Global Disability Trajectories Over the First Decade Following Combat Concussion.
Global Disability Trajectories Over the First Decade Following Combat Concussion.
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DOI：
10.1097/htr.0000000000000738
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发表时间：
2022-03-01
期刊：
影响因子：
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通讯作者：
Temkin N
中科院分区：
文献类型：
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作者：
Mac Donald CL;Barber J;Johnson A;Patterson J;Temkin N
在部署后的第一个十年内，检查美国军队中有和没有创伤性脑损伤（TBI）的全球残疾轨迹，以确定更好的干预分层的风险特征，希望降低长期成本。患者和参与者在受伤时参加战斗或直接在医疗后送后登记，每6个月随访一次，持续10年。有四个主要组（n=475）;两个主要组，两个探索组：（1）无爆炸暴露史的战斗部署对照组“非爆炸对照组”（n=143），（2）震荡性爆炸性TBI“爆炸-TBI”（n=236）（原发），和（3）有爆炸暴露史的战斗部署对照组“爆炸-对照组”（n=54），（4）非冲击波“非冲击波-TBI”所致战斗脑震荡患者（n=42）（探索性）。前瞻性、观察性、纵向研究。在部署后的第一个十年内对抗脑震荡、爆炸暴露和随后的头部损伤暴露。通过扩展格拉斯哥结局量表（GOSE）测量的整体残疾。潜在类别增长分析确定了全球结果的四个主要轨迹，与非爆炸对照相比，服务人员持续战斗脑震荡的可能性高出37-49倍（爆炸-TBI OR 49.33，CI 19.77-123.11 p<0.001，非爆炸-TBI OR 37.50，CI 10.01-140.50，p<0.001）。即使是爆炸暴露对照组，与非爆炸对照组相比，这些较低残疾类别的可能性也高5倍（OR 5.00，CI 1.59-15.99，p=0.007）。调整人口因素和随后的头部损伤暴露并没有实质性改变这些比值比。对于那些在战斗中遭受脑震荡，受伤时年龄较小，受教育程度较低，并且在军队中入伍的风险高于单独部署的风险的人，确定了长期结果轨迹不佳的可能性非常高。这些发现有助于确定风险状况，可用于针对早期干预和筛查不良长期结果，以帮助降低高昂的公共卫生成本，并提高部署后这些服务人员的长期生活质量。
To examine global disability trajectories in US military with and without traumatic brain injury(TBI) over the first decade following deployment to identify risk profiles for better intervention stratification, hopefully reducing long-term cost. Patients and participants were enrolled in combat or directly following medical evacuation at the time of injury and followed every 6 months for 10 years. There are four main groups(n=475); two primary, two exploratory: (1) combat-deployed controls without history of blast exposure ‘non-blast-control’ (n=143), (2) concussive blast TBI ‘blast-TBI’ (n=236) (primary), and (3) combat-deployed controls with history of blast exposure ‘blast-control’ (n=54), (4) patients sustaining a combat concussion not from blast ‘non-blast-TBI’ (n=42) (exploratory). Prospective, observational, longitudinal study. Combat concussion, blast exposure and subsequent head injury exposure over the first decade post-deployment. Global disability measured by the Glasgow Outcome Scale Extended (GOSE). Latent class growth analysis identified four main trajectories of global outcome, with service members sustaining combat concussion 37–49 times more likely to be in the higher disability trajectories than non-blast-controls (blast-TBI OR 49.33, CI 19.77–123.11 p<0.001, non-blast-TBI OR 37.50, CI 10.01–140.50, p<0.001). Even blast-exposed-controls were 5 times more likely to be in these lower disability categories compared to non-blast-controls (OR 5.00, CI 1.59–15.99, p=0.007). Adjustment for demographic factors and subsequent head injury exposure did not substantially alter these odds ratios. Very high odds of poor long-term outcome trajectory was identified for those who sustained a concussion in combat, were younger at the time of injury, had lower education, and enlisted in the Army above the risk of deployment alone. These findings help identify a risk profile that could be used to target early intervention and screen for poor long-term outcome to aid in reducing the high public health cost and enhance the long-term quality of life for these service members following deployment.