Jodoin Marianne, Rouleau Dominique M, Charlebois-Plante Camille, Benoit Benoit, Leduc Stéphane, Laflamme G-Yves, Gosselin Nadia, Larson-Dupuis Camille, De Beaumont Louis
Research Center in Neuropsychology and Cognition (CERNEC), Department of Psychology, University of Montreal, Montreal, Quebec, Canada; Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada.
Montreal Sacred Heart Hospital Research Centre, Montreal, Quebec, Canada; Department of Surgery, University of Montreal, Montreal, Quebec, Canada, Canada.
Injury. 2016 Aug;47(8):1835-40. doi: 10.1016/j.injury.2016.05.036. Epub 2016 May 27.
This study compares the incidence rate of mild traumatic brain injury (mild TBI) detected at follow-up visits (retrospective diagnosis) in patients suffering from an isolated limb trauma, with the incidence rate held by the hospital records (prospective diagnosis) of the sampled cohort. This study also seeks to determine which types of fractures present with the highest incidence of mild TBI.
Retrospective assessment of mild TBI among orthopaedic monotrauma patients, randomly selected for participation in an Orthopaedic clinic of a Level I Trauma Hospital. Patients in the remission phase of a limb fracture were recruited between August 2014 and May 2015. No intervention was done (observational study).
Standardized semi-structured interviews were conducted with all patients to retrospectively assess for mild TBI at the time of the fracture. Emergency room related medical records of all patients were carefully analyzed to determine whether a prospective mild TBI diagnosis was made following the accident.
A total of 251 patients were recruited (54% females, Mean age=49). Study interview revealed a 23.5% incidence rate of mild TBI compared to an incidence rate of 8.8% for prospective diagnosis (χ(2)=78.47; p<0.0001). Patients suffering from an upper limb monotrauma (29.6%; n=42/142) are significantly more at risk of sustaining a mild TBI compared to lower limb fractures (15.6%; n=17/109) (χ(2)=6.70; p=0.010). More specifically, patients with a proximal upper limb injury were significantly more at risk of sustaining concomitant mild TBI (40.6%; 26/64) compared to distal upper limb fractures (20.25%; 16/79) (χ(2)=7.07; p=0.008).
Results suggest an important concomitance of mild TBI among orthopaedic trauma patients, the majority of which go undetected during acute care. Patients treated for an upper limb fracture are particularly at risk of sustaining concomitant mild TBI.
本研究比较了单纯肢体创伤患者随访时（回顾性诊断）检测到的轻度创伤性脑损伤（轻度TBI）发病率与抽样队列医院记录（前瞻性诊断）中的发病率。本研究还试图确定哪种类型的骨折伴发轻度TBI的发生率最高。
对一家一级创伤医院骨科门诊随机选取参与研究的单纯创伤患者进行轻度TBI的回顾性评估。2014年8月至2015年5月招募肢体骨折缓解期的患者。未进行干预（观察性研究）。
对所有患者进行标准化半结构化访谈，以回顾性评估骨折时的轻度TBI情况。仔细分析所有患者的急诊室相关病历，以确定事故后是否做出前瞻性轻度TBI诊断。
共招募251例患者（54%为女性，平均年龄=49岁）。研究访谈显示轻度TBI发病率为23.5%，而前瞻性诊断的发病率为8.8%（χ(2)=78.47；p<0.0001）。与下肢骨折（15.6%；n=17/109）相比，上肢单纯创伤患者发生轻度TBI的风险显著更高（29.6%；n=42/142）（χ(2)=6.70；p=0.010）。更具体地说，与上肢远端骨折（20.25%；16/79）相比，上肢近端损伤患者发生伴发轻度TBI的风险显著更高（40.6%；26/64）（χ(2)=7.07；p=0.008）。
结果表明骨科创伤患者中轻度TBI伴发情况较为重要，其中大多数在急性护理期间未被发现。接受上肢骨折治疗的患者尤其有发生伴发轻度TBI的风险。
