Division of Experimental Medicine, McGill University, Montréal, QC, Canada.
Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Montréal, QC, Canada.
Pain. 2023 Dec 1;164(12):2627-2641. doi: 10.1097/j.pain.0000000000002949. Epub 2023 Jun 28.
The most recent prevalence estimate of post-traumatic headache (PTH) after traumatic brain injury (TBI) in veterans and civilians dates back to 2008. The prevalence was found to be 57.8%, with surprising higher rates (75.3%) in mild TBI when compared with those with moderate/severe TBI (32.1%). However, the revision of mild TBI diagnostic criteria and an historic peak of TBI in the elderly individuals attributed to the ageing population may lead to different results. Thus, we conducted a systematic review and meta-analysis to assess the updated prevalence of PTH during the past 14 years only in civilians. A literature search was conducted following PRISMA guidelines guided by a librarian. Screening, full-text assessment, data extraction, and risk of bias assessment were performed blindly by 2 raters. Meta-analysis of proportions using the Freeman and Tukey double arcsine method of transformation was conducted. Heterogeneity, sensitivity analysis, and meta-regressions were performed with the predictors: year of publication, mean age, sex, TBI severity, and study design. Sixteen studies were selected for the qualitative analysis and 10 for the meta-analysis. The overall prevalence estimate of PTH was 47.1%, (confidence interval = 34.6, 59.8, prediction intervals = 10.8, 85.4), being similar at different time points (3, 6, 12, and 36+ months). Heterogeneity was high, and none of the meta-regressions were significant. The overall prevalence of PTH after TBI over the past 14 years remains high even if assessed only in civilians. However, the prevalence rates attributed to mild and moderate/severe TBI were similar, differing significantly from previous reports. Efforts are needed to improve TBI outcomes.
创伤性脑损伤（TBI）后创伤后头痛（PTH）的最新流行率估计可追溯到 2008 年。研究发现，退伍军人和平民中的 PTH 患病率为 57.8%，与中度/重度 TBI（32.1%）相比，轻度 TBI 的患病率更高（75.3%）。然而，轻度 TBI 诊断标准的修订以及因人口老龄化而导致的老年人 TBI 历史高峰可能会导致不同的结果。因此，我们进行了一项系统评价和荟萃分析，仅评估过去 14 年平民中 PTH 的最新患病率。在一名图书管理员的指导下，按照 PRISMA 指南进行了文献检索。由两名评估员进行盲法筛选、全文评估、数据提取和偏倚风险评估。采用 Freeman 和 Tukey 双反正弦变换法对比例进行荟萃分析。采用异质性、敏感性分析和荟萃回归分析预测因子：出版年份、平均年龄、性别、TBI 严重程度和研究设计。选择 16 项研究进行定性分析，10 项研究进行荟萃分析。PTH 的总体患病率估计为 47.1%（置信区间=34.6,59.8，预测区间=10.8,85.4），在不同时间点（3、6、12 和 36+个月）相似。异质性较高，且没有一个荟萃回归分析有统计学意义。即使仅在平民中评估，过去 14 年 TBI 后 PTH 的总体患病率仍然较高。然而，轻度和中度/重度 TBI 所致的患病率相似，与之前的报告有显著差异。需要努力改善 TBI 的结局。
