University Division of Anaesthesia, Department of Medicine (Drs Carroll, Menon, and Newcombe and Mss Manktelow, Outtrim, Chatfield, and Forsyth), Academic Department of Neurosurgery, Department of Clinical Neurosciences (Dr Hutchinson), Wolfson Brain Imaging Centre, Department of Clinical Neurosciences (Drs Sahakian, Menon, and Newcombe), Department of Psychiatry (Dr Sahakian), and Behavioural & Clinical Neuroscience Institute (Dr Sahakian), University of Cambridge, Cambridge, United Kingdom; Turku Brain Injury Center, University of Turku, Turku, Finland (Drs Tenovuo and Posti); Turku University Hospital, Turku, Finland (Drs Tenovuo and Posti); Department of Neurosurgery, Turku University Hospital, Turku, Finland (Dr Posti); and Division of Psychology, University of Stirling, Stirling, United Kingdom (Dr Wilson).
J Head Trauma Rehabil. 2020 Nov/Dec;35(6):E513-E523. doi: 10.1097/HTR.0000000000000575.
To determine the effect of extracranial injury (ECI) on 6-month outcome in patients with mild traumatic brain injury (TBI) versus moderate-to-severe TBI.
PARTICIPANTS/SETTING: Patients with TBI (n = 135) or isolated orthopedic injury (n = 25) admitted to a UK major trauma center and healthy volunteers (n = 99).
Case-control observational study.
Primary outcomes: (a) Glasgow Outcome Scale Extended (GOSE), (b) depression, (c) quality of life (QOL), and (d) cognitive impairment including verbal fluency, episodic memory, short-term recognition memory, working memory, sustained attention, and attentional flexibility.
Outcome was influenced by both TBI severity and concomitant ECI. The influence of ECI was restricted to mild TBI; GOSE, QOL, and depression outcomes were significantly poorer following moderate-to-severe TBI than after isolated mild TBI (but not relative to mild TBI plus ECI). Cognitive impairment was driven solely by TBI severity. General health, bodily pain, semantic verbal fluency, spatial recognition memory, working memory span, and attentional flexibility were unaffected by TBI severity and additional ECI.
The presence of concomitant ECI ought to be considered alongside brain injury severity when characterizing the functional and neurocognitive effects of TBI, with each presenting challenges to recovery.
确定颅脑外损伤（ECI）对轻度创伤性脑损伤（TBI）与中重度 TBI 患者 6 个月预后的影响。
参与者/设置：颅脑损伤患者（n=135）或单纯骨科损伤患者（n=25），均收治于英国一家大型创伤中心，以及健康志愿者（n=99）。
病例对照观察性研究。
主要结局指标：（a）格拉斯哥预后量表扩展版（GOSE），（b）抑郁，（c）生活质量（QOL），以及（d）认知障碍，包括词语流畅性、情景记忆、短期识别记忆、工作记忆、持续注意力和注意力灵活性。
结局受到 TBI 严重程度和并发 ECI 的影响。ECI 的影响仅限于轻度 TBI；与单纯轻度 TBI 相比，中重度 TBI 后 GOSE、QOL 和抑郁结局明显更差（但与轻度 TBI 加 ECI 相比则不然）。认知障碍完全由 TBI 严重程度引起。一般健康、躯体疼痛、语义词语流畅性、空间识别记忆、工作记忆广度和注意力灵活性不受 TBI 严重程度和额外 ECI 的影响。
在描述 TBI 的功能和神经认知影响时，应当将并发 ECI 与脑损伤严重程度一并考虑，因为两者都对恢复构成挑战。
