Brown Allen W, Malec James F, McClelland Robyn L, Diehl Nancy N, Englander Jeffrey, Cifu David X
Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
J Neurotrauma. 2005 Oct;22(10):1040-51. doi: 10.1089/neu.2005.22.1040.
Traumatic brain injury (TBI) often presents clinicians with a complex combination of clinical elements that can confound treatment and make outcome prediction challenging. Predictive models have commonly used acute physiological variables and gross clinical measures to predict mortality and basic outcome endpoints. The primary goal of this study was to consider all clinical elements available concerning a survivor of TBI admitted for inpatient rehabilitation, and identify those factors that predict disability, need for supervision, and productive activity one year after injury. The Traumatic Brain Injury Model Systems (TBIMS) database was used for decision tree analysis using recursive partitioning (n = 3463). Outcome measures included the Functional Independence Measure(), the Disability Rating Scale, the Supervision Rating Scale, and a measure of productive activity. Predictor variables included all physical examination elements, measures of injury severity (initial Glasgow Coma Scale score, duration of post-traumatic amnesia [PTA], length of coma, CT scan pathology), gender, age, and years of education. The duration of PTA, age, and most elements of the physical examination were predictive of early disability. The duration of PTA alone was selected to predict late disability and independent living. The duration of PTA, age, sitting balance, and limb strength were selected to predict productive activity at 1 year. The duration of PTA was the best predictor of outcome selected in this model for all endpoints and elements of the physical examination provided additional predictive value. Valid and reliable measures of PTA and physical impairment after TBI are important for accurate outcome prediction.
创伤性脑损伤（TBI）常常给临床医生带来一系列复杂的临床症状，这些症状会干扰治疗并使预后预测变得困难。预测模型通常使用急性生理变量和粗略的临床指标来预测死亡率和基本的预后终点。本研究的主要目的是综合考虑所有与因住院康复而收治的TBI幸存者相关的临床因素，并确定那些能够预测受伤一年后残疾情况、监督需求和生产活动能力的因素。使用创伤性脑损伤模型系统（TBIMS）数据库进行递归划分的决策树分析（n = 3463）。结局指标包括功能独立性测量量表（FIM）、残疾评定量表、监督评定量表以及一项生产活动测量指标。预测变量包括所有体格检查项目、损伤严重程度指标（初始格拉斯哥昏迷量表评分、创伤后遗忘症（PTA）持续时间、昏迷时长、CT扫描病理结果）、性别、年龄和受教育年限。PTA持续时间、年龄以及大多数体格检查项目可预测早期残疾情况。仅PTA持续时间被选用于预测晚期残疾和独立生活能力。PTA持续时间、年龄、坐位平衡和肢体力量被选用于预测1年后的生产活动能力。在该模型中，PTA持续时间是所有终点指标的最佳预后预测指标，体格检查项目提供了额外的预测价值。TBI后PTA和身体损伤的有效且可靠的测量指标对于准确的预后预测很重要。
