Dischinger Patricia C, Ryb Gabriel E, Kufera Joseph A, Auman Kimberly M
National Study Center for Trauma and EMS, The University of Maryland School of Medicine, Baltimore, Maryland, USA.
J Trauma. 2009 Feb;66(2):289-96; discussion 296-7. doi: 10.1097/TA.0b013e3181961da2.
The purpose of this analysis was to determine which of the initial symptoms after mild traumatic brain injury (MTBI) can best predict the development of persistent postconcussive syndrome (PCS).
One hundred eighty MTBI patients admitted to a level I trauma center were enrolled in a prospective study and 110 followed for 3 months. MTBI was defined as a Glasgow Coma Score of 13 to 15 with a transient loss of consciousness or report of being dazed or confused. PCS was defined as the persistence of four or more symptoms long term. Patients were screened at admission and at 3 days to 10 days and 3 months. Symptom checklists were administered to ascertain the presence of symptoms (cognitive, emotional, and physical) after concussion. For a subset of patients that were physically able, balance tests were also conducted. Stepwise logistic regression was used to identify which symptoms best predicted PCS.
The mean age of the subjects was 35 years, and 65% were men. Physical symptoms were the most prevalent in the 3 days to 10 days postinjury with most declining thereafter to baseline levels. Emotional and cognitive symptoms were less prevalent but more likely to remain elevated at 3 months; 41.8% of subjects reported PCS at 3 months. The strongest individual symptoms that predicted long-term PCS included anxiety, noise sensitivity (NS), and trouble thinking; reported by 49%, 27%, and 31% of the subjects at 3 days to 10 days, respectively. In multivariate regressions including age, gender, and early symptoms, only anxiety, NS and gender remained significant in the prediction of PCS. Interactions revealed that the effect of anxiety was seen primarily among women. NS had an odds ratio of 3.1 for PCS at 3 months.
After MTBI, anxiety among women and NS are important predictors of PCS. Other physical symptoms, while more prevalent are poor predictors of PCS.
本分析的目的是确定轻度创伤性脑损伤（MTBI）后的初始症状中，哪些能够最好地预测持续性脑震荡后综合征（PCS）的发生。
180名入住一级创伤中心的MTBI患者参与了一项前瞻性研究，其中110名患者随访3个月。MTBI定义为格拉斯哥昏迷评分为13至15分，伴有短暂意识丧失或自述感到眩晕或困惑。PCS定义为长期存在四种或更多症状。患者在入院时、3至10天以及3个月时接受筛查。使用症状清单来确定脑震荡后症状（认知、情绪和身体方面）的存在情况。对于身体状况允许的部分患者，还进行了平衡测试。采用逐步逻辑回归来确定哪些症状最能预测PCS。
受试者的平均年龄为35岁，65%为男性。身体症状在受伤后第3至10天最为普遍，之后大多数症状降至基线水平。情绪和认知症状不太普遍，但在3个月时更有可能持续升高；41.8%的受试者在3个月时报告患有PCS。预测长期PCS的最强个体症状包括焦虑、噪声敏感（NS）和思维困难；在3至10天时，分别有49%、27%和31%的受试者报告有这些症状。在包括年龄、性别和早期症状的多变量回归分析中，只有焦虑、NS和性别在PCS预测中仍然具有显著性。交互作用显示，焦虑的影响主要在女性中出现。NS在3个月时发生PCS的比值比为3.1。
MTBI后，女性的焦虑和NS是PCS的重要预测因素。其他身体症状虽然更普遍，但对PCS的预测性较差。
