Computer Assisted Radiology & Surgery Switzerland, University Hospital Basel, Switzerland.
Acta Anaesthesiol Scand. 2012 Oct;56(9):1163-74. doi: 10.1111/j.1399-6576.2012.02724.x. Epub 2012 Jun 26.
To investigate the long-term outcome in polytrauma victims with traumatic brain injury (TBI) and without traumatic brain injury (NTBI).
Cohort study based on prospectively collected data. Evaluation of functional outcome and quality of life at least 2 years (median 2.5) following trauma in 111 survivors [39.5 ± 20.9 years; injury severity score (ISS) 27.9 ± 8.2; TBI: n = 45; NTBI: n = 66] out of a total of 211 consecutive multiply-injured patients with an ISS > 16, all primarily admitted to the intensive care unit.
Significantly fewer TBI patients lived independently compared with NTBI patients (71% vs. 95%; P < 0.001). TBI patients showed a higher decrease in their capacity to work compared with NTBI patients (P < 0.002). Both study groups experienced a significantly reduced long-term outcome in comparison with pre-injury level in all dimensions of the short form (SF)-36. Following stepwise logistic regression, the mental sum component of the SF-36 and the Nottingham Health Profile discriminated independently between TBI and NTBI patients (R(2) = 0.219; P < 0.001).
More than 2 years after injury, polytraumatized patients with and without TBI suffer from a reduction in functional outcome and quality of life, but TBI patients are doing importantly worse. Any comparison of trauma patient cohorts should consider these differences between TBI and NTBI patients. Given their discriminatory potential, the sensitivity of self-reported measures needs further affirmation with neuropsychological assessments.
调查创伤性脑损伤（TBI）和非创伤性脑损伤（NTBI）的多发伤患者的长期预后。
基于前瞻性收集的数据进行队列研究。在 211 例连续多发伤患者（ISS > 16，所有患者均主要收入重症监护病房）中，评估至少 2 年（中位数 2.5 年）后 111 例存活者的功能结局和生活质量，其中包括 39.5 ± 20.9 岁，ISS 27.9 ± 8.2，TBI：n = 45；NTBI：n = 66。
与 NTBI 患者相比，TBI 患者独立生活的比例明显较低（71%比 95%；P < 0.001）。与 NTBI 患者相比，TBI 患者的工作能力下降更为明显（P < 0.002）。与受伤前相比，两组患者在所有 SF-36 维度的长期预后均明显下降。逐步逻辑回归后，SF-36 的心理总和成分和诺丁汉健康概况独立区分了 TBI 和 NTBI 患者（R(2) = 0.219；P < 0.001）。
多发伤患者在受伤 2 年以上后，无论是否患有 TBI，均会出现功能结局和生活质量下降，但 TBI 患者的情况明显更差。任何对创伤患者队列的比较都应考虑 TBI 和 NTBI 患者之间的这些差异。鉴于其潜在的鉴别能力，自我报告措施的敏感性需要进一步通过神经心理学评估来证实。
