ZNS-Hannelore-Kohl-Foundation, Bonn; BARMER Institute for Health Care System Research (bifg), Berlin.
Dtsch Arztebl Int. 2023 Apr 21;120(16):271-276. doi: 10.3238/arztebl.m2023.0046.
The acute effects of traumatic brain injury (TBI) are well documented, but there is no systematic quantification of its long-term sequelae in Germanlanguage literature. The purpose of this article is to compare the frequency of conditions linked to prior TBI with their frequency in the non-brain-injured population.
A matched cohort study was carried out on the basis of routine data from the BARMER statutory health insurance carrier. The exposure group consisted of patients treated over the period 2006-2009 for TBI at a variety of treatment intensities, including persons with multiple organ trauma. The control group consisted of BARMER insurees without prior TBI who were matched with the patients in the exposure group for age, sex, and pre-existing diseases. Late sequelae were sought in the routine data for a period of ten years after the injury. The outcome rates of the exposure and control groups were compared with Kaplan-Meier estimators and Poisson regression.
114 296 persons with TBI in the period 2006-2009 were included in the study. The mortality within ten years of TBI was 305 per 1000 individuals. The relative mortality in the exposure group was higher than that in control individuals of the same age and sex, with an incidence rate ratio (IRR) of 1.67 (95% confidence interval, [1.60; 1.74]). Immobility, dementia, epilepsy, endocrine disorders, functional disorders, depression, anxiety, cognitive deficits, headache, and sleep disorders were also more common in the exposure group. Persons with TBI requiring highintensity treatment displayed the highest relative incidence rates of the conditions studied over 10 years of follow-up. Persons who had been admitted to the hospital because of TBI had higher relative incidence rates for epilepsy and dementia than those who had been cared for on an outpatient basis.
Adverse sequelae of TBI can still be seen ten years after the exposure. These patients die earlier than persons without TBI and suffer earlier and more frequently from associated conditions.
外伤性脑损伤 (TBI) 的急性影响已有充分记录，但在德语文献中，没有系统地对其长期后果进行量化。本文的目的是比较与 TBI 相关的疾病的发生频率与其在非脑损伤人群中的发生频率。
基于 BARMER 法定健康保险公司的常规数据，进行了一项匹配队列研究。暴露组由 2006 年至 2009 年期间因各种治疗强度的 TBI 接受治疗的患者组成，包括有多器官创伤的患者。对照组由 BARMER 参保人组成，他们没有 TBI 病史，与暴露组的患者在年龄、性别和既往疾病方面相匹配。在受伤后 10 年内，在常规数据中寻找迟发性后遗症。使用 Kaplan-Meier 估计器和泊松回归比较暴露组和对照组的结局发生率。
在 2006 年至 2009 年期间，共有 114 296 名 TBI 患者纳入研究。TBI 后 10 年内的死亡率为每 1000 人中有 305 人。暴露组的相对死亡率高于同年龄和性别的对照组个体，发病率比（IRR）为 1.67（95%置信区间[1.60；1.74]）。在暴露组中，活动受限、痴呆、癫痫、内分泌紊乱、功能障碍、抑郁、焦虑、认知缺陷、头痛和睡眠障碍也更为常见。在 10 年的随访中，需要高强度治疗的 TBI 患者显示出所研究疾病的相对发病率最高。因 TBI 住院的患者比门诊治疗的患者发生癫痫和痴呆的相对发病率更高。
TBI 的不良后果在暴露后 10 年仍可见。这些患者比没有 TBI 的患者更早死亡，并且更早且更频繁地发生相关疾病。
