Zatzick Douglas F, Rivara Frederick P, Jurkovich Gregory J, Hoge Charles W, Wang Jin, Fan Ming-Yu, Russo Joan, Trusz Sarah Geiss, Nathens Avery, Mackenzie Ellen J
Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, 98104, USA.
Arch Gen Psychiatry. 2010 Dec;67(12):1291-300. doi: 10.1001/archgenpsychiatry.2010.158.
Few large-scale, multisite investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms and health outcomes across the spectrum of patients with mild, moderate, and severe traumatic brain injury (TBI).
To understand the risk of developing PTSD symptoms and to assess the impact of PTSD on the development of health and cognitive impairments across the full spectrum of TBI severity.
Multisite US prospective cohort study.
Eighteen level I trauma centers and 51 non-trauma center hospitals.
A total of 3047 (weighted n = 10 372) survivors of multiple traumatic injuries between the ages of 18 and 84 years.
Severity of TBI was categorized from chart-abstracted International Classification of Diseases, Ninth Revision, Clinical Modification codes. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist 12 months after injury. Self-reported outcome assessment included the 8 Medical Outcomes Study 36-Item Short Form Health Survey health status domains and a 4-item assessment of cognitive function at telephone interviews 3 and 12 months after injury.
At the time of injury hospitalization, 20.5% of patients had severe TBI, 11.7% moderate TBI, 12.9% mild TBI, and 54.9% no TBI. Patients with severe (relative risk, 0.72; 95% confidence interval, 0.58-0.90) and moderate (0.63; 0.44-0.89) TBI, but not mild TBI (0.83; 0.61-1.13), demonstrated a significantly diminished risk of PTSD symptoms relative to patients without TBI. Across TBI categories, in adjusted analyses patients with PTSD demonstrated an increased risk of health status and cognitive impairments when compared with patients without PTSD.
More severe TBI was associated with a diminished risk of PTSD. Regardless of TBI severity, injured patients with PTSD demonstrated the greatest impairments in self-reported health and cognitive function. Treatment programs for patients with the full spectrum of TBI severity should integrate intervention approaches targeting PTSD.
很少有大规模、多中心的调查评估过轻度、中度和重度创伤性脑损伤（TBI）患者群体中创伤后应激障碍（PTSD）症状的发展及健康结局。
了解发生PTSD症状的风险，并评估PTSD对整个TBI严重程度范围内健康和认知障碍发展的影响。
美国多中心前瞻性队列研究。
18家一级创伤中心和51家非创伤中心医院。
共3047名（加权n = 10372）年龄在18至84岁之间的多发创伤幸存者。
TBI严重程度根据从病历摘要中提取的《国际疾病分类（第九版）临床修订本》编码进行分类。受伤12个月后，使用PTSD检查表评估与DSM-IV诊断的PTSD一致的症状。自我报告的结局评估包括8个医学结局研究36项简短健康调查健康状况领域，以及在受伤后3个月和12个月电话访谈时进行的4项认知功能评估。
在受伤住院时，20.5%的患者患有重度TBI，11.7%患有中度TBI，12.9%患有轻度TBI，54.9%没有TBI。与没有TBI的患者相比，重度（相对风险，0.72；95%置信区间，0.58 - 0.90）和中度（0.63；0.44 - 0.89）TBI患者发生PTSD症状的风险显著降低，但轻度TBI患者（0.83；0.61 - 1.13）并非如此。在调整分析中，与没有PTSD的患者相比，各TBI类别中患有PTSD的患者出现健康状况和认知障碍的风险增加。
更严重的TBI与PTSD风险降低相关。无论TBI严重程度如何，患有PTSD的受伤患者在自我报告的健康和认知功能方面受损最大。针对整个TBI严重程度范围患者的治疗方案应纳入针对PTSD的干预方法。
