创伤性脑损伤相关听力损伤与认知的关系：TRACK-TBI 研究。
Association Between TBI-Related Hearing Impairment and Cognition: A TRACK-TBI Study.
机构信息
Department of Anatomy & Neurobiology, Boston University, Boston, Massachusetts (Dr Hwang); Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee (Drs Nelson and McCrea); Departments of Otolaryngology (Dr Sharon) and Neurological Surgery (Dr Manley), University of California San Francisco; Departments of Rehabilitation Medicine (Dr Dikmen), Neurological Surgery (Dr Temkin), and Biostatistics (Dr Temkin), University of Washington, Seattle; and Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California (Ms Markowitz).
出版信息
J Head Trauma Rehabil. 2022;37(5):E327-E335. doi: 10.1097/HTR.0000000000000735. Epub 2021 Oct 25.
OBJECTIVE
To examine the association between hearing impairment and cognitive function after traumatic brain injury (TBI).
SETTING
A total of 18 level I trauma centers throughout the United States in the T ransforming R esearch a nd C linical K nowledge in TBI (TRACK-TBI) study.
PARTICIPANTS
From February 2014 to June 2018, a total of 2697 participants with TBI were enrolled in TRACK-TBI. Key eligibility criteria included external force trauma to the head, presentation to a participating level I trauma center, and receipt of a clinically indicated head computed tomographic (CT) scan within 24 hours of injury. A total of 1267 participants were evaluated in the study, with 216 participants with hearing impairment and 1051 participants without hearing impairment. Those with missing or unknown hearing status or cognitive assessment were excluded from analysis.
DESIGN
Prospective, observational cohort study.
MAIN MEASURES
Hearing impairment at 2 weeks post-TBI was based on self-report. Participants who indicated worse hearing in one or both ears were defined as having hearing impairment, whereas those who denied worse hearing in either ear were defined as not having hearing impairment and served as the reference group. Cognitive outcomes at 6 months post-TBI included executive functioning and processing speed, as measured by the Trail Making Test (TMT) B/A and the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index subscale (WAIS-IV PSI), respectively.
RESULTS
TBI-related hearing impairment had a small but significantly greater TMT B/A ratio than without TBI-related hearing impairment: mean difference ( B ) = 0.25; 95% CI, 0.07 to 0.43; P = .005. No significant mean differences on WAIS-IV PSI scores were found between participants with and without TBI-related hearing impairment: B = 0.36; 95% CI, -2.07 to 2.60; P = .825.
CONCLUSION
We conclude that TBI-related hearing impairment at 6 months postinjury was significantly associated with worse executive functioning but not cognitive processing speed.
目的
探讨创伤性脑损伤（TBI）后听力损伤与认知功能的关系。
背景
在美国 18 家一级创伤中心进行的转化研究和临床知识 TBI（TRACK-TBI）研究。
参与者
2014 年 2 月至 2018 年 6 月，共有 2697 名 TBI 患者纳入 TRACK-TBI 研究。主要入选标准包括头部外伤的外力、就诊于参与的一级创伤中心以及伤后 24 小时内进行临床指征的头部计算机断层扫描（CT）。共有 1267 名参与者在研究中进行了评估，其中 216 名参与者有听力损伤，1051 名参与者无听力损伤。缺失或未知听力状况或认知评估的患者被排除在分析之外。
设计
前瞻性观察队列研究。
主要观察指标
TBI 后 2 周的听力损伤基于自我报告。报告单侧或双侧听力下降的患者定义为听力损伤，而否认任何一侧听力下降的患者定义为无听力损伤，并作为参考组。TBI 后 6 个月的认知结局包括执行功能和处理速度，分别采用连线测试（TMT）B/A 和韦氏成人智力量表第四版处理速度指数（WAIS-IV PSI）进行测量。
结果
TBI 相关听力损伤的 TMT B/A 比值明显高于无 TBI 相关听力损伤：平均差异（B）=0.25；95%置信区间，0.07 至 0.43；P=0.005。在 WAIS-IV PSI 评分上，有 TBI 相关听力损伤的参与者与无 TBI 相关听力损伤的参与者之间无显著的平均差异：B=0.36；95%置信区间，-2.07 至 2.60；P=0.825。
结论
我们的结论是，TBI 后 6 个月的听力损伤与执行功能下降显著相关，但与认知处理速度无关。
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