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创伤性脑损伤后的病假。是个人还是诊断对病假的影响更大?

Sick leave after traumatic brain injury. The person or the diagnosis--which has greater impact?

机构信息

Department of Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.

出版信息

Scand J Public Health. 2010 Jul;38(5):541-7. doi: 10.1177/1403494810371143. Epub 2010 May 19.

Abstract

PURPOSE

The aim of this study was to describe if and when a sample of traumatic brain injury (TBI) patients could finish their time of sick leave during a 4-year follow up and to explore which factors that influenced the time for sick leave.

MATERIALS AND METHODS

All persons, 1999-2002, between 18 and 64 years of age (250 in total), admitted to the emergency room and diagnosed according to ICD 10 as S062 and S063, were included. Demographic data were gathered from medical charts and data concerning sick leave 1 year before trauma and 4 years after trauma, were collected from the Swedish social insurance system. To explore predictors of sick leave, two logistic regressions were performed.

RESULTS

The sample (mean age 39.68) consisted of 78% men. More than half of the accidents were due to fall. In the sample, 28 % was on sick leave on the day of trauma and 96 % of these were still on sick leave 4 years after trauma, compared with 39 % in the group not on sick leave on the day of TBI. Sick leave at the day for trauma was found to be a predictor for sick leave 4 years after trauma for the whole group (p = 0.000) together with Glasgow Coma Scale (GCS) (p = 0.002) and length of stay (p = 0.049). In the logistic regression with only the group not on sick leave, the only significant variable was GCS (p = 0.003).

CONCLUSION

The findings support the necessity to consider premorbid and social factors in the TBI rehabilitation.

摘要

目的

本研究旨在描述创伤性脑损伤(TBI)患者在 4 年随访期间是否能够结束病假,如果可以,描述其结束病假的时间,并探讨影响病假时间的因素。

材料和方法

纳入标准为 1999-2002 年期间年龄在 18-64 岁之间(共 250 人)、因 ICD 10 编码为 S062 和 S063 而被急诊室收治的 TBI 患者。从病历中收集人口统计学数据,从瑞典社会保险系统中收集创伤前 1 年和创伤后 4 年的病假数据。为了探讨病假的预测因素,进行了两次逻辑回归分析。

结果

该样本(平均年龄 39.68 岁)中男性占 78%。超过一半的事故是由跌倒引起的。在样本中,28%的患者在创伤当天处于病假状态,而 96%的患者在创伤后 4 年仍处于病假状态,而在未在创伤当天处于病假状态的患者中,这一比例为 39%。创伤当天的病假状态是整个样本 4 年后病假状态的预测因素(p=0.000),与格拉斯哥昏迷量表(GCS)(p=0.002)和住院时间(p=0.049)相关。在仅包括未处于病假状态的患者的逻辑回归中,唯一显著的变量是 GCS(p=0.003)。

结论

这些发现支持在 TBI 康复中考虑发病前和社会因素的必要性。

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