Yue John K, Rick Jonathan W, Morrissey Molly Rose, Taylor Sabrina R, Deng Hansen, Suen Catherine G, Vassar Mary J, Cnossen Maryse C, Lingsma Hester F, Yuh Esther L, Mukherjee Pratik, Gardner Raquel C, Valadka Alex B, Okonkwo David O, Cage Tene A, Manley Geoffrey T
Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
NeuroRehabilitation. 2018;43(2):169-182. doi: 10.3233/NRE-172375.
Preinjury employment status may contribute to disparity, injury risk, and recovery patterns following mild traumatic brain injury (MTBI).
To characterize associations between preinjury unemployment, prior comorbidities, and outcomes following MTBI.
MTBI patients from TRACK-TBI Pilot with complete six-month outcomes were extracted. Preinjury unemployment, comorbidities, injury factors, and intracranial pathology were considered. Multivariable regression was performed for employment and outcomes, correcting for demographic and injury factors. Mean-differences (B) and 95% CIs are reported. Statistical significance was assessed at p < 0.05.
162 MTBI patients were aged 39.8±15.4-years and 24.6% -unemployed. Unemployed patients demonstrated increased psychiatric comorbidities (45.0% -vs.- 23.8%; p = 0.010), drug use (52.5% -vs.- 21.3%; p < 0.001), smoking (62.5% -vs.- 27.0%; p < 0.001), prior TBI (78.4% -vs.- 55.0%; p = 0.012), and lower education (15.0% -vs.- 45.1% college degree; p = 0.003). On multivariable analysis, unemployment associated with decreased six-month functional outcome (Glasgow Outcome Scale-Extended: B = - 0.50, 95% CI [- 0.88, - 0.11]), increased psychiatric disturbance (Brief Symptom Inventory-18: B = 6.22 [2.33, 10.10]), postconcussional symptoms (Rivermead Questionnaire: B = 4.91 [0.38, 9.44]), and post-traumatic stress disorder (PTSD Checklist-Civilian: B = 5.99 [0.76, 11.22]). No differences were observed for cognitive measures or satisfaction with life.
Unemployed patients are at risk for preinjury psychosocial comorbidities, poorer six-month functional recovery and increased psychiatric/postconcussional/PTSD symptoms. Resource allocation and return precautions should be implemented to mitigate and/or prevent the decline of at-risk patients.
受伤前的就业状况可能导致轻度创伤性脑损伤（MTBI）后的差异、受伤风险和恢复模式。
描述受伤前失业、先前的合并症与MTBI后结果之间的关联。
从TRACK-TBI试点研究中提取有完整六个月结果的MTBI患者。考虑受伤前的失业情况、合并症、损伤因素和颅内病变。对就业情况和结果进行多变量回归分析，并对人口统计学和损伤因素进行校正。报告平均差异（B）和95%置信区间。以p<0.05评估统计学显著性。
162例MTBI患者年龄为39.8±15.4岁，24.6%为失业状态。失业患者的精神合并症增加（45.0%对23.8%；p=0.010）、药物使用增加（52.5%对21.3%；p<0.001）、吸烟增加（62.5%对27.0%；p<0.001）、既往有创伤性脑损伤（78.4%对55.0%；p=0.012），且受教育程度较低（大学学位者为15.0%对45.1%；p=0.003）。多变量分析显示，失业与六个月功能结局下降相关（格拉斯哥扩展结局量表：B=-0.50，95%置信区间[-0.88，-0.11]）、精神障碍增加（简明症状量表-18：B=6.22[2.33，10.10]）、脑震荡后症状（Rivermead问卷：B=4.91[0.38，9.44]）和创伤后应激障碍（PTSD检查表-平民版：B=5.99[0.76，11.22]）。在认知测量或生活满意度方面未观察到差异。
失业患者存在受伤前心理社会合并症风险、六个月功能恢复较差以及精神/脑震荡后/PTSD症状增加的风险。应实施资源分配和回归预防措施，以减轻和/或防止高危患者的病情恶化。
