Madhok Debbie Y, Yue John K, Sun Xiaoying, Suen Catherine G, Coss Nathan A, Jain Sonia, Manley Geoffrey T
Department of Emergency Medicine and Neurology, University of California San Francisco, Suite 6A, 1001 Potrero Ave, Building 5, Suite 6A, San Francisco, CA 94110, USA.
Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA 94143, USA.
Brain Sci. 2020 May 1;10(5):269. doi: 10.3390/brainsci10050269.
A considerable subset of mild traumatic brain injury (mTBI) patients fail to return to baseline functional status at or beyond 3 months postinjury. Identifying at-risk patients for poor outcome in the emergency department (ED) may improve surveillance strategies and referral to care. Subjects with mTBI (Glasgow Coma Scale 13-15) and negative ED initial head CT < 24 h of injury, completing 3- or 6-month functional outcome (Glasgow Outcome Scale-Extended; GOSE), were extracted from the prospective, multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study. Outcomes were dichotomized to full recovery (GOSE = 8) vs. functional deficits (GOSE < 8). Univariate predictors with < 0.10 were considered for multivariable regression. Adjusted odds ratios (AOR) were reported for outcome predictors. Significance was assessed at < 0.05. Subjects who completed GOSE at 3- and 6-month were 211 (GOSE < 8: 60%) and 185 (GOSE < 8: 65%). Risk factors for 6-month GOSE < 8 included less education (AOR = 0.85 per-year increase, 95% CI: (0.74-0.98)), prior psychiatric history (AOR = 3.75 (1.73-8.12)), Asian/minority race (American Indian/Alaskan/Hawaiian/Pacific Islander) (AOR = 23.99 (2.93-196.84)), and Hispanic ethnicity (AOR = 3.48 (1.29-9.37)). Risk factors for 3-month GOSE < 8 were similar with the addition of injury by assault predicting poorer outcome (AOR = 3.53 (1.17-10.63)). In mTBI patients seen in urban trauma center EDs with negative CT, education, injury by assault, Asian/minority race, and prior psychiatric history emerged as risk factors for prolonged disability.
相当一部分轻度创伤性脑损伤（mTBI）患者在受伤后3个月及更长时间未能恢复到基线功能状态。在急诊科（ED）识别出预后不良的高危患者可能会改善监测策略并促进转诊治疗。从创伤性脑损伤转化研究与临床知识（TRACK-TBI）前瞻性多中心试点研究中提取受伤后24小时内急诊科初始头部CT阴性、格拉斯哥昏迷量表（Glasgow Coma Scale）评分为13 - 15分且完成3个月或6个月功能结局评估（扩展格拉斯哥结局量表；GOSE）的mTBI患者。结局分为完全恢复（GOSE = 8）与功能缺陷（GOSE < 8）。单变量预测因子P值< 0.10的纳入多变量回归分析。报告结局预测因子的校正比值比（AOR）。显著性检验水准设定为P < 0.05。在3个月和6个月完成GOSE评估的患者分别为211例（GOSE < 8：60%）和185例（GOSE < 8：65%）。6个月时GOSE < 8的危险因素包括受教育程度较低（每年增加AOR = 0.85，95%可信区间：(0.74 - 0.98)）、既往精神病史（AOR = 3.75 (,1.73 - 8.12)）、亚洲/少数族裔（美国印第安人/阿拉斯加人/夏威夷人/太平洋岛民）（AOR = 23.99 (2.93 - 196.84)）以及西班牙裔（AOR = 3.48 (1.29 - 9.37)）。3个月时GOSE < 8的危险因素与之相似，此外袭击所致损伤预示预后较差（AOR = 3.53 (1.17 - 10.63)）。在城市创伤中心急诊科就诊且CT阴性的mTBI患者中，受教育程度、袭击所致损伤、亚洲/少数族裔以及既往精神病史成为长期残疾的危险因素。
