Jourdan C, Bosserelle V, Azerad S, Ghout I, Bayen E, Aegerter P, Weiss J J, Mateo J, Lescot T, Vigué B, Tazarourte K, Pradat-Diehl P, Azouvi P
Service de Médecine Physique et de Réadaptation, APHP Hôpital Raymond Poincaré, Garches, France.
Brain Inj. 2013;27(9):1000-7. doi: 10.3109/02699052.2013.794971. Epub 2013 Jun 3.
To assess outcome and predicting factors 1 year after a severe traumatic brain injury (TBI).
Multi-centre prospective inception cohort study of patients aged 15 or older with a severe TBI in the Parisian area, France. Data were collected prospectively starting the day of injury. One-year evaluation included the relatives-rating of the Dysexecutive Questionnaire (DEX-R), the Glasgow Outcome Scale-Extended (GOSE) and employment. Univariate and multivariate tests were computed.
Among 257 survivors, 134 were included (mean age 36 years, 84% men). Good recovery concerned 19%, moderate disability 43% and severe disability 38%. Among patients employed pre-injury, 42% were working, 28% with no job change. DEX-R score was significantly associated with length of education only. Among initial severity measures, only the IMPACT prognostic score was significantly related to GOSE in univariate analyses, while measures relating to early evolution were more significant predictors. In multivariate analyses, independent predictors of GOSE were length of stay in intensive care (LOS), age and education. Independent predictors of employment were LOS and age.
Age, education and injury severity are independent predictors of global disability and return to work 1 year after a severe TBI.
评估重度创伤性脑损伤（TBI）1年后的预后及预测因素。
对法国巴黎地区15岁及以上重度TBI患者进行多中心前瞻性起始队列研究。从受伤当天开始前瞻性收集数据。1年评估包括亲属对执行功能障碍问卷（DEX-R）的评分、格拉斯哥扩展预后量表（GOSE）和就业情况。进行单变量和多变量检验。
在257名幸存者中，纳入了134名（平均年龄36岁，84%为男性）。恢复良好的占19%，中度残疾的占43%，重度残疾的占38%。在伤前就业的患者中，42%仍在工作，28%工作岗位未变。DEX-R评分仅与受教育年限显著相关。在初始严重程度指标中，单变量分析中只有IMPACT预后评分与GOSE显著相关，而与早期病情演变相关的指标是更显著的预测因素。多变量分析中，GOSE的独立预测因素是重症监护病房住院时间（LOS）、年龄和受教育程度。就业的独立预测因素是LOS和年龄。
年龄、受教育程度和损伤严重程度是重度TBI 1年后总体残疾和重返工作的独立预测因素。
