Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study
Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study
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美国一级创伤中心轻度创伤性脑损伤患者的恢复：创伤性脑损伤（TRACK-TBI）研究的转化研究和临床知识
DOI：
10.1001/jamaneurol.2019.1313
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发表时间：
2019-09-01
期刊：
影响因子：
29
通讯作者：
Zafonte, Ross
中科院分区：
文献类型：
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作者：
Nelson, Lindsay D.;Temkin, Nancy R.;Zafonte, Ross
关键点问题与骨科创伤相比，轻度创伤性脑损伤后与损伤相关的持续性功能障碍有多常见？在1154例轻型颅脑损伤患者和299例骨科创伤患者作为对照的队列研究中，53%的轻型颅脑损伤患者在12个月后报告了损伤，而骨科创伤患者的这一比例为38%。有颅内异常的患者预后最差；然而，没有异常的患者在12个月时也报告了问题。许多在I级创伤中心就诊的轻度创伤性脑损伤的患者在损伤后12个月经历了困难，这表明这种损伤并不总是良性的；似乎需要更好的随访和治疗。重要信息大多数创伤性脑损伤(TBI)根据入院格拉斯哥昏迷评分(GCS)13到15分被归类为轻度(MTBI)。这些患者的持续性功能障碍的流行率尚不清楚。目的利用创伤性脑损伤的转化研究和临床知识研究(Track-TBI)的数据，描述mTBI组与外周骨科创伤后12个月内日常功能恢复的自然历史，并利用临床CT扫描，检查mTBI组中有(CT+)或无(CT-)急性颅内病变与预后的关系。设计、设置和参与者TRACK-TBI是一项对在美国I级创伤中心就诊的mTBI患者进行的队列研究，从2014年2月26日到2018年8月8日招募患者，并进行了12个月的随访。11个I级创伤中心急诊科或住院单位的1453名患者符合纳入标准(即mTBI[n=1154]或周围骨科创伤[n=299])，并在受伤后24小时内入选；mTBI参与者入院时GCS评分为13~15分，临床头颅CT扫描。周围骨科创伤患者为对照组(OTC组)。暴露患有mTBI或非处方药的参与者。主要结果和测量主要结果是格拉斯哥预后量表扩展(GOSE)评分，反映了损伤后2周、3、6和12个月的广泛生活领域中与损伤相关的功能限制。Gose评分的可能范围是1(死亡)到8(上级良好恢复)，低于8分表示某种程度的功能损害。结果在1453名受试者中，953名(65.6%)为男性；平均年龄(SD)：mTBI组为40.9岁(17.1岁)，OTC组为40.9岁(15.4岁)。大多数参与者(mTBI，87%；OTC，93%)报告功能受限(Gose
Key PointsQuestionHow common are persistent, injury-related functional limitations following mild traumatic brain injury vs orthopedic trauma? FindingsIn this cohort study of 1154 patients with mild traumatic brain injury and 299 patients with orthopedic trauma serving as controls, 53% of participants with mild traumatic brain injury reported impairment 12 months postinjury vs 38% of those with orthopedic trauma. Patients with intracranial abnormalities had the poorest outcomes; however, patients without abnormalities also reported problems at 12 months. MeaningMany patients who present to level I trauma centers with mild traumatic brain injury experience difficulties at 12 months postinjury, suggesting that this injury is not always benign; better follow-up and treatment appear to be needed.ImportanceMost traumatic brain injuries (TBIs) are classified as mild (mTBI) based on admission Glasgow Coma Scale (GCS) scores of 13 to 15. The prevalence of persistent functional limitations for these patients is unclear. ObjectivesTo characterize the natural history of recovery of daily function following mTBI vs peripheral orthopedic traumatic injury in the first 12 months postinjury using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, and, using clinical computed tomographic (CT) scans, examine whether the presence (CT+) or absence (CT-) of acute intracranial findings in the mTBI group was associated with outcomes. Design, Setting, and ParticipantsTRACK-TBI, a cohort study of patients with mTBI presenting to US level I trauma centers, enrolled patients from February 26, 2014, to August 8, 2018, and followed up for 12 months. A total of 1453 patients at 11 level I trauma center emergency departments or inpatient units met inclusion criteria (ie, mTBI [n=1154] or peripheral orthopedic traumatic injury [n=299]) and were enrolled within 24 hours of injury; mTBI participants had admission GCS scores of 13 to 15 and clinical head CT scans. Patients with peripheral orthopedic trauma injury served as the control (OTC) group. ExposuresParticipants with mTBI or OTC. Main Outcomes and MeasuresThe Glasgow Outcome Scale Extended (GOSE) scale score, reflecting injury-related functional limitations across broad life domains at 2 weeks and 3, 6, and 12 months postinjury was the primary outcome. The possible score range of the GOSE score is 1 (dead) to 8 (upper good recovery), with a score less than 8 indicating some degree of functional impairment. ResultsOf the 1453 participants, 953 (65.6%) were men; mean (SD) age was 40.9 (17.1) years in the mTBI group and 40.9 (15.4) years in the OTC group. Most participants (mTBI, 87%; OTC, 93%) reported functional limitations (GOSE