Eagle Shawn R, Jain Sonia, Sun Xiaoying, Preszler Jonathan, McCrea Michael A, Giacino Joseph T, Manley Geoffrey T, Okonkwo David O, Nelson Lindsay D
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States.
Front Neurol. 2023 Dec 12;14:1308540. doi: 10.3389/fneur.2023.1308540. eCollection 2023.
Mild traumatic brain injury (mTBI) is a heterogenous injury which can be difficult to characterize and manage. Using cross-sectional network analysis (NA) to conceptualize mTBI symptoms offers an innovative solution to identify how mTBI symptoms relate to each other. The centrality hypothesis of network theory posits that certain symptoms in a network are more relevant (central) or have above average influence over the rest of the network. However, no studies have used NA to characterize the interrelationships between symptoms in a cohort of patients who presented with mTBI to a U.S. Level 1 trauma center emergency department and how subacute central symptoms relate to long-term outcomes.
Patients with mTBI (Glasgow Coma Scale = 13-15) evaluated across 18 U.S. Level 1 trauma centers from 2013 to 2019 completed the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 2 weeks (W2) post-injury ( = 1,593) and at 3 months (M3), 6 months (M6), and 12 months (M12) post-injury. Network maps were developed from RPQ subscale scores at each timepoint. RPQ scores at W2 were associated with M6 and M12 functional and quality of life outcomes.
Network structure did not differ across timepoints, indicating no difference in symptoms/factors influence on the overall symptom network across time. The cognitive factor had the highest expected influence at W2 (1.761), M3 (1.245), and M6 (1.349). Fatigue had the highest expected influence at M12 (1.275). The emotional factor was the only other node with expected influence >1 at any timepoint, indicating disproportionate influence of emotional symptoms on overall symptom burden (M3 = 1.011; M6 = 1.076).
Several symptom factors at 2-weeks post-injury were more strongly associated with incomplete recovery and/or poorer injury-related quality of life at 6 and 12 months post-injury than previously validated demographic and clinical covariates. The network analysis suggests that emotional, cognitive, and fatigue symptoms may be useful treatment targets in this population due to high centrality and activating potential of the overall symptom network.
轻度创伤性脑损伤（mTBI）是一种异质性损伤，其特征和管理可能具有挑战性。使用横断面网络分析（NA）来概念化mTBI症状，为识别mTBI症状之间的相互关系提供了一种创新方法。网络理论的中心性假设认为，网络中的某些症状更相关（中心性更高），或者对网络的其他部分具有高于平均水平的影响。然而，尚无研究使用NA来描述就诊于美国一级创伤中心急诊科的mTBI患者队列中症状之间的相互关系，以及亚急性中心性症状与长期预后的关系。
2013年至2019年期间，在美国18家一级创伤中心接受评估的mTBI患者（格拉斯哥昏迷量表=13 - 15）在受伤后2周（W2）（n = 1,593）、3个月（M3）、6个月（M6）和12个月（M12）完成了Rivermead脑震荡后症状问卷（RPQ）。在每个时间点根据RPQ子量表得分绘制网络地图。W2时的RPQ得分与M6和M12时的功能及生活质量预后相关。
各时间点的网络结构无差异，表明症状/因素对总体症状网络的影响随时间无差异。认知因素在W2（1.761）、M3（1.245）和M6（1.349）时具有最高的预期影响力。疲劳在M12时具有最高的预期影响力（1.275）。情绪因素是在任何时间点预期影响力>1的唯一其他节点，表明情绪症状对总体症状负担具有不成比例的影响（M3 = 1.011；M6 = 1.076）。
与先前验证的人口统计学和临床协变量相比，受伤后2周的几个症状因素与受伤后6个月和12个月的恢复不完全和/或较差的损伤相关生活质量更密切相关。网络分析表明，由于总体症状网络的高中心性和激活潜力，情绪、认知和疲劳症状可能是该人群有用的治疗靶点。
