Rabinowitz Amanda R, Li Xiaoqi, McCauley Stephen R, Wilde Elisabeth A, Barnes Amanda, Hanten Gerri, Mendez Donna, McCarthy James J, Levin Harvey S
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.
J Neurotrauma. 2015 Oct 1;32(19):1488-96. doi: 10.1089/neu.2014.3555. Epub 2015 Jul 17.
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.
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。