Outcome 3 to 5 years after moderate to severe traumatic brain injury
Outcome 3 to 5 years after moderate to severe traumatic brain injury
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DOI：
10.1016/s0003-9993(03)00287-9
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发表时间：
2003-10-01
影响因子：
4.3
通讯作者：
Temkin, NR
中科院分区：
文献类型：
--
作者：
Dikmen, SS;Machamer, JE;Temkin, NR
目的：调查中重度创伤性脑损伤（TBI）后3至5年的神经心理、情绪、功能状态以及生活质量（QOL）。
设计：观察性队列研究。
地点：一级创伤中心。
参与者：连续收治的伴有颅内异常的成年TBI患者，进行了3至5年的前瞻性随访，随访率为80%。
干预措施：不适用。
主要观察指标：神经心理功能（节奏听觉连续加法测验、加利福尼亚语言学习测验）、情绪状态（流行病学研究中心抑郁量表、简明症状量表）、功能状态（功能状态检查、格拉斯哥预后量表、医疗结果研究36项简短健康调查、就业情况）以及感知生活质量。
结果：在所有方面都观察到明显的功能受限。恢复到伤前水平的比例从个人护理方面的65%到认知能力、主要活动以及休闲娱乐方面的约40%不等。通过改良简略损伤量表测量的脑损伤严重程度与功能状态和神经心理功能有关，但与情绪或生活质量指标无关。意识受损的时长似乎比解剖学损伤对预后的影响更大。
结论：研究结果提供了伴有颅内病变的TBI患者长期发病率的代表性估计。发病率很高。尽管TBI的直接成本受到了最多关注，但长期后果及其成本影响要大得多，随着时间推移逐渐显现，并且由幸存者、其家庭以及公共补贴系统承担。
Objective: To investigate neuropsychologic, emotional, and functional status and quality of life (QOL) 3 to 5 years after moderate to severe traumatic brain injury (TBI).Design: Observational cohort.Setting: Level I trauma center.Participants: Consecutive adult admissions with TBI involving intracranial abnormalities, prospectively followed up for 3 to 5 years, with 80% follow-up.Interventions: Not applicable.Main Outcome Measures: Neuropsychologic functioning (Paced Auditory Serial Addition Test, California Verbal Learning Test), emotional status (Center for Epidemiologic Studies Depression Scale, Brief Symptom Inventory), functional status (Functional Status Examination, Glasgow Outcome Scale, Medical Outcomes Study 36-Item Short-Form Health Survey, employment), and perceived QOL.Results: Significant functional limitations were observed in all areas. Recovery to preinjury levels ranged from 65% of cases in personal care to approximately 40% in cognitive competency, major activity, and leisure and recreation. Brain injury severity, measured by the modified Abbreviated Injury Scale, related to functional status and neuropsychologic functioning, but not to emotional or QOL measures. Length of impaired consciousness appeared to contribute to outcome more than did anatomic lesions.Conclusions: The results provide representative estimates of long-term morbidity in patients with TBI involving intracranial lesions. The magnitude of morbidity was high. Although direct costs of TBI have received the most attention, the long-term consequences and their cost implications are much larger, unfold over time, and are home by the survivors, their families, and the public subsidy system.