Whitnall L, McMillan T M, Murray G D, Teasdale G M
Department of Neurosurgery, University of Glasgow, Southern General Hospital, Glasgow G12 OXH, UK.
J Neurol Neurosurg Psychiatry. 2006 May;77(5):640-5. doi: 10.1136/jnnp.2005.078246.
Improvement 1-2 years after head injury is well established but the pattern thereafter is unclear. Past studies have not examined representative head injury populations and typically report findings in terms of functioning across social, psychological, neurobehavioural, or cognitive domains rather than global outcome.
To determine the late outcome of a representative cohort of participants admitted to hospital after a head injury 5-7 years previously and to identify early and late factors correlating with persisting disability and change between one and 5-7 years.
A representative cohort of head injured people whose outcome one year after injury was reported previously, were followed up 5-7 years after injury. Participants were assessed using structured and validated measures of global outcome (Glasgow Outcome Scale Extended), cognitive impairment, psychological wellbeing, health status, and social factors.
Of 475 survivors studied at one year, 115 (24%) had died by seven years. In survivors at 5-7 years, disability remained frequent (53%); and the rate, similar to that found at one year (57%). Sixty three participants (29%) had improved but 55 (25%) deteriorated. The persistence of disability and its development after previous recovery each showed stronger associations with indices of depression, anxiety, and low self-esteem than with initial severity of injury or persisting cognitive impairment.
Admission to hospital after head injury is followed 5-7 years later by disability in a high proportion of survivors. Persistence of disability and development of new disability are strongly associated with psychosocial factors that may be open to remediation, even late after injury.
头部受伤后1至2年的改善情况已得到充分证实，但此后的模式尚不清楚。过去的研究没有对具有代表性的头部受伤人群进行调查，通常报告的结果是关于社会、心理、神经行为或认知领域的功能，而不是整体结果。
确定5至7年前因头部受伤入院的具有代表性队列参与者的晚期结局，并确定与持续残疾以及1年至5至7年期间变化相关的早期和晚期因素。
对一组曾报告过受伤后1年结局的具有代表性的头部受伤人群进行随访，随访时间为受伤后5至7年。使用结构化且经过验证的整体结局（扩展格拉斯哥结局量表）、认知障碍、心理健康、健康状况和社会因素测量方法对参与者进行评估。
在1年时研究的475名幸存者中，到7年时有115人（24%）死亡。在5至7年的幸存者中，残疾仍然很常见（53%）；这一比例与1年时的比例相似（57%）。63名参与者（29%）有所改善，但55名（25%）恶化。残疾的持续存在及其在先前恢复后的发展，与抑郁、焦虑和低自尊指数的关联比与初始损伤严重程度或持续认知障碍的关联更强。
头部受伤入院后5至7年，很大一部分幸存者存在残疾。残疾的持续存在和新残疾的发展与心理社会因素密切相关，这些因素即使在受伤后期也可能易于矫正。
