J Neurotrauma. 2014 Apr 1;31(7):658-69. doi: 10.1089/neu.2013.3160.
Clinical research into outcomes after traumatic brain injury (TBI) frequently combines injuries that have been sustained through different causes (e.g., car accidents, assaults, and falls), the effect of which is not well understood. This study examined the contribution of injury-related psychological trauma—which is more commonly associated with specific types of injuries—to outcomes after nonpenetrating TBI in order to determine whether it may be having a differential effect in samples containing mixed injuries. Data from three groups that were prospectively recruited for two larger studies were compared: one that sustained a TBI as a result of physical assaults (i.e., psychologically traumatizing) and another as a result of sporting injuries (i.e., nonpsychologically traumatizing), as well as an orthopedic control group (OC). Psychosocial and emotional (postconcussion symptoms, injury-related stress, and depression), cognitive (memory, abstract reasoning, problem solving, and verbal fluency), and functional (general outcome; resumption of home, social, and work roles) outcomes were all assessed. The TBI(assault) group reported significantly poorer psychosocial and emotional outcomes and higher rates of litigation (criminal rather than civil) than both the TBI(sport) and OC groups approximately 6 months postinjury, but there were no differences in the cognitive or functional outcomes of the three groups. The findings suggest that the cause of a TBI may assist in explaining some of the differences in outcomes of people who have seemingly comparable injuries. Involvement in litigation and the cause of an injury may also be confounded, which may lead to the erroneous conclusion that litigants have poorer outcomes.
创伤性脑损伤（TBI）后的临床研究经常合并因不同原因（如车祸、袭击和跌倒）导致的损伤，而这些损伤的影响尚未得到很好的理解。本研究旨在探讨与损伤相关的心理创伤对非穿透性 TBI 后结果的影响，以确定其在包含混合损伤的样本中是否具有不同的影响。本研究比较了三个前瞻性招募的研究小组的数据：一组因身体袭击（即心理创伤）而导致 TBI，另一组因运动损伤（即非心理创伤）而导致 TBI，以及骨科对照组（OC）。对心理社会和情感（脑震荡后症状、与损伤相关的压力和抑郁）、认知（记忆、抽象推理、解决问题和语言流畅性）和功能（一般结果；家庭、社会和工作角色的恢复）结局进行了评估。大约在损伤后 6 个月，TBI（袭击）组报告的心理社会和情感结局明显较差，且诉讼率（刑事而非民事）高于 TBI（运动）组和 OC 组，但三组在认知或功能结局方面没有差异。这些发现表明，TBI 的原因可能有助于解释一些看似具有相似损伤的患者的结局差异。诉讼的参与和损伤的原因也可能存在混杂，这可能导致错误地得出结论认为诉讼者的结局较差。
