Neurobehavioral outcome 1 year after severe head injury. Experience of the Traumatic Coma Data Bank.
Neurobehavioral outcome 1 year after severe head injury. Experience of the Traumatic Coma Data Bank.
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DOI：
10.3171/jns.1990.73.5.0699
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发表时间：
1990-11
影响因子：
4.1
通讯作者：
H. Levin;H. Gary;H. Eisenberg;R. Ruff;J. Barth;J. Kreutzer;W. High;S. Portman;M. Foulkes;J. Jane;A. Marmarou;L. Marshall
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文献类型：
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作者：
H. Levin;H. Gary;H. Eisenberg;R. Ruff;J. Barth;J. Kreutzer;W. High;S. Portman;M. Foulkes;J. Jane;A. Marmarou;L. Marshall
在创伤性昏迷数据库（TCDB）的四个中心之一的神经外科服务中心，对严重头部损伤后1年的结果进行了调查。在300名符合条件的幸存者中，263名患者（87%）在受伤后1年至少通过格拉斯哥结局量表（GOS）评估恢复质量，而127名（42%）符合条件的幸存者进行了完整的神经心理学评估。患者在受伤后1年接受神经心理学测试的能力是恢复的标准，这与急性损伤的神经指标和出院时的GOS评分有显著关系。损伤后1年的神经行为数据在四个患者样本中基本相当，其特征是记忆受损和信息处理减慢。相反，语言和视觉空间能力恢复到正常范围内。复苏后最低的格拉斯哥昏迷评分（GCS）评分和瞳孔反应性可预测1年GOS评分和神经心理学表现。在复苏后至少有一个无反应性瞳孔的患者中，最低GCS评分特别能预测伤后1年的神经心理学表现。尽管TCDB的范围和随访材料的损耗存在局限性，但结果表明了严重头部损伤后神经行为恢复的特征模式，并鼓励在临床试验中使用神经行为结局测量来评估头部损伤患者的干预措施。
The outcome 1 year after they had sustained a severe head injury was investigated in patients who were admitted to the neurosurgery service at one of four centers participating in the Traumatic Coma Data Bank (TCDB). Of 300 eligible survivors, the quality of recovery 1 year after injury was assessed by at least the Glasgow Outcome Scale (GOS) in 263 patients (87%), whereas complete neuropsychological assessment was performed in 127 (42%) of the eligible survivors. The capacity of the patients to undergo neuropsychological testing 1 year after injury was a criterion of recovery as reflected by a significant relationship to neurological indices of acute injury and the GOS score at the time of hospital discharge. The neurobehavioral data at 1 year after injury were generally comparable across the four samples of patients and characterized by impairment of memory and slowed information processing. In contrast, language and visuospatial ability recovered to within the normal range. The lowest postresuscitation Glasgow Coma Scale (GCS) score and pupillary reactivity were predictive of the 1-year GOS score and neuropsychological performance. The lowest GCS score was especially predictive of neuropsychological performance 1 year postinjury in patients who had at least one nonreactive pupil following resuscitation. Notwithstanding limitations related to the scope of the TCDB and attrition in follow-up material, the results indicate a characteristic pattern of neurobehavioral recovery from severe head injury and encourage the use of neurobehavioral outcome measurements in clinical trials to evaluate interventions for head-injured patients.