Pape Theresa Louise-Bender, Lundgren Sandra, Heinemann Allen W, Guernon Ann, Giobbie-Hurder Anita, Wang Jia, Roth Heidi, Blahnik Melanie, Williams Vanessa
The Department of Veterans Affairs (VA), Research Service, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA.
Brain Inj. 2006 Jun;20(7):743-58. doi: 10.1080/02699050600676933.
One of the most challenging tasks for clinicians caring for survivors of severe brain injury (BI) is establishing a prognosis, for long-term functional outcome, while the patient is unconscious. The objective of this article is to report findings regarding the prediction of functional outcomes 1-year after severe BI using data available when the patient is unconscious.
Longitudinal prognostication study.
Persons unconscious after severe BI who present to inpatient (IP) rehabilitation hospitals in the Midwestern US are enrolled in an ongoing study. Each subject is followed for 1-year and the final outcome interview includes approximately 70 questions; 32 of these questions are from the Craig Handicap Assessment and Reporting Technique (CHART). A sample of 63 persons was abstracted from the study database to examine the predictability of 42 independent variables and 16 dichotomous outcomes.
Twelve of the 16 dichotomous outcomes were found to be significantly predictable (p < 0.05). These involve activity, participation, environment and quality of life outcomes. Ten predictors were found to be significant (p < 0.05): aetiology (Closed Head Injury vs. Other BI), presence of urinary tract infection (UTI), seizure, hypertension during IP rehabilitation, veteran benefit eligibility, health insurance, marital status at injury, whether or not recovery of consciousness occurred within 1 year, the number of days between injury and admission to acute rehabilitation and the average length of IP rehabilitation stay. Eight of the 10 variables are available early after injury or when the patient is unconscious.
对于照料重度脑损伤（BI）幸存者的临床医生而言，最具挑战性的任务之一是在患者昏迷时确定其长期功能预后。本文的目的是报告利用患者昏迷时可用的数据对重度脑损伤后1年功能预后进行预测的研究结果。
纵向预后研究。
在美国中西部住院康复医院就诊的重度脑损伤后昏迷患者被纳入一项正在进行的研究。对每位受试者进行为期1年的随访，最终结局访谈包括约70个问题；其中32个问题来自克雷格残疾评估与报告技术（CHART）。从研究数据库中抽取63人的样本，以检验42个自变量和16个二分结局的可预测性。
16个二分结局中有12个被发现具有显著可预测性（p<0.05）。这些涉及活动、参与、环境和生活质量结局。发现10个预测因素具有显著性（p<0.05）：病因（闭合性颅脑损伤与其他脑损伤）、尿路感染（UTI）的存在、癫痫、住院康复期间的高血压、退伍军人福利资格、健康保险、受伤时的婚姻状况、伤后1年内是否恢复意识、受伤至进入急性康复的天数以及住院康复的平均时长。10个变量中有8个在受伤后早期或患者昏迷时即可获得。
