Traumatic Brain Injury in Spinal Cord Injury: Frequency and Risk Factors
Traumatic Brain Injury in Spinal Cord Injury: Frequency and Risk Factors
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DOI：
10.1097/htr.0000000000000153
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发表时间：
2016-07-01
影响因子：
2.4
通讯作者：
Green, Robin E.
中科院分区：
文献类型：
--
作者：
Budisin, Bojana;Bradbury, Cheryl C. L. B.;Green, Robin E.
背景：尽管过去有许多研究，但创伤性脑损伤(TBI)与创伤性脊髓损伤(TSCI)并存的频率尚不清楚；此外，也有有限的研究检验了TSCI患者合并脑损伤的预测因素。目的：(1)总结过去关于TSCI合并脑挫伤诊断的文献，以便在一项旨在消除过去方法学局限性的研究中重新检查双重诊断的频率；(1)比较双重诊断频率与不包括诊断模糊病例的VS；以及(2)测量TSCI和合并脑外伤的危险因素。方法：在135例符合条件的成年TSCI患者中，91例在损伤后3-6个月从三级住院患者TSCI康复计划中前瞻性招募。脑外伤的诊断是基于全面的、有效的临床神经学和神经影像测量。结果：目标1：39.6%的TSCI患者合并脑外伤，但剔除不明确的病例后，患病率上升至58.1%。目的2：机动车碰撞最有可能导致脑损伤的诊断，但31.6%的跌倒也会导致脑损伤。颈部和胸部损伤的患者表现出非常相似的合并创伤性脑损伤的频率。结论：不同的方法学方法，特别是决定纳入/排除不明确的病例，可能解释了TSCI中不同的过去对TBI的估计。然而，即使是这项研究的较低频率估计，近40%，在临床上也很重要。普遍的假设是，双重诊断在胸椎损伤中比在颈椎损伤中更少见，这一假设不被支持。最后，虽然合并创伤性脑损伤最常发生在机动车碰撞中，但在我们的样本中，近三分之一的tSCI在跌倒中导致并发创伤性脑损伤。
Background: The frequency of traumatic brain injury (TBI) co-occurring with traumatic spinal cord injury (tSCI) is unclear despite a number of past studies; as well, limited research has examined predictors of co-morbid TBI in tSCI patients. Objectives: (1a) To summarize past literature on comorbid diagnosis of TBI in tSCI in order to reexamine the frequency of dual diagnosis in a study designed to obviate past methodological limitations; (1b) to compare dual-diagnosis frequency with vs without the inclusion of diagnostically ambiguous cases; and (2) to measure risk factors for tSCI and comorbid TBI. Methods: Ninety-one of 135 eligible adults with tSCI, 3 to 6 months postinjury, were prospectively recruited from a tertiary inpatient tSCI rehabilitation program. TBI diagnosis was based on comprehensive, validated clinical neurological and neuroimaging measures. Results: Objective 1: 39.6% of the tSCI patients sustained a concomitant TBI, but when ambiguous cases were removed from analysis, frequency rose to 58.1%. Objective 2: Motor vehicle collisions were most likely to yield a comorbid TBI diagnosis, but 31.6% of falls also resulted in TBI. Patients with cervical and thoracic injuries showed a very similar frequency of comorbid TBI. Conclusions: Varied methodological approaches, particularly the decision to include/exclude ambiguous cases, likely explain disparate past estimates of TBI in tSCI. However, even this study's lower frequency estimate, at nearly 40%, is clinically important. The prevailing assumption that dual diagnosis is less common in thoracic than cervical spine injuries was not supported. Finally, while comorbid TBI most frequently occurred in motor vehicle collisions, nearly a third of tSCIs sustained in falls resulted in comorbid TBI in our sample.