Nelson Lindsay D, Wilson Lindsay, Albrecht Jennifer S, Arciniegas David B, Barthélemy Ernest J, Fontaine Sarah N, Gardner Raquel C, Juengst Shannon B, Pappadis Monique R, Ponsford Jennie, Thomas Danny G, Yeates Keith Owen, Dams-O'Connor Kristin, Manley Geoffrey T, Maas Andrew I R, McCrea Michael A, Awwad Hibah O, Doperalski Adele, Umoh Nsini
Departments of Neurosurgery & Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK.
J Neurotrauma. 2025 Jul;42(13-14):1023-1037. doi: 10.1089/neu.2024.0569. Epub 2025 Jun 4.
Biopsychosocial and environmental factors play a major role in acute clinical presentation, recovery, and outcome of traumatic brain injury (TBI). As part of the 2024 National Institute of Neurological Disorders and Stroke (NINDS) TBI Classification and Nomenclature Initiative, the Psychosocial and Environmental Modifiers (PEM) Working Group was assembled to perform a narrative review and summary of expert opinions regarding how non-TBI factors influence the presenting features and outcomes of TBI and to make recommendations for incorporating these Modifiers into clinical care and research. With input from working group members and other interested parties, we summarize the membership, methods, and outcomes of the PEM Working Group activities. Modifiers were considered with the NINDS Social Determinants of Health Framework in mind and fall under three broad headings: individual-level variables (e.g., demographics, preinjury health, culture), injury-related variables (e.g., cause and context of injury, second insults), and community-/societal-level factors (e.g., family/community support, socioeconomic position, structural racism). Recommendations include steps to increase awareness of Modifiers in health care encounters, identify Modifier-related disparities in TBI-related care and outcomes, better understand the mechanisms by which Modifiers influence TBI-related clinical presentation and outcomes, and intervene to improve the health and well-being of persons exposed to TBI. These recommendations are intended to be a starting point that will evolve as knowledge grows and additional input is incorporated.
生物心理社会和环境因素在创伤性脑损伤（TBI）的急性临床表现、恢复及预后中起着重要作用。作为2024年美国国立神经疾病和中风研究所（NINDS）TBI分类与命名倡议的一部分，组建了心理社会和环境修饰因素（PEM）工作组，以对关于非TBI因素如何影响TBI的呈现特征和预后的专家意见进行叙述性综述和总结，并就将这些修饰因素纳入临床护理和研究提出建议。根据工作组成员和其他相关方的意见，我们总结了PEM工作组活动的成员构成、方法和成果。在考虑NINDS健康的社会决定因素框架的情况下对修饰因素进行了考量，其分为三大类：个体层面变量（如人口统计学、伤前健康状况、文化）、损伤相关变量（如损伤原因和背景、二次损伤）以及社区/社会层面因素（如家庭/社区支持、社会经济地位、结构性种族主义）。建议包括提高在医疗保健接触中对修饰因素的认识、识别TBI相关护理和预后中与修饰因素相关的差异、更好地理解修饰因素影响TBI相关临床表现和预后的机制，以及进行干预以改善TBI患者的健康和福祉。这些建议旨在作为一个起点，随着知识的增长和纳入更多的意见而不断发展。
