Perception of Recovery After Pediatric Mild Traumatic Brain Injury Is Influenced by the "Good Old Days" Bias: Tangible Implications for Clinical Practice and Outcomes Research
Perception of Recovery After Pediatric Mild Traumatic Brain Injury Is Influenced by the "Good Old Days" Bias: Tangible Implications for Clinical Practice and Outcomes Research
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DOI：
10.1093/arclin/act083
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发表时间：
2014-03-01
影响因子：
2.6
通讯作者：
Barlow, Karen M.
中科院分区：
文献类型：
--
作者：
Brooks, Brian L.;Kadoura, Basil;Barlow, Karen M.
轻度创伤性脑损伤（mTBI）的恢复主要基于脑震荡后症状恢复到发病前水平。然而，“美好的旧时光”的偏见意味着较少的发病前症状被回忆起来，从而扭曲了相对于受伤前的康复判断。本研究的目的是调查儿童mTBI中的“美好时光”偏见，并证明这种偏见对感知恢复的影响。在持续mTBI后招募2-18岁的儿童和青少年（平均10.9,SD 4.4, N 412）。提供了病前症状的评分：(a)在急诊科（ED），由父母提供，(b)回顾性随访1个月（由父母和青少年），(c)回顾性随访3个月（由父母和青少年）。从ED到损伤后1个月，父母对病前症状的评分下降了80% (p < 0.001)，但在损伤后1至3个月保持稳定（p < 0.05）。青少年发病前评分在受伤后1至3个月下降。缓慢恢复对发病前报告没有差异影响。使用在ED中获得的发病前评分，而不是随访时的回顾性症状报告，表明有相当一部分被认为“未恢复”的患者在损伤后1个月（29%）和3个月（41%）的症状评分与损伤前相比“相同或更低”。“美好的过去”偏差在儿童mTBI损伤后1个月出现，影响回顾性症状报告，并对研究和临床实践中确定恢复具有可测量的意义。
Recovery from mild traumatic brain injury (mTBI) is primarily based on the resolution of post-concussive symptoms back to a premorbid level. However, the "good old days" bias means fewer premorbid symptoms are retrospectively recalled, thus skewing the determination of recovery relative to pre-injury. The objectives of this study were to investigate the "good old days" bias in pediatric mTBI and demonstrate the implications of this bias on perceived recovery. Children and adolescents 2-18 years old (mean 10.9, SD 4.4, N 412) were recruited after sustaining an mTBI. Ratings of premorbid symptoms were provided: (a) in the Emergency Department (ED; by parents), (b) retrospectively at a 1-month follow-up (by parents and adolescents), and (c) retrospectively at a 3-month follow-up (by parents and adolescents). Parent ratings of premorbid symptoms decreased by 80% from the ED to 1-month post-injury (p < .001) but were stable from 1 to 3 months post-injury (p < .05). Adolescents premorbid ratings declined from 1 to 3 months post-injury. Slow recovery did not have a differential impact on premorbid reporting. Using premorbid ratings obtained in the ED, instead of retrospective symptom reporting at the time of follow-up, suggests that a significant minority of patients believed to be "not recovered" actually have the "same or lower" symptom ratings at 1 (29%) and 3 months (41%) post-injury compared with before the injury. The "good old days" bias is present in pediatric mTBI by 1-month post-injury, influences retrospective symptom reporting, and has measureable implications for determining recovery in research and clinical practice.