Longitudinal trajectories and risk factors for persistent postconcussion symptom reporting following uncomplicated mild traumatic brain injury in US Military service members
Longitudinal trajectories and risk factors for persistent postconcussion symptom reporting following uncomplicated mild traumatic brain injury in US Military service members
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DOI：
10.1080/13854046.2020.1746832
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发表时间：
2020-04-10
影响因子：
3.9
通讯作者：
Brickell, Tracey A.
中科院分区：
文献类型：
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作者：
Lange, Rael T.;Lippa, Sara M.;Brickell, Tracey A.
目的：本研究的目的是研究轻度创伤性脑损伤(MTBI)后个体脑震荡后症状[PCSx]的轨迹，并探讨持续报告PCSx的危险因素。方法：受试者是138名美国军人和退伍军人(SMV)，他们在国防和退伍军人脑损伤中心进行了为期15年的纵向脑损伤研究。受试者分为三组：单纯MTBI组(n=54)、损伤对照组(IC)和非损伤对照组(NIC，n=58)。参与者完成了神经行为症状问卷、创伤后应激障碍检查表和创伤性脑损伤生活质量基线(0.05)。然而，随着时间的推移，个别症状的轨迹有很大的变异性。大多数参与者的症状轨迹被归类为“持续性”(类似于32-55%)或“无症状”(类似于30-36%)，相当一部分人被归类为“改善”(类似于7-12%)或“发展”(类似于7-19%)。与持续的PCD轨迹相关的因素包括认知主诉、创伤后应激障碍、抑郁、焦虑、疼痛和头痛；但不包括MTBI的存在/不存在。与“发展的”PCD轨迹相关的因素包括创伤后应激障碍和终生接触爆炸的次数。结论：随着时间的推移，报告“新的”PCSx在有和没有MTBI的个体中都很常见。如果不加批判地认为PCSx报告的多年损伤后只反映了持续的症状，或者完全可以归因于脑损伤的直接后果，那将是错误的。
Objective: The purpose of this study was to examine individual postconcussion symptom [PCSx] trajectories following mild traumatic brain injury (MTBI), and to examine risk factors for persistent PCSx reporting. Method: Participants were 138 U.S. military service members and veterans (SMVs) prospectively enrolled in the Defense and Veterans Brain Injury Center, 15-Year Longitudinal TBI study. Participants were classified into three groups: uncomplicated MTBI (n = 54), injured controls (IC, n = 26), and non-injured controls (NIC, n = 58). Participants completed the Neurobehavioral Symptom Inventory, PTSD Checklist, and Traumatic Brain Injury Quality of Life at baseline (.05). However, there was substantial variability in individual symptom trajectories over time. The majority of participants had symptom trajectories classified as either 'persistent' (similar to 32-55%) or 'asymptomatic' (similar to 30-36%), with a substantial minority classified as 'improved' (similar to 7-12%) or 'developed' (similar to 7-19%). Factors associated with 'persistent' PCD trajectories included cognitive complaints, PTSD, depression, anxiety, pain, and headaches at baseline; but not the presence/absence of MTBI. Factors associated with 'developed' PCD trajectories included PTSD and the number of lifetime exposures to blast. Conclusions: Reporting of 'new' PCSx over time was common in individuals with and without MTBI. It would be erroneous to assume uncritically that PCSx reported many years post-injury reflect only persistent symptomatology, or can be solely attributable to the direct consequences of a brain injury.