Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom.
Institute of Neuroscience and Psychology, Queen Elizabeth University Hospital, University of Glasgow, Glasgow, United Kingdom.
JAMA Netw Open. 2024 Jan 2;7(1):e2353318. doi: 10.1001/jamanetworkopen.2023.53318.
Exposure to traumatic brain injury (TBI) has raised widespread concern over participation in sports, particularly over possible long-term consequences. However, little is known about the outcomes of individuals presenting to hospitals with sports-related TBI.
To compare the characteristics and outcomes of individuals presenting to hospitals with sports-related and non-sports-related TBI.
DESIGN, SETTING, AND PARTICIPANTS: The CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) observational cohort study was conducted at hospitals in 18 countries. The study enrolled 4509 patients who had TBI and had an indication for computed tomography (CT), of whom 4360 were 16 years or older. Outcomes were assessed at 3 and 6 months, and groups were compared using regression analyses adjusting for clinical and demographic differences. Data were collected between December 9, 2014, and December 17, 2017, and analyzed from August 2022 to March 2023.
Sports-related and non-sports-related TBI with subgroups selected by severity of injury.
The main outcome was the Glasgow Outcome Scale-Extended (GOSE) at 6 months, with secondary outcomes covering postconcussion symptoms, health-related quality of life, and mental health.
A total of 4360 patients were studied, including 256 (6%) with sports-related TBI (mean [SD] age, 38.9 [18.1] years; 161 [63%] male) and 4104 with non-sports-related TBI (mean [SD] age, 51.0 [20.2] years; 2773 [68%] male). Compared with patients with non-sports-related TBI, patients with sports-related TBI were younger, more likely to have tertiary education, more likely to be previously healthy, and less likely to have a major extracranial injury. After adjustment, the groups did not differ in incomplete recovery (GOSE scores <8) at 6 months (odds ratio [OR], 1.27; 95% CI, 0.90-1.78; P = .22 for all patients; OR, 1.20; 95% CI, 0.83-1.73; P = .34 for those with mild TBI; and OR, 1.19; 95% CI, 0.74-1.92; P = .65 for those with mild TBI and negative CT findings). At 6 months, there was incomplete recovery in 103 of 223 patients (46%) with outcomes in the sports-related TBI group, 65 of 168 (39%) in those with mild sports-related TBI, and 30 of 98 (31%) in those with mild sports-related TBI and negative CT findings. In contrast, at 6 months, the sports-related TBI group had lower prevalence of anxiety, depression, posttraumatic stress disorder, and postconcussion symptoms than the non-sports-related group.
In this cohort study of 4360 patients with TBI, functional limitations 6 months after injury were common after sports-related TBI, even mild sports-related TBI. Persisting impairment was evident in the sports-related TBI group despite better recovery compared with non-sports-related TBI on measures of mental health and postconcussion symptoms. These findings caution against taking an overoptimistic view of outcomes after sports-related TBI, even if the initial injury appears mild.
创伤性脑损伤（TBI）的暴露引发了人们对参与体育运动的广泛关注，尤其是对可能存在的长期后果的关注。然而，对于因运动相关 TBI 而到医院就诊的个体的结果知之甚少。
比较因运动相关和非运动相关 TBI 而到医院就诊的个体的特征和结局。
设计、设置和参与者：CENTER-TBI（欧洲协作神经创伤效应研究中的创伤性脑损伤）观察性队列研究在 18 个国家的医院进行。该研究纳入了 4509 名 TBI 患者，这些患者有进行计算机断层扫描（CT）的指征，其中 4360 名患者年龄在 16 岁及以上。在 3 个月和 6 个月时评估结局，并使用回归分析比较了调整了临床和人口统计学差异的两组。数据于 2014 年 12 月 9 日至 2017 年 12 月 17 日收集，并于 2022 年 8 月至 2023 年 3 月进行分析。
运动相关和非运动相关 TBI，通过损伤严重程度的亚组进行选择。
主要结局是 6 个月时的格拉斯哥结局量表扩展版（GOSE），次要结局包括脑震荡后症状、健康相关生活质量和心理健康。
共纳入 4360 名患者，其中 256 名（6%）为运动相关 TBI（平均[标准差]年龄，38.9[18.1]岁；161 名[63%]为男性），4104 名为非运动相关 TBI（平均[标准差]年龄，51.0[20.2]岁；2773 名[68%]为男性）。与非运动相关 TBI 患者相比，运动相关 TBI 患者更年轻，更有可能接受过高等教育，更有可能之前身体健康，更不可能有严重的颅外损伤。调整后，两组在 6 个月时不完全恢复（GOSE 评分＜8）的比例无差异（比值比[OR]，1.27；95%置信区间[CI]，0.90-1.78；P=0.22，所有患者；OR，1.20；95%CI，0.83-1.73；P=0.34，轻度 TBI 患者；OR，1.19；95%CI，0.74-1.92；P=0.65，轻度 TBI 且 CT 检查结果为阴性的患者）。在 6 个月时，223 名运动相关 TBI 患者中有 103 名（46%）、168 名轻度运动相关 TBI 患者中有 65 名（39%）和 98 名轻度运动相关 TBI 且 CT 检查结果为阴性的患者中有 30 名（31%）存在不完全恢复。相比之下，在 6 个月时，运动相关 TBI 组比非运动相关 TBI 组的焦虑、抑郁、创伤后应激障碍和脑震荡后症状的患病率更低。
在这项对 4360 名 TBI 患者的队列研究中，运动相关 TBI 后 6 个月时的功能限制很常见，即使是轻度运动相关 TBI。尽管运动相关 TBI 组在心理健康和脑震荡后症状等指标上的恢复情况好于非运动相关 TBI，但仍存在持续的损伤。这些发现告诫人们，即使初始损伤看起来较轻，也不应对运动相关 TBI 的结果持过于乐观的态度。
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