Andelic Nada, Jerstad Tone, Sigurdardottir Solrun, Schanke Anne-Kristine, Sandvik Leiv, Roe Cecilie
Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway.
J Trauma Manag Outcomes. 2010 May 26;4:6. doi: 10.1186/1752-2897-4-6.
The aims of this study were to describe the occurrence of substance use at the time of injury and pre-injury substance abuse in patients with moderate-to-severe traumatic brain injury (TBI). Effects of acute substance use and pre-injury substance abuse on TBI severity were also investigated.
A prospective study of 111 patients, aged 16-55 years, injured from May 2005 to May 2007 and hospitalised at the Trauma Referral Centre in Eastern Norway with acute TBI (Glasgow Coma Scale 3-12). Based on structural brain damages shown on a computed tomography (CT) scan, TBI severity was defined by modified Marshall classification as less severe (score <3) and more severe (score >/=3). Clinical definition of substance use (alcohol and/or other psychoactive substances) was applied when hospital admission records reflected blood alcohol levels or a positive drug screen, or when a physician verified influence by examining the patient. Pre-injury substance abuse (alcohol and drug problems) was screened by using the CAGE questionnaire.
Forty-seven percent of patients were positive for substance use on admission to hospital. Significant pre-injury substance abuse was reported by 26% of patients. Substance use at the time of injury was more frequent in the less severe group (p = 0.01). The frequency of pre-injury substance abuse was higher in the more severe group (30% vs. 23%). In a logistic regression model, acute substance use at time of injury tended to decrease the probability of more severe intracranial injury, but the effect was not statistically significant after adjusting for age, gender, education, cause of injury and substance abuse, OR = 0.39; 95% CI 0.11-1.35, p = 0.14. Patients with positive screens for pre-injury substance abuse (CAGE >/=2) were more likely to have more severe TBI in the adjusted regression analyses, OR = 4.05; 95% CI 1.10-15.64, p = 0.04.
Acute substance use was more frequent in patients with less severe TBI caused by low-energy events such as falls, violence and sport accidents. Pre-injury substance abuse increased the probability of more severe TBI caused by high-energy trauma such as motor vehicle accidents and falls from higher levels. Preventive efforts to reduce substance consumption and abuse in at-risk populations are needed.
本研究旨在描述中度至重度创伤性脑损伤（TBI）患者受伤时物质使用情况及伤前物质滥用情况。还调查了急性物质使用和伤前物质滥用对TBI严重程度的影响。
对2005年5月至2007年5月期间受伤、年龄在16 - 55岁、因急性TBI（格拉斯哥昏迷量表评分为3 - 12分）入住挪威东部创伤转诊中心的111例患者进行前瞻性研究。根据计算机断层扫描（CT）显示的脑结构损伤，TBI严重程度通过改良马歇尔分类法定义为轻度（评分<3）和重度（评分≥3）。当入院记录显示血酒精水平或药物筛查呈阳性，或医生通过检查患者证实有影响时，采用物质使用（酒精和/或其他精神活性物质）的临床定义。使用CAGE问卷筛查伤前物质滥用（酒精和药物问题）。
47%的患者入院时物质使用呈阳性。26%的患者报告有明显的伤前物质滥用。轻度组受伤时物质使用更为频繁（p = 0.01）。重度组伤前物质滥用频率更高（30%对23%）。在逻辑回归模型中，受伤时急性物质使用倾向于降低重度颅内损伤的概率，但在调整年龄、性别、教育程度、损伤原因和物质滥用后，该效应无统计学意义，OR = 0.39；95% CI 0.11 - 1.35，p = 0.14。在调整后的回归分析中，伤前物质滥用筛查呈阳性（CAGE≥2）的患者更有可能患有重度TBI，OR = 4.05；95% CI 1.10 - 15.64，p = 0.04。
在因跌倒、暴力和体育事故等低能量事件导致的轻度TBI患者中，急性物质使用更为频繁。伤前物质滥用增加了因机动车事故和高处坠落等高能量创伤导致重度TBI的可能性。需要对高危人群采取预防措施以减少物质消费和滥用。
