Department of Rehabilitation Medicine, Hospital Sultan Ismail, Johor Bahru, Malaysia.
Disabil Rehabil. 2013 Aug;35(18):1546-51. doi: 10.3109/09638288.2012.748832. Epub 2013 Jan 7.
This study aims to describe the presence and severity of extracranial concomitant injuries in traumatic brain injury (TBI) patients and to ascertain their effect on long-term functional outcome.
A retrospective cohort study was performed in a single-center recruiting patients with first episode of TBI. The types and severity of extracranial concomitant injuries were documented for patients who fulfilled the inclusion criteria. Injuries with Abbreviated Injury Scale (AIS) grade 3-6 were considered to be high grade. A cross-sectional functional assessment was conducted at 18 months post-injury using Glasgow Outcome Scale.
A total of 100 patients were included in the analysis. Extracranial concomitant injuries were seen in 78% of the patients. Three commonest injuries were facial (44%), lower extremity (20%) and upper extremity (12%) injuries. Among the AIS grade ≥ 3, injury involving the chest was most common (41%). Presence of extracranial concomitant injuries AIS grade ≥ 3 was significantly associated with disability in TBI patients at 18 months (OR 12.74, 95% CI 2.39-67.95, p = 0.003).
Presence of extracranial concomitant injuries was high. In TBI survivors, extracranial concomitant injuries AIS grade ≥ 3 influenced the long-term functional outcome at 18 months, causing moderate and severe disabilities.
Concomitant injuries should be suspected in patients with traumatic brain injury, especially in a high-speed trauma mechanisms as the incidence can be as high as 78% as in this study and may interfere with the long term rehabilitation and outcome. This study shows that severe extra cranial concomitant injuries are associated with a poor long term functional outcome even in the mild traumatic brain injury patients and therefore need to be addressed early in the rehabilitation of this group of patients. Early diagnosis and management of severe concomitant injuries is warranted and may improve the functional gains in the long term after traumatic brain injury.
本研究旨在描述创伤性脑损伤（TBI）患者的颅外合并伤的存在和严重程度，并确定其对长期功能预后的影响。
这是一项单中心的回顾性队列研究，纳入了首次发生 TBI 的患者。对于符合纳入标准的患者，记录颅外合并伤的类型和严重程度。采用损伤严重程度评分（Abbreviated Injury Scale，AIS）3-6 级的损伤为高等级损伤。在损伤后 18 个月进行横断面功能评估，采用 Glasgow 结局量表（Glasgow Outcome Scale）。
共纳入 100 例患者进行分析。78%的患者存在颅外合并伤。最常见的三种损伤是面部（44%）、下肢（20%）和上肢（12%）损伤。在 AIS 分级≥3 的患者中，胸部损伤最常见（41%）。存在 AIS 分级≥3 的颅外合并伤与 TBI 患者 18 个月时的残疾显著相关（OR 12.74，95%CI 2.39-67.95，p=0.003）。
颅外合并伤的发生率较高。在 TBI 幸存者中，AIS 分级≥3 的颅外合并伤影响 18 个月时的长期功能预后，导致中度和重度残疾。
在创伤性脑损伤患者中应怀疑存在合并伤，尤其是在高速创伤机制中，如本研究中高达 78%的发生率，这可能会干扰长期康复和预后。本研究表明，即使是轻度创伤性脑损伤患者，严重的颅外合并伤与长期不良功能预后相关，因此需要在该组患者的康复早期进行干预。早期诊断和处理严重的合并伤是必要的，可能会改善创伤性脑损伤后长期的功能恢复。
