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急性康复环境下创伤性脑损伤患者行为和认知缺陷的预测

Prediction of behavioural and cognitive deficits in patients with traumatic brain injury at an acute rehabilitation setting.

作者信息

de Guise E, LeBlanc J, Feyz M, Lamoureux J, Greffou S

机构信息

a Department of Psychology , University of Montreal , Montreal , QC , Canada.

b Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR) , Montreal , QC , Canada.

出版信息

Brain Inj. 2017;31(8):1061-1068. doi: 10.1080/02699052.2017.1297485. Epub 2017 May 8.

Abstract

OBJECTIVE

The goal of this study was to identify factors that would predict short-term neuropsychological outcome in patients with traumatic brain injury (TBI) hospitalized in an acute rehabilitation setting.

METHODS

Data was collected in the context of an acute early rehabilitation setting of a trauma centre. A brief neuropsychological assessment was carried out for 348 patients within a month following their trauma.

RESULTS

Length of post-traumatic amnesia (PTA) was the best predictor of behavioural, memory and executive function variables within a month post TBI. The odds of being agitated, labile, irritable and disinhibited at one month post trauma were almost six times higher for those with PTA that lasted more than 7 days compared to those with a PTA of less than 24 hours. Also, the odds of having a higher mental manipulation score (less significant executive function impairment) were almost two times lower for those with frontal lesions, and three to six times lower for those with PTA of more than 24 hours. In addition, TBI severity, education and age were considered good predictors of some aspects of neuropsychological outcome.

CONCLUSION

This model may help clinicians and administrators recognize the probable post-traumatic deficits as quickly as possible and to plan interventions as well as post-acute discharge orientation accordingly and early on.

摘要

目的

本研究的目的是确定能够预测在急性康复环境中住院的创伤性脑损伤(TBI)患者短期神经心理结果的因素。

方法

数据收集于创伤中心的急性早期康复环境中。对348例患者在创伤后一个月内进行了简短的神经心理评估。

结果

创伤后遗忘(PTA)的时长是TBI后一个月内行为、记忆和执行功能变量的最佳预测指标。与PTA少于24小时的患者相比,PTA持续超过7天的患者在创伤后一个月出现激动、情绪不稳定、易怒和去抑制的几率高出近六倍。此外,额叶病变患者的心理操作得分较高(执行功能损害较轻)的几率几乎低两倍,PTA超过24小时的患者则低三到六倍。另外,TBI严重程度、教育程度和年龄被认为是神经心理结果某些方面的良好预测指标。

结论

该模型可能有助于临床医生和管理人员尽快识别可能的创伤后缺陷,并据此尽早规划干预措施以及急性出院后的指导。

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