创伤后综合征的预期病程：轻度创伤性脑损伤的作用。

The prospective course of postconcussion syndrome: the role of mild traumatic brain injury.

机构信息

Department of Psychology, Macquarie University, Sydney, Australia.

出版信息

Neuropsychology. 2011 Jul;25(4):454-65. doi: 10.1037/a0022580.

DOI:10.1037/a0022580

PMID:21574719

Abstract

OBJECTIVE

To investigate whether postconcussion syndrome (PCS) represents long-term sequelae associated with mild traumatic brain injury (mTBI).

METHODS

Prospective consecutive admissions to a Level 1 trauma hospital were assessed a mean 4.9 days and again 106.2 days post-injury. The final sample comprised 62 mTBI and 58 nonbrain injured trauma controls (TC). Change or lack of change in individual PCS-like symptoms and PCS was examined. Multilevel logistic regression was used to analyze whether mTBI predicts 3-month PCS (Time 2; T2); whether predictors of PCS (within 14 days of injury, Time 1; T1) predict 3-month PCS, and how change in these predictors from T1 to T2 were associated with change in PCS status. Variables included demographic, injury-related, financial incentives, neuropsychological, and psychiatric disorder.

RESULTS

MTBI did not predict PCS. PCS was comparable (T1: mTBI: 40.3%, TC: 50.0%; T2: mTBI: 46.8%, TC: 48.3%). At T2, 38.6% were new cases of PCS; between 30.8% and 86.2% reported either a new or more frequent symptom. A pre-injury depressive or anxiety disorder (OR = 2.99, 95% CI [1.38, 6.45]), and acute posttraumatic stress (OR = 1.05, 95% CI [1.00, 1.00]) were early markers of PCS, regardless of mTBI. An interaction between time and posttraumatic stress disorder (PTSD) suggested the relationship between the severity of PTSD symptoms and PCS strengthened over time (OR = 2.66, 95% CI [1.08, 6.55]). Pain was related to PCS. Females were more likely than males to have PCS.

CONCLUSION

The data suggest the phenomenon of PCS in trauma patients does not show an association with mTBI.

摘要

目的

探讨脑震荡后综合征（PCS）是否代表与轻度创伤性脑损伤（mTBI）相关的长期后遗症。

方法

对一家 1 级创伤医院的连续入院患者进行评估，平均在受伤后 4.9 天和 106.2 天再次进行评估。最终样本包括 62 例 mTBI 和 58 例非脑外伤对照（TC）。检查个体类似 PCS 的症状和 PCS 的变化或不变。多水平逻辑回归用于分析 mTBI 是否预测 3 个月 PCS（时间 2；T2）；受伤后 14 天内的 PCS 预测因子（时间 1；T1）是否预测 3 个月 PCS，以及这些预测因子从 T1 到 T2 的变化与 PCS 状态的变化有何关联。变量包括人口统计学、与损伤相关、经济激励、神经心理学和精神障碍。

结果

mTBI 并未预测 PCS。PCS 在 T1 时（mTBI：40.3%，TC：50.0%）和 T2 时（mTBI：46.8%，TC：48.3%）均相似。在 T2 时，38.6%出现新的 PCS 病例；30.8%至 86.2%报告出现新的或更频繁的症状。受伤前患有抑郁或焦虑障碍（OR=2.99，95%CI[1.38,6.45]）和急性创伤后应激（OR=1.05，95%CI[1.00,1.00]）是 PCS 的早期标志物，与 mTBI 无关。创伤后应激障碍（PTSD）与时间之间的相互作用表明，PTSD 症状的严重程度与 PCS 之间的关系随着时间的推移而增强（OR=2.66，95%CI[1.08,6.55]）。疼痛与 PCS 有关。女性发生 PCS 的可能性大于男性。