Steel Jennifer, Youssef Michael, Pfeifer Roman, Ramirez Juliana M, Probst Christian, Sellei Richard, Zelle Boris A, Sittaro Nicola-Alexander, Khalifa Farah, Pape Hans Christoph
Department of Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
J Trauma. 2010 Sep;69(3):523-30; discussion 530-1. doi: 10.1097/TA.0b013e3181e90c24.
The aim of this study was to examine the long-term physical and psychological consequences of multiple blunt forced trauma at ≥ 10-year follow-up for patients with and without traumatic brain injury (TBI).
A total of 620 patients with multiple injuries were assessed with the Medical Outcomes Study-Short Form-12 and a physical reexamination at ≥ 10-year follow-up. Injury-related characteristics were collected from patients' medical record. Chi-square analysis, Analysis of Variance, and linear and logistic regression were performed to test differences between groups and examine predictors of physical and psychological functioning at ≥ 10-year follow-up.
Patients with multiple injuries who sustained a TBI (n = 398) were more likely to be female (p = 0.001), younger in age at the time of injury (p = 0.02), have higher Injury Severity Scores (p = 0.001), shorter ward stays (p = 0.001), and a greater number of upper extremity injuries (p = 0.02) when compared with those without TBI (n = 222). Patients with TBI reported poorer psychological functioning (p = 0.02) and more frequently reported chronic pain (p = 0.01). Patients with TBI used medical aids (p = 0.002) less frequently at follow-up when compared with patients without TBI. Significant predictors of health-related quality of life at ≥ 10-year follow-up included age at the time of injury (physical; p = 0.001), gender (p = 0.05), number of ventilation days (p = 0.02), satisfaction with rehabilitation (p = 0.001), disability caused by the injury (p = 0.001), and use of medical aids (physical p = 0.02).
Prospective studies are needed with a broader range of measures that may be sensitive to the consequences of TBI. Evidence-based interventions to facilitate physical and psychological rehabilitation, designed to target at risk patients, are warranted.
本研究的目的是在≥10年的随访期内，对有和没有创伤性脑损伤（TBI）的患者，检查多处钝器强迫性创伤的长期身体和心理后果。
共有620例多处受伤患者在≥10年随访期时接受医学结果研究简表-12评估和体格复查。从患者病历中收集损伤相关特征。进行卡方分析、方差分析以及线性和逻辑回归，以检验组间差异，并检查≥10年随访期时身体和心理功能的预测因素。
与没有TBI的患者（n = 222）相比，遭受TBI的多处受伤患者（n = 398）更可能为女性（p = 0.001），受伤时年龄更小（p = 0.02），损伤严重程度评分更高（p = 0.001），住院时间更短（p = 0.001），上肢损伤数量更多（p = 0.02）。有TBI的患者报告心理功能较差（p = 0.02），且更频繁报告慢性疼痛（p = 0.01）。与没有TBI的患者相比，有TBI的患者在随访时使用医疗辅助器具的频率更低（p = 0.002）。≥10年随访期时健康相关生活质量的显著预测因素包括受伤时年龄（身体方面；p = 0.001）、性别（p = 0.05）、通气天数（p = 0.02）、对康复的满意度（p = 0.001）、损伤导致的残疾（p = 0.001）以及医疗辅助器具的使用（身体方面p = 0.02）。
需要开展前瞻性研究，采用更广泛的可能对TBI后果敏感的测量方法。有必要针对高危患者设计基于证据的干预措施，以促进身体和心理康复。
