NIH Consens Statement. 1998;16(1):1-41.
The objective of this NIH Consensus Statement is to inform the biomedical research and clinical practice communities of the results of the NIH Consensus Development Conference on Rehabilitation of Persons with Traumatic Brain Injury. The statement provides state-of-the-art information regarding effective rehabilitation measures for persons who have suffered a traumatic brain injury (TBI) and presents the conclusions and recommendations of the consensus panel regarding these issues. In addition, the statement identifies those areas that deserve further investigation. Upon completion of this educational activity, the reader should possess a clear working clinical knowledge of the state of the art regarding this topic. The target audience for this statement includes, but is not limited to, pediatricians, family practitioners, internists, neurologists, physiatrists, psychologists, and behavioral medicine specialists.
Participants were a non-Federal, 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, 23 experts from these same fields presented data to the panel and a conference audience of 883.
The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. A compendium of evidence was prepared by the panel which included a contribution from a patient with TBI, a report from an Evidence Based Practice Center of the Agency for Health Care Policy and Research, and a report from the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. Scientific evidence was given precedence over clinical anecdotal experience.
The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and 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 World Wide Web immediately following its release at the conference and was updated with the panel's final revisions.
Traumatic Brain Injury (TBI) results principally from vehicular incidents, falls, acts of violence, and sports injuries, and is more than twice as likely in males as in females. The estimated incidence rate is 100 per 100,000 persons with 52,000 annual deaths. The highest incidence is among persons 15 to 24 years of age and 75 years and older, with an additional less striking peak in incidence in children ages 5 and younger. Since TBI may result in lifelong impairment of an individual's physical, cognitive, and psychosocial functioning and prevalence is estimated to be 2.5 million to 6.5 million individuals, TBI is a disorder of major public health significance. Furthermore, mild TBI is significantly under diagnosed and the likely societal burden 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 available for the cognitive and behavioral consequences of TBI. Although studies are relatively limited, available 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. (ABSTRACT TRUNCATED)
本美国国立卫生研究院（NIH）共识声明的目的是向生物医学研究和临床实践领域通报NIH关于创伤性脑损伤患者康复的共识发展会议的结果。该声明提供了有关创伤性脑损伤（TBI）患者有效康复措施的最新信息，并阐述了共识小组在这些问题上的结论和建议。此外，该声明还确定了那些值得进一步研究的领域。完成本教育活动后，读者应具备关于该主题最新情况的清晰实用临床知识。本声明的目标受众包括但不限于儿科医生、家庭医生、内科医生、神经科医生、物理医学与康复医生、心理学家和行为医学专家。
参与者是一个由16名成员组成的非联邦、无党派小组，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、言语与听力、职业治疗、护理、流行病学、生物统计学和公众等领域。此外，来自这些相同领域的23位专家向小组和883名会议听众提供了数据。
通过医学在线数据库（Medline）检索文献，并向小组和会议听众提供了一份广泛的参考文献目录。专家们编写了带有文献相关引用的摘要。小组编写了一份证据汇编，其中包括一名TBI患者的贡献、医疗保健政策与研究机构循证实践中心的一份报告，以及疾病控制与预防中心国家伤害预防与控制中心的一份报告。科学证据优先于临床轶事经验。
小组根据公开论坛上展示的科学证据和科学文献，回答预先设定的问题，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修订的定稿。声明草案在会议发布后立即在万维网上提供，并根据小组的最终修订进行了更新。
创伤性脑损伤（TBI）主要由交通事故、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。发病率最高的人群是15至24岁以及75岁及以上的人，5岁及以下儿童的发病率有一个不太明显的小高峰。由于TBI可能导致个体身体、认知和心理社会功能的终身损害，估计患病率为250万至650万人，因此TBI是一种具有重大公共卫生意义的疾病。此外，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认知和行为后果的可用康复措施。尽管研究相对有限，但现有证据支持对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、更权威的临床试验中重复进行。（摘要截选）
