1Department of Neurosurgery, University Hospital Heidelberg, Germany.
2Department of Public Health, Erasmus MC-University Medical Center Rotterdam, The Netherlands; and.
J Neurosurg Pediatr. 2021 Feb 26;27(5):538-547. doi: 10.3171/2020.9.PEDS20421. Print 2021 May 1.
The aim of this paper was to evaluate the prevalence of postconcussive symptoms and their relation to health-related quality of life (HRQOL) in pediatric and adolescent patients with mild traumatic brain injury (mTBI) who received head CT imaging during initial assessment.
Patients aged between 5 and 21 years with mTBI (Glasgow Coma Scale scores 13-15) and available Rivermead Post Concussion Questionnaire (RPQ) at 6 months of follow-up in the multicenter, prospectively collected CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) study were included. The prevalence of postconcussive symptoms was assessed, and the occurrence of postconcussive syndrome (PSC) based on the ICD-10 criteria, was analyzed. HRQOL was compared in patients with and without PCS using the Quality of Life after Brain Injury (QOLIBRI) questionnaire.
A total of 196 adolescent or pediatric mTBI patients requiring head CT imaging were included. High-energy trauma was prevalent in more than half of cases (54%), abnormalities on head CT scans were detected in 41%, and admission to the regular ward or intensive care unit was necessary in 78%. Six months postinjury, 36% of included patients had experienced at least one moderate or severe symptom on the RPQ. PCS was present in 13% of adolescents and children when considering symptoms of at least moderate severity, and those patients had significantly lower QOLIBRI total scores, indicating lower HRQOL, compared with young patients without PCS (57 vs 83 points, p < 0.001).
Adolescent and pediatric mTBI patients requiring head CT imaging show signs of increased trauma severity. Postconcussive symptoms are present in up to one-third of those patients, and PCS can be diagnosed in 13% 6 months after injury. Moreover, PCS is significantly associated with decreased HRQOL.
本文旨在评估在初始评估中接受头部 CT 成像的儿科和青少年轻度创伤性脑损伤 (mTBI) 患者中，脑震荡后症状的发生率及其与健康相关生活质量 (HRQOL) 的关系。
该多中心前瞻性收集的 CENTER-TBI（欧洲合作神经创伤有效性研究在 TBI 中的应用）研究中，纳入年龄在 5 至 21 岁之间、格拉斯哥昏迷量表评分为 13-15 分且在 6 个月随访时可获得 Rivermead 脑震荡后问卷 (RPQ) 的 mTBI 患者。评估脑震荡后症状的发生率，并根据 ICD-10 标准分析脑震荡后综合征 (PCS) 的发生情况。使用生活质量量表（QOLIBRI）比较有和无 PCS 的患者的 HRQOL。
共纳入 196 例需行头部 CT 成像的青少年或儿科 mTBI 患者。超过一半的病例（54%）为高能量创伤，41%的头部 CT 扫描有异常，78%的患者需要入住普通病房或重症监护病房。受伤后 6 个月，196 例患者中有 36%在 RPQ 上至少出现 1 项中度或重度症状。当考虑至少中度严重程度的症状时，13%的青少年和儿童患有 PCS，这些患者的 QOLIBRI 总分明显较低，表明 HRQOL 较低，与无 PCS 的年轻患者相比（57 分比 83 分，p < 0.001）。
需要头部 CT 成像的青少年和儿科 mTBI 患者表现出创伤严重程度增加的迹象。多达三分之一的患者存在脑震荡后症状，13%的患者在受伤后 6 个月可诊断为 PCS。此外，PCS 与 HRQOL 降低显著相关。
