Neurologic Functional and Quality of Life Outcomes after TBI: Clinic Attendees versus Non-Attendees.
Neurologic Functional and Quality of Life Outcomes after TBI: Clinic Attendees versus Non-Attendees.
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TBI 后的神经功能和生活质量结果：诊所参加者与未参加者。
DOI：
10.1089/neu.2014.3652
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发表时间：
2015
影响因子：
4.2
通讯作者：
Guillamondegui,OscarD
中科院分区：
文献类型：
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作者：
Patel,MayurB;Wilson,LauraD;Bregman,JanaA;Leath,TaylorC;Humble,StephenS;Davidson,MarioA;deRiesthal,MichaelR;Guillamondegui,OscarD
这项调查描述了TBI患者的人口统计学、生活质量结果和临床参与者和非参与者的功能状态结果之间的关系。颅内出血的成年TBI幸存者中，63人到我们的TBI诊所就诊，167人未到。使用扩展格拉斯哥结局量表（GOSE）、脑损伤后生活质量量表（QOLIBRI）和出院后治疗问卷对所有患者进行电话调查。为了确定GOSE和QOLIBRI结果的危险因素，我们建立了多变量回归模型，采用协变量为年龄、损伤特征、就诊次数、保险状况、出院后康复和损伤时间。与严重TBI患者相比，轻度TBI（优势比[OR]=2.0； 95%可信区间[CI]: 1.1-3.6）和中度TBI （OR=4.7； 95%可信区间[CI]: 1.6-14.1）患者的GOSE评分均较高。此外，与公共保险（OR=2.0; 95% CI: 1.1-3.6）、工伤赔偿（OR=8.4; 95% CI: 2.6-26.9）和无保险（OR=3.1; 95% CI: 1.6-6.2）相比，拥有私人保险的幸存者的GOSE评分更高。与严重TBI患者相比，轻度TBI患者的QOLIBRI评分高11.7分（95% CI: 3.7-19.7），中度TBI患者的QOLIBRI评分高17.3分（95% CI: 3.2-31.5）。此外，接受出院后康复治疗的幸存者的QOLIBRI评分比未接受康复治疗的幸存者高11.4分（95% CI: 3.7-19.1）。拥有私人保险的幸存者的QOLIBRI得分比那些有工人赔偿的人高25.5分（95% CI: 11.3-39.7），比没有保险的人高16.8分（95% CI: 7.4-26.2）。由于神经损伤的严重程度、保险状况和接受康复或治疗是功能和生活质量结果的独立危险因素，未来的方向将包括改善早期获得tbi后康复、社会工作服务、负担得起的保险和社区资源。
This investigation describes the relationship between TBI patient demographics, quality of life outcome, and functional status outcome among clinic attendees and non-attendees. Of adult TBI survivors with intracranial hemorrhage, 63 attended our TBI clinic and 167 did not attend. All were telephone surveyed using the Extended-Glasgow Outcome Scale (GOSE), the Quality of Life after Brain Injury (QOLIBRI) scale, and a post-discharge therapy questionnaire. To determine risk factors for GOSE and QOLIBRI outcomes, we created multivariable regression models employing covariates of age, injury characteristics, clinic attendance, insurance status, post-discharge rehabilitation, and time from injury. Compared with those with severe TBI, higher GOSE scores were identified in individuals with both mild (odds ratio [OR]=2.0; 95% confidence interval [CI]: 1.1–3.6) and moderate (OR=4.7; 95% CI: 1.6–14.1) TBIs. In addition, survivors with private insurance had higher GOSE scores, compared with those with public insurance (OR=2.0; 95% CI: 1.1–3.6), workers' compensation (OR=8.4; 95% CI: 2.6–26.9), and no insurance (OR=3.1; 95% CI: 1.6–6.2). Compared with those with severe TBI, QOLIBRI scores were 11.7 points (95% CI: 3.7–19.7) higher in survivors with mild TBI and 17.3 points (95% CI: 3.2–31.5) higher in survivors with moderate TBI. In addition, survivors who received post-discharge rehabilitation had higher QOLIBRI scores by 11.4 points (95% CI: 3.7–19.1) than those who did not. Survivors with private insurance had QOLIBRI scores that were 25.5 points higher (95% CI: 11.3–39.7) than those with workers' compensation and 16.8 points higher (95% CI: 7.4–26.2) than those without insurance. Because neurologic injury severity, insurance status, and receipt of rehabilitation or therapy are independent risk factors for functional and quality of life outcomes, future directions will include improving earlier access to post-TBI rehabilitation, social work services, affordable insurance, and community resources.