2 年预后良好的严重创伤性脑损伤幸存者的指令跟随时间。
Time to Follow Commands in Severe Traumatic Brain Injury Survivors With Favorable Recovery at 2 Years.
机构信息
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
出版信息
Neurosurgery. 2022 Oct 1;91(4):633-640. doi: 10.1227/neu.0000000000002087. Epub 2022 Jul 18.
BACKGROUND
The recovery of severe traumatic brain injury (TBI) survivors with long-term favorable outlook is understudied. Time to follow commands varies widely in this patient population but has important clinical implications.
OBJECTIVE
To (1) evaluate time to follow commands in severe patients with TBI with favorable outcomes, (2) characterize their trajectory of recovery, and (3) identify predictors associated with delayed cognitive improvement.
METHODS
Participants were recruited prospectively at a Level I trauma center through the Brain Trauma Research Center from 2003 to 2018. Inclusion criteria were age 16 to 80 years, Glasgow Coma Scale score ≤8 and motor score <6, and Glasgow Outcome Scale-Extended measure ≥4 at 2 years postinjury.
RESULTS
In 580 patients, there were 229 (39.5%) deaths and 140 (24.1%) patients had favorable outcomes at 2 years. The mean age was 33.7 ± 14.5 years, median Glasgow Coma Scale was 7 (IQR 6-7), and median Injury Severity Score was 30 (IQR 26-38). The mean time to follow commands was 12.7 ± 11.8 days. On multivariable linear regression, the presence of diffuse axonal injury (B = 9.2 days [4.8, 13.7], P < .0001) or intraventricular hemorrhage (B = 6.4 days [0.5, 12.3], P < .035) was associated with longer time before following commands and patients who developed nosocomial infections (B = 6.5 days [1.6-11.4], P < .01).
CONCLUSION
In severe TBI survivors with favorable outcomes, time to follow commands varied widely. Most patients began to follow commands within 2 weeks. Evidence of diffuse axonal injury, intraventricular hemorrhage, and infections can delay cognitive improvement in the acute period. Patients make considerable recovery up to 2 years after their injury.
背景
长期预后良好的严重创伤性脑损伤（TBI）幸存者的恢复情况研究较少。该患者群体的听从指令时间差异很大，但具有重要的临床意义。
目的
（1）评估预后良好的严重 TBI 患者听从指令的时间，（2）描述他们的恢复轨迹，（3）确定与认知改善延迟相关的预测因素。
方法
参与者通过 Brain Trauma Research Center 从 2003 年至 2018 年在一级创伤中心前瞻性招募。纳入标准为年龄 16 至 80 岁，损伤后 2 年格拉斯哥昏迷量表（GCS）评分≤8 分，运动评分 <6 分，格拉斯哥结局量表扩展版（GOSE）测量值≥4 分。
结果
在 580 例患者中，229 例（39.5%）死亡，140 例（24.1%）患者在 2 年时预后良好。平均年龄为 33.7 ± 14.5 岁，中位数 GCS 为 7（IQR 6-7），中位数损伤严重程度评分（ISS）为 30（IQR 26-38）。听从指令的平均时间为 12.7 ± 11.8 天。多变量线性回归显示，弥漫性轴索损伤（B = 9.2 天[4.8, 13.7]，P <.0001）或脑室内出血（B = 6.4 天[0.5, 12.3]，P <.035）的存在与听从指令前的时间较长相关，且发生医院获得性感染的患者（B = 6.5 天[1.6-11.4]，P <.01）。
结论
在预后良好的严重 TBI 幸存者中，听从指令的时间差异很大。大多数患者在 2 周内开始听从指令。弥漫性轴索损伤、脑室内出血和感染的证据可在急性期延迟认知改善。患者在受伤后 2 年内仍有较大的恢复。
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