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轻度创伤性脑损伤恢复不佳的患病率及预测因素

Prevalence and Predictors of Poor Recovery from Mild Traumatic Brain Injury.

作者信息

Rabinowitz Amanda R, Li Xiaoqi, McCauley Stephen R, Wilde Elisabeth A, Barnes Amanda, Hanten Gerri, Mendez Donna, McCarthy James J, Levin Harvey S

机构信息

1 Department of Neurosurgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania.

2 Physical Medicine and Rehabilitation Alliance of Baylor College of Medicine and the University of Texas-Houston Medical School.

出版信息

J Neurotrauma. 2015 Oct 1;32(19):1488-96. doi: 10.1089/neu.2014.3555. Epub 2015 Jul 17.

Abstract

Although most patients with mild traumatic brain injury (mTBI) recover within 3 months, a subgroup of patients experience persistent symptoms. Yet, the prevalence and predictors of persistent dysfunction in patients with mTBI remain poorly understood. In a longitudinal study, we evaluated predictors of symptomatic and cognitive dysfunction in adolescents and young adults with mTBI, compared with two control groups-patients with orthopedic injuries and healthy uninjured individuals. Outcomes were assessed at 3 months post-injury. Poor symptomatic outcome was defined as exhibiting a symptom score higher than 90% of the orthopedic control (OC) group, and poor cognitive outcome was defined as exhibiting cognitive performance poorer than 90% of the OC group. At 3 months post-injury, more than half of the patients with mTBI (52%) exhibited persistently elevated symptoms, and more than a third (36.4%) exhibited poor cognitive outcome. The rate of high symptom report in mTBI was markedly greater than that of typically developing (13%) and OC (17%) groups; the proportion of those with poor cognitive performance in the mTBI group exceeded that of typically developing controls (15.8%), but was similar to that of the OC group (34.9%). Older age at injury, female sex, and acute symptom report were predictors of poor symptomatic outcome at 3 months. Socioeconomic status was the only significant predictor of poor cognitive outcome at 3 months.

摘要

虽然大多数轻度创伤性脑损伤(mTBI)患者在3个月内康复,但仍有一小部分患者会出现持续症状。然而,mTBI患者持续功能障碍的患病率和预测因素仍知之甚少。在一项纵向研究中,我们评估了mTBI青少年和年轻人出现症状性和认知功能障碍的预测因素,并与两个对照组——骨科损伤患者和健康未受伤个体进行了比较。在受伤后3个月评估结果。症状性预后不良定义为症状评分高于骨科对照组(OC)的90%,认知预后不良定义为认知表现低于OC组的90%。在受伤后3个月,超过一半的mTBI患者(52%)症状持续升高,超过三分之一(36.4%)认知预后不良。mTBI患者高症状报告率明显高于正常发育组(13%)和OC组(17%);mTBI组认知表现不佳的比例超过正常发育对照组(15.8%),但与OC组(34.9%)相似。受伤时年龄较大、女性以及急性症状报告是3个月时症状性预后不良的预测因素。社会经济地位是3个月时认知预后不良的唯一显著预测因素。

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