创伤后遗忘持续时间可预测复杂轻度创伤性脑损伤的神经心理学及整体预后。
Duration of Posttraumatic Amnesia Predicts Neuropsychological and Global Outcome in Complicated Mild Traumatic Brain Injury.
作者信息
Hart Tessa, Novack Thomas A, Temkin Nancy, Barber Jason, Dikmen Sureyya S, Diaz-Arrastia Ramon, Ricker Joseph, Hesdorffer Dale C, Jallo Jack, Hsu Nancy H, Zafonte Ross
机构信息
Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Hart); Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham (Dr Novack); Neurological Surgery and Biostatistics (Dr Temkin), Neurological Surgery (Mr Barber), Department of Rehabilitation Medicine, (Dr Dikmen), University of Washington, Seattle; Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Diaz-Arrastia); Department of Rehabilitation Medicine, NYU School of Medicine, New York (Dr Ricker); GH Sergievsky Center and Department of Epidemiology, Columbia University, New York (Dr Hesdorffer); Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania (Dr Jallo); Department of Physical Medicine & Rehabilitation, Virginia Commonwealth University, Richmond, Virginia (Dr Hsu); and Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston (Dr Zafonte).
出版信息
J Head Trauma Rehabil. 2016 Nov/Dec;31(6):E1-E9. doi: 10.1097/HTR.0000000000000210.
OBJECTIVES
Examine the effects of posttraumatic amnesia (PTA) duration on neuropsychological and global recovery from 1 to 6 months after complicated mild traumatic brain injury (cmTBI).
PARTICIPANTS
A total of 330 persons with cmTBI defined as Glasgow Coma Scale score of 13 to 15 in emergency department, with well-defined abnormalities on neuroimaging.
METHODS
Enrollment within 24 hours of injury with follow-up at 1, 3, and 6 months.
MEASURES
Glasgow Outcome Scale-Extended, California Verbal Learning Test II, and Controlled Oral Word Association Test. Duration of PTA was retrospectively measured with structured interview at 30 days postinjury.
RESULTS
Despite all having a Glasgow Coma Scale Score of 13 to 15, a quarter of the sample had a PTA duration of greater than 7 days; half had PTA duration of 1 of 7 days. Both cognitive performance and Extended Glasgow Outcome Scale outcomes were strongly associated with time since injury and PTA duration, with those with PTA duration of greater than 1 week showing residual moderate disability at 6-month assessment.
CONCLUSIONS
Findings reinforce importance of careful measurement of duration of PTA to refine outcome prediction and allocation of resources to those with cmTBI. Future research would benefit from standardization in computed tomographic criteria and use of severity indices beyond Glasgow Coma Scale to characterize cmTBI.
目的
研究创伤后遗忘（PTA）持续时间对复杂轻度创伤性脑损伤（cmTBI）后1至6个月神经心理和整体恢复的影响。
参与者
共有330例cmTBI患者，其在急诊科的格拉斯哥昏迷量表评分为13至15分，神经影像学检查有明确异常。
方法
受伤后24小时内入组，在1、3和6个月进行随访。
测量指标
格拉斯哥结局量表扩展版、加利福尼亚言语学习测验第二版和受控口语词汇联想测验。受伤后30天通过结构化访谈回顾性测量PTA持续时间。
结果
尽管所有患者的格拉斯哥昏迷量表评分为13至15分，但四分之一的样本PTA持续时间超过7天；一半患者的PTA持续时间为1至7天。认知表现和格拉斯哥结局量表扩展版结果均与受伤时间和PTA持续时间密切相关，PTA持续时间超过1周的患者在6个月评估时仍有中度残疾。
结论
研究结果强化了仔细测量PTA持续时间对改善cmTBI患者结局预测和资源分配的重要性。未来的研究将受益于计算机断层扫描标准的标准化以及使用除格拉斯哥昏迷量表之外的严重程度指数来描述cmTBI。
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