College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.
PLoS One. 2019 Feb 7;14(2):e0211684. doi: 10.1371/journal.pone.0211684. eCollection 2019.
Assault is the third most common cause of traumatic brain injury (TBI), after falls and road traffic collisions. TBI can lead to multiple long-term physical, cognitive and emotional sequelae, including post-traumatic stress disorder (PTSD). Intentional violence may further compound the psychological trauma of the event, in a way that conventional outcome measures, like the Glasgow Outcome Scale (GOS), fail to capture. This study aims to examine the influence of assault on self-reported outcomes, including quality of life and symptoms of PTSD.
Questionnaire were completed by 256 patients attending a TBI clinic, including Quality of Life after Brain Injury (QOLIBRI) and PTSD checklist (PCL-C). Medical records provided demographics, clinical data and aetiology of injury. Subjective outcomes were compared between assault and other causes.
Of 202 patients analysed, 21% sustained TBI from assault. There was no difference in severity of injuries between assault and non-assault groups. No relationship was found between self-reported outcomes and TBI severity or GOS. The assault group scored worse in all self-reported questionnaires, with statistically significant differences for measures of PTSD and post-concussion symptoms. However, using threshold scores, the prevalence of PTSD in assaulted patients was not higher than non-assault. After adjusting for age, ethnicity and the presence of extra-cranial trauma, assault did not have a significant effect on questionnaire scores. Exploratory analysis showed that assault and road traffic accidents were associated with significantly worse outcomes compared to falls.
Quality of life is significantly related to functional and psychological outcomes after TBI. Assaulted patients suffer from worse self-reported outcomes than other patients, but these differences were insignificant when adjusted for demographic factors. Intentionality behind the traumatic event is likely more important than cause alone. Differences in quality of life and other self-reported outcomes are not reflected by the Glasgow Outcome Scale. This information is useful in arranging earlier and targeted review and support.
袭击是创伤性脑损伤（TBI）的第三大常见原因，仅次于跌倒和道路交通碰撞。TBI 可导致多种长期的身体、认知和情绪后遗症，包括创伤后应激障碍（PTSD）。故意暴力可能会进一步加剧事件的心理创伤，而常规的结局测量方法（如格拉斯哥结局量表（GOS））无法捕捉到这一点。本研究旨在探讨袭击对自我报告结局的影响，包括生活质量和 PTSD 症状。
256 名在 TBI 诊所就诊的患者完成了问卷调查，包括脑损伤后生活质量（QOLIBRI）和 PTSD 检查表（PCL-C）。病历提供了人口统计学、临床数据和损伤病因。将主观结局与袭击和其他原因进行比较。
在分析的 202 名患者中，21%的患者因袭击导致 TBI。袭击和非袭击组的损伤严重程度无差异。自我报告结局与 TBI 严重程度或 GOS 之间没有关系。袭击组在所有自我报告问卷中的得分均较差，PTSD 和脑震荡后症状的测量值存在统计学显著差异。然而，使用阈值评分，受袭患者的 PTSD 患病率并不高于非受袭患者。在校正年龄、种族和是否存在颅外创伤后，袭击对问卷评分没有显著影响。探索性分析表明，与跌倒相比，袭击和道路交通意外与更差的结局相关。
生活质量与 TBI 后的功能和心理结局显著相关。与其他患者相比，受袭患者的自我报告结局更差，但在调整人口统计学因素后，这些差异并不显著。创伤性事件的意图比原因本身更重要。格拉斯哥结局量表无法反映生活质量和其他自我报告结局的差异。这些信息有助于安排更早和有针对性的审查和支持。
