Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion.
Comparison of Clinical Outcomes 1 and 5 Years Post-Injury Following Combat Concussion.
复制标题
DOI：
10.1212/wnl.0000000000011089
复制
发表时间：
2021-01-19
期刊：
影响因子：
9.9
通讯作者：
Temkin NR
中科院分区：
文献类型：
--
作者：
Mac Donald CL;Barber J;Patterson J;Johnson AM;Parsey C;Scott B;Fann JR;Temkin NR
比较2组无脑损伤的战斗部署服务人员与2组战斗相关脑震荡人员的1年和5年临床结局，以更好地了解长期临床结局轨迹。这项前瞻性、观察性、纵向多队列研究检查了4个战斗部署组：无头部损伤的对照组（有或无爆炸暴露）和因爆炸或钝伤引起战斗脑震荡的患者。一年和五年的临床评估包括相同的神经行为、精神和认知结果组合。共有347名参与者完成了两个时间点的评价。进行了横向和纵向比较。总体组效应建模为4类变量，秩回归使用双侧显著性阈值0.05调整人口统计学因素，计算成对比较的事后Tukey p值。在5年的随访中，与对照组相比，两个战斗脑震荡组在神经行为方面存在显著的组间差异。（神经行为评定量表-修订版[NRS]; Cohen d，−1.10至−1.40，各组置信区间[CI] [−0.82，−1.32]至[−0.97，−1.83]）和精神病领域（临床医生管理的创伤后应激障碍量表DSM-IV [CAPS];科恩d，−0.91至−1.19，各组的CI [−0.63，−1.19]至[−0.76，−1.62]）认知表现差异极小的症状。从1年到5年的评估中，两个战斗脑震荡组也显示出临床显著下降（66%-76%的神经行为NRS; 41%-54%的精神CAPS）。两个对照组的表现更好，但一个子集也有临床显著下降（37%-50%的神经行为NRS; 9%-25%的精神CAPS组）。从1年到5年的评估中，症状发生了演变，而不是消退，这对脑震荡损伤的慢性阶段相对稳定的假设提出了挑战。甚至一些战斗部署的控制也恶化了。证据支持新的考虑慢性轨迹脑震荡的结果在战斗部署的服务人员。
To compare 1-year and 5-year clinical outcomes in 2 groups of combat-deployed service members without brain injury to those of 2 groups with combat-related concussion to better understand long-term clinical outcome trajectories. This prospective, observational, longitudinal multicohort study examined 4 combat-deployed groups: controls without head injury with or without blast exposure and patients with combat concussion arising from blast or blunt trauma. One-year and 5-year clinical evaluations included identical batteries for neurobehavioral, psychiatric, and cognitive outcomes. A total of 347 participants completed both time points of evaluation. Cross-sectional and longitudinal comparisons were assessed. Overall group effect was modeled as a 4-category variable with rank regression adjusting for demographic factors using a 2-sided significance threshold of 0.05, with post hoc Tukey p values calculated for the pairwise comparisons. Significant group differences in both combat concussion groups were identified cross-sectionally at 5-year follow-up compared to controls in neurobehavioral (Neurobehavioral Rating Scale–Revised [NRS]; Cohen d, −1.10 to −1.40, confidence intervals [CIs] [−0.82, −1.32] to [−0.97, −1.83] by group) and psychiatric domains (Clinician-Administered PTSD Scale for DSM-IV [CAPS]; Cohen d, −0.91 to −1.19, CIs [−0.63, −1.19] to [−0.76, −1.62] by group) symptoms with minimal differences in cognitive performance. Both combat concussion groups also showed clinically significant decline from 1- to 5-year evaluation (66%–76% neurobehavioral NRS; 41%–54% psychiatric CAPS by group). Both control groups fared better but a subset also had clinically significant decline (37%–50% neurobehavioral NRS; 9%–25% psychiatric CAPS by group). There was an evolution, not resolution, of symptoms from 1- to 5-year evaluation, challenging the assumption that chronic stages of concussive injury are relatively stable. Even some of the combat-deployed controls worsened. The evidence supports new considerations for chronic trajectories of concussion outcome in combat-deployed service members.