Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury.
Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury.
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DOI：
10.1001/jamanetworkopen.2023.3660
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发表时间：
2023-03-01
影响因子：
13.8
通讯作者：
Manley, Geoffrey T.
中科院分区：
文献类型：
--
作者：
Nelson, Lindsay D.;Temkin, Nancy R.;Barber, Jason;Brett, Benjamin L.;Okonkwo, David O.;McCrea, Michael A.;Giacino, Joseph T.;Bodien, Yelena G.;Robertson, Claudia;Corrigan, John D.;Diaz-Arrastia, Ramon;Markowitz, Amy J.;Manley, Geoffrey T.
轻度外伤性脑损伤（mTBI）和中重度外伤性脑损伤（msTBI）后1 - 5年的功能、症状和生活质量的过程是什么？在这项对1196名一级创伤中心患者（859名mTBI， 188名msTBI， 152名骨科创伤对照组）进行的5年队列研究中，msTBI与死亡率增加有关，但msTBI幸存者在1至5年内表现出改善的独立性。mTBI幸存者的预后比对照组差。这些结果表明，更好地了解TBI恢复，以及增加临床和社区对mTBI和msTBI的支持，有必要解决与TBI相关的长期风险。这项对一级创伤中心患者的队列研究比较了轻度和中重度创伤性脑损伤患者在损伤后5年内的功能和生活质量。许多一级创伤中心患者在创伤性脑损伤（TBI）后1年出现临床后遗症。需要更长期的结果数据来发展更好的监测和康复服务。目的：观察损伤后1 ~ 5年的功能恢复、创伤性脑损伤相关症状和生活质量。这项队列研究在2014年至2018年期间招募了18个美国一级创伤中心的创伤患者。符合条件的参与者在受伤后24小时内入组，并随访至受伤后5年。数据分析于2023年1月。轻度TBI (mTBI)，中重度TBI (msTBI)，或骨科创伤控制（OTC）。功能独立性（格拉斯哥结局量表-扩展[GOSE]评分5分或更高）、功能完全恢复（GOSE评分8分）、更好（即更低）的创伤性脑损伤相关症状负担（Rivermead脑震荡后症状问卷评分15分或更低）、更好（即更高）的健康相关生活质量（脑损伤后生活质量量表-总体评分52分或更高）；死亡率作为次要结果进行分析。共纳入1196例患者（平均[SD]年龄40.8[16.9]岁，男性781例[65%]，黑人158例[13%]，白人965例[81%]）。mTBI组和OTC组表现出稳定、高的功能独立性（98%至100%）。虽然msTBI存活者独立的几率较低，但大多数存活者在1年时是独立的（72%），并且这一比例随着时间的推移而增加（5年时为80%；组×年，P = 0.005；每年独立：msTBI的比值比[OR]为1.28；95% CI为1.03-1.58；mTBI的OR为0.81；95% CI为0.64-1.03）。对于其他结果，组间1年的差异随时间保持稳定（组×年，P≥0.44）。mTBI患者与OTC患者相比，完全功能恢复的几率仍然较低（OR, 0.39; 95% CI, 0.28-0.56）， msTBI患者与mTBI患者的完全功能恢复几率更低（OR, 0.34; 95% CI, 0.24-0.48）。两个TBI亚组较好的TBI相关症状负担和生活质量的几率相似，低于otc。msTBI的1 - 5年死亡率（5.5%）高于mTBI（1.5%）和OTC （0.7%, P = 0.02）。在这项队列研究中，既往msTBI患者在5年内表现出更高的独立性；msTBI还与死亡率增加有关。这些发现，再加上mTBI与对照组相比不良结局发生率持续升高，意味着需要对TBI进行更多的监测和康复。
What is the course of functional, symptom, and quality of life outcomes 1 to 5 years after mild traumatic brain injury (mTBI) and moderate-severe traumatic brain injury (msTBI)? In this cohort study of 1196 level I trauma center patients (859 mTBI, 188 msTBI, 152 orthopedic trauma controls) followed 5 years postinjury, msTBI was associated with increased mortality, yet msTBI survivors displayed improved independence from 1 to 5 years. mTBI survivors had poorer outcomes than controls. These results suggest that better understanding of TBI recovery, as well as increased clinical and community support for mTBI and msTBI, are warranted to address long-term risks associated with TBI. This cohort study of level I trauma center patients compares outcomes for function and quality of life of patients with mild and moderate-severe traumatic brain injury over the course of 5 years following injury. Many level I trauma center patients experience clinical sequelae at 1 year following traumatic brain injury (TBI). Longer-term outcome data are needed to develop better monitoring and rehabilitation services. To examine functional recovery, TBI-related symptoms, and quality of life from 1 to 5 years postinjury. This cohort study enrolled trauma patients across 18 US level I trauma centers between 2014 and 2018. Eligible participants were enrolled within 24 hours of injury and followed up to 5 years postinjury. Data were analyzed January 2023. Mild TBI (mTBI), moderate-severe TBI (msTBI), or orthopedic traumatic controls (OTC). Functional independence (Glasgow Outcome Scale-Extended [GOSE] score 5 or higher), complete functional recovery (GOSE score, 8), better (ie, lower) TBI-related symptom burden (Rivermead Post Concussion Symptoms Questionnaire score of 15 or lower), and better (ie, higher) health-related quality of life (Quality of Life After Brain Injury Scale-Overall Scale score 52 or higher); mortality was analyzed as a secondary outcome. A total 1196 patients were included in analysis (mean [SD] age, 40.8 [16.9] years; 781 [65%] male; 158 [13%] Black, 965 [81%] White). mTBI and OTC groups demonstrated stable, high rates of functional independence (98% to 100% across time). While odds of independence were lower among msTBI survivors, the majority were independent at 1 year (72%), and this proportion increased over time (80% at 5 years; group × year, P = .005; independence per year: odds ratio [OR] for msTBI, 1.28; 95% CI, 1.03-1.58; OR for mTBI, 0.81; 95% CI, 0.64-1.03). For other outcomes, group differences at 1 year remained stable over time (group × year, P ≥ .44). Odds of complete functional recovery remained lower for persons with mTBI vs OTC (OR, 0.39; 95% CI, 0.28-0.56) and lower for msTBI vs mTBI (OR, 0.34; 95% CI, 0.24-0.48). Odds of better TBI-related symptom burden and quality of life were similar for both TBI subgroups and lower than OTCs. Mortality between 1 and 5 years was higher for msTBI (5.5%) than mTBI (1.5%) and OTC (0.7%; P = .02). In this cohort study, patients with previous msTBI displayed increased independence over 5 years; msTBI was also associated with increased mortality. These findings, in combination with the persistently elevated rates of unfavorable outcomes in mTBI vs controls imply that more monitoring and rehabilitation are needed for TBI.
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DOI：
10.1016/j.apmr.2013.01.023
发表时间：
2013-06-01
影响因子：
4.3
作者：
Corrigan, John D.;Hammond, Flora M.
通讯作者：
Hammond, Flora M.
影响因子：
4.2
作者：
Asemota, Anthony O.;George, Benjamin P.;Schneider, Eric B.
通讯作者：
Schneider, Eric B.
影响因子：
29
作者：
Nelson, Lindsay D.;Temkin, Nancy R.;Zafonte, Ross
通讯作者：
Zafonte, Ross
影响因子：
1.1
作者：
Booker, James;Sinha, Saurabh;Singh, Rajiv
通讯作者：
Singh, Rajiv
影响因子：
4.2
作者：
Cnossen, Maryse C.;van der Naalt, Joukje;Lingsma, Hester F.
通讯作者：
Lingsma, Hester F.