Tracy Brett M, Silverman Michael E, Cordero-Caballero Carlos, Durr Emily A, Gelbard Rondi B
Division of Trauma, Critical Care, Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; Division of Acute Care Surgery, Grady Memorial Hospital, Atlanta, Georgia.
J Surg Res. 2021 Dec;268:546-551. doi: 10.1016/j.jss.2021.07.037. Epub 2021 Aug 28.
Neurostimulants (NS) can be used to treat patients with a traumatic brain injury (TBI) with altered levels of consciousness. We sought to determine if amantadine alone (monotherapy) versus amantadine + methylphenidate (dual therapy) would correlate with better neurorecovery (NR) among acutely hospitalized patients with a severe TBI.
We performed a retrospective review of adult patients admitted to our level I trauma center from 2016-2019 with a severe TBI. NR was calculated by dividing the difference between admission and discharge Glasgow Coma Scale (GCS) scores by 12. Resulting ratios were used to divide the cohort into two groups: excellent NR (1) and non-excellent NR (<1).
A total of 76 patients comprised the cohort; 19.7% (n = 15) had excellent NR. The excellent NR group had a larger proportion of patients receiving dual therapy compared to the non-excellent group (86.7% versus 59%, P = 0.04). In monotherapy (n = 27), amantadine was initiated 13 (8-20) d following injury and treatment lasted 7 (2-16) d. In dual therapy (n = 49), amantadine was initiated 12 (6-19) d following injury and continued for 9 (4-25.5) d. Methylphenidate was initiated 15 (7-20.5) d following injury and continued for 5 (2-13.5) d. After adjusting for confounders, dual versus monotherapy predicted excellent NR (OR 5.4, 95% CI 1.2 - 38.9, P = 0.03).
During the acute hospitalization for a severe TBI, dual NS therapy compared to monotherapy is associated with an increased likelihood of excellent NR. Larger prospective trials are warranted to validate these findings.
神经兴奋剂（NS）可用于治疗意识水平改变的创伤性脑损伤（TBI）患者。我们试图确定，在急性住院的重度TBI患者中，单独使用金刚烷胺（单一疗法）与金刚烷胺+哌甲酯（联合疗法）相比，是否与更好的神经恢复（NR）相关。
我们对2016年至2019年入住我院一级创伤中心的重度TBI成年患者进行了回顾性研究。NR通过将入院和出院时格拉斯哥昏迷量表（GCS）评分的差值除以12来计算。所得比值用于将队列分为两组：优秀NR（≥1）和非优秀NR（<1）。
该队列共有76例患者；19.7%（n = 15）有优秀的NR。与非优秀组相比，优秀NR组接受联合疗法的患者比例更高（86.7%对59%，P = 0.04）。在单一疗法组（n = 27）中，金刚烷胺在受伤后13（8 - 20）天开始使用，治疗持续7（2 - 16）天。在联合疗法组（n = 49）中，金刚烷胺在受伤后12（6 - 19）天开始使用，并持续9（4 - 25.5）天。哌甲酯在受伤后15（7 - 20.5）天开始使用，并持续5（2 - 13.5）天。在对混杂因素进行调整后，联合疗法与单一疗法相比可预测优秀的NR（比值比5.4，95%置信区间1.2 - 38.9，P = 0.03）。
在重度TBI的急性住院期间，与单一疗法相比，联合NS疗法与优秀NR的可能性增加相关。需要进行更大规模的前瞻性试验来验证这些发现。
