Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark; Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Arch Phys Med Rehabil. 2014 Mar;95(3 Suppl):S132-51. doi: 10.1016/j.apmr.2013.08.299.
To update the mild traumatic brain injury (MTBI) prognosis review published by the World Health Organization Task Force in 2004.
MEDLINE, PsycINFO, Embase, CINAHL, and SPORTDiscus were searched from 2001 to 2012. We included published, peer-reviewed studies with more than 30 adult cases.
Controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to assess subjective, self-reported outcomes. After 77,914 titles and abstracts were screened, 299 articles were eligible and reviewed for scientific quality. This includes 3 original International Collaboration on MTBI Prognosis (ICoMP) research studies.
Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Two reviewers independently reviewed each study and tabled data from accepted articles. A third reviewer was consulted for disagreements.
Evidence from accepted studies was synthesized qualitatively into key findings, and prognostic information was prioritized according to design as exploratory or confirmatory. Of 299 reviewed studies, 101 (34%) were accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including 2 of the 3 original ICoMP research studies. These studies show that common postconcussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor recovery after MTBI is associated with poorer premorbid mental and physical health status and with more injury-related stress. Most recover over 1 year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress.
Common subjective symptoms after MTBI are not necessarily caused by brain injury per se, but they can be persistent in some patients. Those with more initial complaints and psychological distress recover slower. We need more high-quality research on these issues.
更新世界卫生组织 2004 年发布的轻度创伤性脑损伤（MTBI）预后综述。
从 2001 年到 2012 年，我们在 MEDLINE、PsycINFO、Embase、CINAHL 和 SPORTDiscus 上进行了搜索。我们纳入了发表的、同行评议的、超过 30 例成人病例的研究。
根据预设标准选择了对照试验和队列及病例对照研究。这些研究必须评估主观的、自我报告的结果。在筛选了 77914 篇标题和摘要后，有 299 篇文章符合条件，并对其进行了科学质量的审查。这包括 3 项国际 MTBI 预后协作（ICoMP）的原始研究。
使用苏格兰校际指南网络标准对合格的研究进行了批判性评价。两名审查员独立审查了每项研究，并列出了被接受文章的数据。对于有分歧的研究，咨询了第三位审查员。
将合格研究的证据从关键发现中进行了定性综合，并根据设计将预后信息分为探索性或验证性。在审查的 299 项研究中，有 101 项（34%）被接受，并构成了我们预后研究的证据基础。其中 23 项研究涉及成人自我报告的结果，包括 3 项原始 ICoMP 研究中的 2 项。这些研究表明，常见的脑震荡后症状并不一定是 MTBI/脑震荡本身引起的，也会在其他损伤后出现。MTBI 后恢复不良与较差的前期精神和身体健康状况以及更多与损伤相关的压力有关。大多数人在 1 年内恢复，但在初始症状更严重和情绪压力更大的患者中，持续的症状更有可能出现。
MTBI 后常见的主观症状本身不一定是由脑损伤引起的，但在一些患者中可能持续存在。那些初始症状和心理困扰更多的患者恢复较慢。我们需要更多关于这些问题的高质量研究。
