Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Arch Phys Med Rehabil. 2021 Jun;102(6):1102-1112. doi: 10.1016/j.apmr.2020.10.106. Epub 2020 Oct 27.
To describe personal factors in patients with mild traumatic brain injury (MTBI) and 2 control groups and to explore how such factors were associated with postconcussion symptoms (PCSs).
Prospective cohort study.
Level 1 trauma center and outpatient clinic.
Participants (N=541) included patients with MTBI (n=378), trauma controls (n=82), and community controls (n=81).
Data on preinjury health and work status, personality, resilience, attention deficit/hyperactivity, and substance use. Computed tomography (CT) findings and posttraumatic amnesia were recorded. Symptoms were assessed at 3 months with the British Columbia Postconcussion Symptom Inventory and labeled as PCS+ if ≥3 symptoms were reported or the total score was ≥13. Predictive models were fitted with penalized logistic regression using the least absolute shrinkage and selection operator (lasso) in the MTBI group, and model fit was assessed with optimism-corrected area under the curve (AUC) of the receiver operating characteristic curve.
There were few differences in personal factors between the MTBI group and the 2 control groups without MTBI. Rates of PCS+ were 20.8% for the MTBI group, 8.0% for trauma controls, and 1.3% for community controls. In the MTBI group, there were differences between the PCS+ and PCS- group on most personal factors and injury-related variables in univariable comparisons. In the lasso models, the optimism-corrected AUC for the full model was 0.79, 0.73 for the model only including personal factors, and 0.63 for the model only including injury variables. Working less than full time before injury, having preinjury pain and poor sleep quality, and being female were among the selected predictors, but also resilience and some personality traits contributed in the model. Intracranial abnormalities on CT were also a risk factor for PCS.
Personal factors convey important prognostic information in patients with MTBI. A vulnerable work status and preinjury health problems might indicate a need for follow-up and targeted interventions.
描述轻度创伤性脑损伤（MTBI）患者的个人因素和 2 个对照组，并探讨这些因素与脑震荡后症状（PCS）的关系。
前瞻性队列研究。
1 级创伤中心和门诊诊所。
参与者（N=541）包括 MTBI 患者（n=378）、创伤对照组（n=82）和社区对照组（n=81）。
受伤前的健康和工作状况、人格、韧性、注意力缺陷/多动障碍和物质使用情况的数据。记录计算机断层扫描（CT）结果和外伤后遗忘。在 3 个月时使用不列颠哥伦比亚脑震荡后症状清单（British Columbia Postconcussion Symptom Inventory）评估症状，如果报告≥3 个症状或总分≥13，则标记为 PCS+。在 MTBI 组中使用最小绝对收缩和选择算子（least absolute shrinkage and selection operator，lasso）进行惩罚逻辑回归模型拟合，并使用校正后的接收者操作特征曲线下面积（area under the curve，AUC）评估模型拟合度。
MTBI 组与无 MTBI 的 2 个对照组在个人因素方面差异不大。MTBI 组的 PCS+发生率为 20.8%，创伤对照组为 8.0%，社区对照组为 1.3%。在 MTBI 组中，PCS+组和 PCS-组在大多数个人因素和损伤相关变量上存在差异。在lasso 模型中，全模型的校正后的 AUC 为 0.79，仅包括个人因素的模型为 0.73，仅包括损伤变量的模型为 0.63。受伤前工作时间少于全职、受伤前有疼痛和睡眠质量差以及女性是选定的预测因素之一，但韧性和一些人格特征在模型中也有贡献。CT 上的颅内异常也是 PCS 的危险因素。
个人因素在 MTBI 患者中提供了重要的预后信息。脆弱的工作状态和受伤前的健康问题可能表明需要随访和有针对性的干预。
