检索了1988年1月至截至1998年8月的文献，并向小组和会议听众提供了一份包含2563条参考文献的详尽书目。专家们为其会议陈述准备了摘要，并附上文献中的相关引用。小组编写了一份证据汇编，包括患者的意见和联邦机构的报告。科学证据优先于临床轶事经验。
小组针对预先设定的问题，根据在公开论坛（1998年10月26 - 28日）上展示的科学证据以及科学文献得出结论。小组撰写了一份声明草案，全文宣读后分发给专家和听众征求意见。此后，小组解决了相互冲突的建议，并在会议结束时发布了一份修订声明。小组在会议结束后的几周内完成了最终修订。声明草案在会议发布后立即在互联网上公布，并根据小组的最终修订进行了更新。
创伤性脑损伤主要由车辆事故、跌倒、暴力行为和运动损伤导致，男性发生TBI的可能性是女性的两倍多。估计发病率为每10万人中有100例，每年有52000人死亡。发病率最高的是15至24岁以及75岁及以上的人群，5岁及以下儿童的发病率有一个不太明显的高峰。由于TBI可能导致身体、认知和心理社会功能的终身损害，估计患病人数为250万至650万，因此TBI是具有重大公共卫生意义的疾病。轻度TBI的诊断明显不足，因此可能的社会负担甚至更大。鉴于TBI造成的巨大损失且尚无治愈方法，预防至关重要。然而，本次会议的重点是评估针对TBI认知和行为后果的康复措施。有证据支持对TBI患者使用某些认知和行为康复策略。这项研究需要在更大规模、更具权威性的临床试验中重复进行，因此需要增加对TBI研究的资金投入。
