Karaliute Migle, Saksvik Simen B, Smevik Hanne, Follestad Turid, Einarsen Cathrine, Vik Anne, Håberg Asta K, Iverson Grant L, Skandsen Toril, Olsen Alexander
Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Neurology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Neurotrauma Rep. 2021 Dec 13;2(1):603-617. doi: 10.1089/neur.2021.0028. eCollection 2021.
Some people experience persistent post-concussion symptoms (PPCS) after mild traumatic brain injury (mTBI). A meaningful clinical classification and scientific progress are hampered by a lack of consensus regarding the phenomenology, assessment, and operationalization of PPCS. Here we demonstrate and evaluate how the methodology used to assess and define persistent symptoms after mTBI influences PPCS as a binary outcome. We present empirical data from 15 classification methods reflecting procedures found in the literature and clinical practice. In total, 221 patients with mTBI, 73 patients with orthopedic injuries, and 77 community controls were included in the study. The prevalence rate of PPCS in the mTBI group varied between 10% and 47%, depending on the method used to assess and define unfavorable outcome. There was generally low positive agreement between the different methods; even the two methods yielding the most similar prevalence rates (89.2% overall proportion agreement) agreed on less than half (45.5% positive agreement) of the PPCS cases. Using a liberal but not uncommon threshold for symptom severity, there was a considerable misclassification rate of PPCS in both comparison groups. Our results highlight the importance for researchers to be aware of the limitations of using binary approaches for classification of PPCS. The poor agreement between methods should be considered when (1) interpreting the heterogeneity in the existing PPCS literature and (2) developing new improved methods. An empirically informed consensus regarding classification of PPCS should be a priority for the research community.
一些人在轻度创伤性脑损伤（mTBI）后会出现持续性脑震荡后症状（PPCS）。由于在PPCS的现象学、评估和操作化方面缺乏共识，有意义的临床分类和科学进展受到阻碍。在此，我们展示并评估用于评估和定义mTBI后持续性症状的方法如何将PPCS作为二元结果进行影响。我们展示了来自15种分类方法的实证数据，这些方法反映了文献和临床实践中发现的程序。该研究共纳入了221例mTBI患者、73例骨科损伤患者和77名社区对照者。mTBI组中PPCS的患病率在10%至47%之间，具体取决于用于评估和定义不良结果的方法。不同方法之间的总体一致性普遍较低；即使是两种患病率最相似的方法（总体比例一致性为89.2%），在不到一半（45.5%的阳性一致性）的PPCS病例上达成一致。使用一个宽松但并非不常见的症状严重程度阈值，两个比较组中PPCS的误分类率都相当高。我们的结果强调了研究人员意识到使用二元方法对PPCS进行分类的局限性的重要性。在（1）解释现有PPCS文献中的异质性以及（2）开发新的改进方法时，应考虑方法之间的低一致性。关于PPCS分类的基于实证的共识应该是研究界的优先事项。
