轻度创伤性脑损伤后既往有工作的受试者六个月内无法恢复工作的预测因素：一项TRACK-TBI试点研究。
Predictors of six-month inability to return to work in previously employed subjects after mild traumatic brain injury: A TRACK-TBI pilot study.
作者信息
Yue John K, Phelps Ryan Rl, Hemmerle Debra D, Upadhyayula Pavan S, Winkler Ethan A, Deng Hansen, Chang Diana, Vassar Mary J, Taylor Sabrina R, Schnyer David M, Lingsma Hester F, Puccio Ava M, Yuh Esther L, Mukherjee Pratik, Huang Michael C, Ngwenya Laura B, Valadka Alex B, Markowitz Amy J, Okonkwo David O, Manley Geoffrey T
机构信息
Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA.
Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
出版信息
J Concussion. 2021 Jan-Dec;5. doi: 10.1177/20597002211007271. Epub 2021 Apr 6.
INTRODUCTION
Return to work (RTW) is an important milestone of mild traumatic brain injury (mTBI) recovery. The objective of this study was to evaluate whether baseline clinical variables, three-month RTW, and three-month postconcussional symptoms (PCS) were associated with six-month RTW after mTBI.
METHODS
Adult subjects from the prospective multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with mTBI (Glasgow Coma Scale 13-15) who were employed at baseline, with completed three-and six-month RTW status, and three-month Acute Concussion Evaluation (ACE), were extracted. Univariate and multivariable analyses were performed for six-month RTW, with focus on baseline employment, three-month RTW, and three-month ACE domains (physical, cognitive, sleep, and/or emotional postconcussional symptoms (PCS)). Odds ratios (OR) and 95% confidence intervals [CI] were reported. Significance was assessed at p < 0.05.
RESULTS
In 152 patients aged 40.7 ± 15.0years, 72% were employed full-time at baseline. Three- and six-month RTW were 77.6% and 78.9%, respectively. At three months, 59.2%, 47.4%, 46.1% and 31.6% scored positive for ACE physical, cognitive, sleep, and emotional PCS domains, respectively. Three-month RTW predicted six-month RTW (OR = 19.80, 95% CI [7.61-51.52]). On univariate analysis, scoring positive in any three-month ACE domain predicted inability for six-month RTW (OR = 0.10-0.11). On multivariable analysis, emotional symptoms predicted inability to six-month RTW (OR = 0.19 [0.04-0.85]). Subjects who scored positive in all four ACE domains were more likely to be unable to RTW at six months (4 domains: 58.3%, vs. 0-to-3 domains: 9.5%; multivariable OR = 0.09 [0.02-0.33]).
CONCLUSIONS
Three-month post-injury is an important time point at which RTW status and PCS should be assessed, as both are prognostic markers for six-month RTW. Clinicians should be particularly vigilant of patients who present with emotional symptoms, and patients with symptoms across multiple PCS categories, as these patients are at further risk of inability to RTW and may benefit from targeted evaluation and support.
引言
重返工作岗位（RTW）是轻度创伤性脑损伤（mTBI）康复的一个重要里程碑。本研究的目的是评估基线临床变量、伤后三个月重返工作岗位情况以及伤后三个月的脑震荡后症状（PCS）是否与mTBI后六个月的重返工作岗位情况相关。
方法
从创伤性脑损伤前瞻性多中心转化研究与临床知识试点研究中选取成年mTBI患者（格拉斯哥昏迷量表评分为13 - 15分），这些患者在基线时已就业，且有完整的伤后三个月和六个月的重返工作岗位状态以及伤后三个月的急性脑震荡评估（ACE）结果。对六个月的重返工作岗位情况进行单因素和多因素分析，重点关注基线就业情况、伤后三个月重返工作岗位情况以及伤后三个月ACE各领域（身体、认知、睡眠和/或情绪性脑震荡后症状（PCS））。报告比值比（OR）和95%置信区间[CI]。以p < 0.05评估显著性。
结果
152例年龄为40.7 ± 15.0岁的患者中，72%在基线时全职工作。伤后三个月和六个月的重返工作岗位率分别为77.6%和78.9%。伤后三个月时，ACE身体、认知、睡眠和情绪性PCS领域的阳性评分率分别为59.2%、47.4%、46.1%和31.6%。伤后三个月重返工作岗位情况可预测六个月重返工作岗位情况（OR = 19.80，95% CI [7.61 - 51.52]）。单因素分析显示，伤后三个月ACE任何一个领域阳性评分预测六个月无法重返工作岗位（OR = 0.10 - 0.11）。多因素分析显示，情绪症状预测六个月无法重返工作岗位（OR = 0.19 [0.04 - 0.85]）。在所有四个ACE领域均为阳性评分的受试者在六个月时更有可能无法重返工作岗位（4个领域：58.3%， vs. 0至3个领域：9.5%；多因素OR = 0.09 [0.02 - 0.33]）。
结论
伤后三个月是评估重返工作岗位状态和PCS的重要时间点，因为二者均为六个月重返工作岗位情况的预后指标。临床医生应特别警惕出现情绪症状的患者以及PCS多个类别均有症状的患者，因为这些患者有更高的无法重返工作岗位的风险，可能受益于针对性评估和支持。
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