Eagle Shawn R, Lamb Bryan, Huber Daniel, McCrea Michael A, Tarima Sergey, deRoon-Cassini Terri A, Okonkwo David O, Nelson Lindsay D
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States.
Department of Physical Medicine & Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States.
Clin Neurol Neurosurg. 2025 Sep;256:109017. doi: 10.1016/j.clineuro.2025.109017. Epub 2025 Jun 16.
There are limited data directly comparing recovery across traumatic brain injury subpopulations. We compared symptom recovery profiles between patients with Glasgow Coma Scale (GCS) 13-15 traumatic brain injury (TBI) from the same region in three cohorts: (1) Participants with sport-related concussion (SRC), (2) participants evaluated and discharged from the level 1 trauma center emergency department (ED), and (3) participants who required 1 + night(s) in the inpatient unit (IP). The current analysis aggregates data from two prospective cohort studies at the same institution resulting in a combined dataset of 395 patients with TBI (224 with SRC, 95 discharged from the ED, and 75 admitted [IP]). The primary outcome measure of interest was self-reported TBI symptom duration (in days). Two multivariable Cox proportional hazards models evaluated differences in symptom recovery between groups while controlling for recovery risk factors, including age, sex, race/ethnicity, acute symptom severity, psychological disorder history, loss of consciousness, and post-traumatic amnesia. The second model included only ED and IP, due to availability of additional predictor variables in these samples (e.g., education, cause of injury, peripheral injury severity). In unadjusted models, hazards of symptom recovery were lower with increasing levels of care (IP vs. ED HR=.40, p < .001; IP vs. SRC HR=.11, p < .001, ED vs. SRC HR=.28, p < .001). Controlling for covariates, longer symptom recovery in the trauma center subsamples versus SRC persisted (IP vs. SRC HR=.26, p = .018, ED vs. SRC HR=.52, p = .021), whereas differences between ED and IP became nonsignificant (HR=.86, p = .782). Acute symptom severity (HR=0.98; p < 0.001-0.010) and psychiatric history (HR=0.27-0.36; p ≤ 0.034) were independent predictors of symptom duration in both models. The results of this study suggest that patients with TBI and GCS 13-15 seen at a level 1 trauma center vary significantly in symptom recovery and severity in comparison to those with SRC, regardless of population differences in age, sex and psychiatric history.
直接比较创伤性脑损伤亚群恢复情况的数据有限。我们比较了来自同一地区的三个队列中格拉斯哥昏迷量表（GCS）评分为13 - 15的创伤性脑损伤（TBI）患者的症状恢复情况：（1）与运动相关的脑震荡（SRC）参与者；（2）在一级创伤中心急诊科（ED）接受评估并出院的参与者；（3）需要在住院部（IP）住院1晚及以上的参与者。当前分析汇总了同一机构两项前瞻性队列研究的数据，得到了一个包含395例TBI患者的合并数据集（224例SRC患者、95例从ED出院的患者和75例入院[IP]患者）。主要关注的结局指标是自我报告的TBI症状持续时间（以天为单位）。两个多变量Cox比例风险模型在控制恢复风险因素（包括年龄、性别、种族/族裔、急性症状严重程度、心理障碍病史、意识丧失和创伤后遗忘）的同时，评估了各组之间症状恢复的差异。由于这些样本中存在其他预测变量（如教育程度、损伤原因、外周损伤严重程度），第二个模型仅纳入了ED和IP的患者。在未调整的模型中，随着护理水平的提高，症状恢复的风险降低（IP组与ED组相比，风险比[HR]=0.40，p<0.001；IP组与SRC组相比，HR=0.11，p<0.001，ED组与SRC组相比，HR=0.28，p<0.001）。在控制协变量后，创伤中心亚组与SRC组相比，症状恢复时间仍然更长（IP组与SRC组相比，HR=0.26，p=0.018，ED组与SRC组相比，HR=0.52，p=0.021），而ED组和IP组之间的差异变得不显著（HR=0.86，p=0.782）。在两个模型中，急性症状严重程度（HR=0.98；p<0.001 - 0.010）和精神病史（HR=0.27 - 0.36；p≤0.034）都是症状持续时间的独立预测因素。本研究结果表明，在一级创伤中心就诊的GCS评分为13 - 15的TBI患者与SRC患者相比，无论年龄、性别和精神病史的人群差异如何，其症状恢复和严重程度都有显著差异。
