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一项关于法医学背景之外的脑震荡后综合征的对照前瞻性起始队列研究。

A controlled prospective inception cohort study on the post-concussion syndrome outside the medicolegal context.

作者信息

Mickeviciene D, Schrader H, Obelieniene D, Surkiene D, Kunickas R, Stovner L J, Sand T

机构信息

Department of Neurology, Red Cross Hospital, Kaunas, Lithuania.

出版信息

Eur J Neurol. 2004 Jun;11(6):411-9. doi: 10.1111/j.1468-1331.2004.00816.x.

Abstract

In an earlier historical cohort study on the post-concussion syndrome (PCS) in Lithuania, a country in which there are few confounding factors, the validity of this condition as a disease entity could not be confirmed. In order to register the post-traumatic symptoms, the influence of sociodemographic factors, and the effect of expectation on these symptoms more reliably, we performed a controlled prospective study. Three hundred subjects with concussion were followed up with repeated questionnaires for 1 year. For each study subject, a sex- and age-matched control person with minor non-head injury was identified. These controls received similar questionnaires. Headache both after 3 months and after 1 year did not differ significantly between the head-injured participants and the non-head-injured controls. Several other symptoms attributed to PCS did not differ significantly between the groups after 3 months. After 1 year the vast majority of symptoms did not differ significantly. Exceptions were slightly significant differences concerning memory problems, concentration problems, dizziness and tiredness. These differences were insignificant when analysing symptoms in unmarried and/or people with lower education, separately. No relationship between cognitive dysfunction and the severity of concussion was found. Although the possibility of a mild organic brain injury cannot be completely ruled out, our results cast doubt on the validity of PCS as a useful clinical entity, at least for head injuries with loss of consciousness for <15 min. Sociodemographic factors and expectation seem to influence reporting of symptoms after concussion.

摘要

在立陶宛进行的一项关于脑震荡后综合征(PCS)的早期历史性队列研究中,该国几乎没有混杂因素,但这种病症作为一种疾病实体的有效性未能得到证实。为了更可靠地记录创伤后症状、社会人口统计学因素的影响以及期望对这些症状的作用,我们进行了一项对照前瞻性研究。300名脑震荡患者通过重复问卷调查进行了1年的随访。为每个研究对象确定了一名性别和年龄匹配的轻度非头部受伤对照者。这些对照者也收到了类似的问卷。受伤组和未受伤对照组在3个月和1年后的头痛情况并无显著差异。3个月后,几组之间归因于PCS的其他几种症状也无显著差异。1年后,绝大多数症状也无显著差异。例外情况是在记忆问题、注意力不集中、头晕和疲劳方面存在轻微的显著差异。在分别分析未婚和/或受教育程度较低人群的症状时,这些差异并不显著。未发现认知功能障碍与脑震荡严重程度之间存在关联。尽管不能完全排除轻度器质性脑损伤的可能性,但我们的结果对PCS作为一个有用的临床实体的有效性提出了质疑,至少对于昏迷时间<15分钟的头部损伤是如此。社会人口统计学因素和期望似乎会影响脑震荡后症状的报告。

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