Korley Frederick K, Diaz-Arrastia Ramon, Falk Hayley J, Peters Matthew E, Leoutsakos Jeannie-Marie S, Roy Durga, Rao Vani, Sair Haris Iqbal, Ofoche Uju, Hall Anna J, Akbari Freshta, Van Meter Timothy E, Everett Allen D, Van Eyk Jennifer E, Bechtold Kathleen T
1 Department of Emergency Medicine, University of Michigan Medical School , Ann Arbor, Michigan.
2 Department of Neurology, University of Pennsylvania Perelman School of Medicine , Penn Presbyterian Medical Center, Philadelphia, Pennsylvania.
J Neurotrauma. 2017 Apr 15;34(8):1531-1538. doi: 10.1089/neu.2016.4723. Epub 2016 Dec 20.
Head injury patients not meeting the American Congress of Rehabilitation Medicine (ACRM)'s criteria for mild traumatic brain injury (mTBI), referred to hereafter as HIBRID (Head Injury BRain Injury Debatable), are often excluded from studies. The prognostic importance of HIBRID is unclear. We investigated the differences in functional and symptomatic recovery at 1 month post-injury among TBI patients classified as: HIBRID, ACRM+ cranial computed tomography (CT)-, and cranial CT+; and trauma and healthy controls. Subjects were enrolled in an ongoing prospective cohort (Head Injury Serum Markers for Assessing Response to Trauma; HeadSMART). Outcomes measured at 1 month post-injury include: incomplete functional recovery (Glasgow Outcome Scale Extended <8); moderate/severe post-concussive symptoms (PCS), defined according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision definition; and moderate/severe depressive symptoms (Patient Health Questionnaire 9 ≥ 10). Between April 2014 and May 2016, 500 TBI and 100 control subjects were enrolled and 376 TBI and 78 control subjects completed outcome assessment. The HIBRID group, constituting 23.9% of study population, had a lower incidence of incomplete functional recovery (36.7% [33 of 90]) than ACRM+, CT- (60.7% [125 of 206]; p < 0.01) and CT+ (78.8% [63 of 80]; p < 0.01) groups. However, the incidence of delayed functional recovery within the HIBRID group was higher than in trauma (9.3% [5 of 54]; p < 0.01) and healthy controls (0% [0 of 24]; p < 0.01). Compared to trauma/healthy controls, the HIBRID group had a higher incidence of moderate/severe depressive symptoms and a similar incidence of moderate/severe PCS. Subjects in the HIBRID group are at high risk for adverse outcomes following head injury and warrant further investigation.
不符合美国康复医学学会（ACRM）轻度创伤性脑损伤（mTBI）标准的颅脑损伤患者（以下简称HIBRID，即颅脑损伤争议性脑损伤）通常被排除在研究之外。HIBRID的预后重要性尚不清楚。我们调查了在损伤后1个月时，被分类为HIBRID、ACRM+头颅计算机断层扫描（CT）阴性和头颅CT阳性的创伤性脑损伤（TBI）患者，以及创伤对照组和健康对照组在功能和症状恢复方面的差异。研究对象纳入了一项正在进行的前瞻性队列研究（用于评估创伤反应的颅脑损伤血清标志物；HeadSMART）。损伤后1个月测量的结果包括：功能恢复不完全（扩展格拉斯哥预后量表<8）；中度/重度脑震荡后症状（PCS），根据《疾病和相关健康问题国际统计分类》第十次修订版定义；以及中度/重度抑郁症状（患者健康问卷9≥10）。在2014年4月至2016年5月期间，纳入了500例TBI患者和100例对照对象，并对376例TBI患者和78例对照对象完成了结局评估。HIBRID组占研究人群的23.9%，其功能恢复不完全的发生率（36.7%[90例中的33例]）低于ACRM+、CT阴性组（60.7%[206例中的125例]；p<0.01）和CT阳性组（78.8%[80例中的63例]；p<0.01）。然而，HIBRID组内延迟功能恢复的发生率高于创伤对照组（9.3%[54例中的5例]；p<0.01）和健康对照组（0%[24例中的0例]；p<0.01）。与创伤/健康对照组相比，HIBRID组中度/重度抑郁症状的发生率较高，中度/重度PCS的发生率相似。HIBRID组中的患者在颅脑损伤后出现不良结局的风险较高，值得进一步研究。
