Roy Durga, Peters Matthew E, Everett Allen, Leoutsakos Jeannie-Marie, Yan Haijuan, Rao Vani, Bechtold Kathleen, Sair Haris, Van Meter Timothy E, Falk Hayley, Vassila Alexandra, Hall Anna, Ofoche Uju, Akbari Freshta, Lyketsos Constantine G, Korley Fredrick
a Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
b Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
Brain Inj. 2019;33(8):1064-1069. doi: 10.1080/02699052.2019.1606447. Epub 2019 Apr 24.
: Limited studies exist on the association between loss of consciousness (LOC) and altered mental state (AMS) and development of depressive and post-concussive symptoms within six months after mild traumatic brain injury (mTBI). We tested the hypothesis that presence of LOC and AMS predict the highest risk of symptoms within the first six months post-mTBI compared to either variable alone, and that LOC alone is more strongly associated with these symptoms. : We analyzed data from 407 subjects with mTBI from the injury erum arkers for ssessing esponse to rauma (HeadSMART) cohort, a prospective cohort of patients post-TBI presenting to two urban emergency departments. : There were higher rates of depressive (44%) and post-concussive symptoms (54%) at 1 month post-injury, among participants with both LOC and AMS compared to other groups. AMS was associated with depressive symptoms at one and six months (OR = 1.59, p = .038; OR = 1.60; p = .060) and post-concussive symptoms at one month (OR = 1.56, p = .053). LOC was associated only with post-concussive symptoms at one month (OR = 1.55;p = .048). Among those without LOC, AMS was associated with depressive symptoms at one month (OR = 2.24; p = .028). : AMS predicts post-mTBI depressive symptoms both in the acute and chronic mTBI phases whereas LOC is a more sensitive predictor of post-concussive symptoms in the acute mTBI period.
关于轻度创伤性脑损伤（mTBI）后六个月内意识丧失（LOC）和精神状态改变（AMS）与抑郁及脑震荡后症状发展之间的关联，相关研究有限。我们检验了以下假设：与单独的任何一个变量相比，LOC和AMS的存在预示着mTBI后前六个月内出现症状的风险最高，并且单独的LOC与这些症状的关联更强。我们分析了来自创伤血清标志物评估创伤反应（HeadSMART）队列中407例mTBI患者的数据，这是一个前瞻性队列，研究对象为前往两个城市急诊科就诊的TBI后患者。与其他组相比，在伤后1个月时，同时存在LOC和AMS的参与者中抑郁（44%）和脑震荡后症状（54%）的发生率更高。AMS在1个月和6个月时与抑郁症状相关（OR = 1.59，p = 0.038；OR = 1.60；p = 0.060），在1个月时与脑震荡后症状相关（OR = 1.56，p = 0.053）。LOC仅在1个月时与脑震荡后症状相关（OR = 1.55；p = 0.048）。在没有LOC的患者中，AMS在1个月时与抑郁症状相关（OR = 2.24；p = 0.028）。AMS在急性和慢性mTBI阶段均能预测mTBI后的抑郁症状，而LOC是急性mTBI期脑震荡后症状更敏感的预测指标。
