Mild Traumatic Brain Injury: Longitudinal Study of Cognition, Functional Status, and Post-Traumatic Symptoms
Mild Traumatic Brain Injury: Longitudinal Study of Cognition, Functional Status, and Post-Traumatic Symptoms
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DOI：
10.1089/neu.2016.4618
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发表时间：
2017-04-01
影响因子：
4.2
通讯作者：
Temkin, Nancy
中科院分区：
文献类型：
--
作者：
Dikmen, Sureyya;Machamer, Joan;Temkin, Nancy
超过75%的寻求医疗照顾的创伤性脑损伤（TBI）是轻度的，并且该组的结果是异质的。在确定敏感和有效的生物标志物之前，需要将轻度TBI分类为更同质的亚组。根据格拉斯哥昏迷量表（GCS）13-15无计算机断层扫描（CT）异常、GCS 15有CT异常和GCS 13-14有CT异常，将421例轻度TBI成人患者分为3组，并与120例创伤对照组进行1个月和1年结局比较。在伤后1个月，几乎所有的神经心理变量组间差异显着。与创伤对照组相比，GCS 13-15 CT正常组在任何神经心理测量或格拉斯哥结局量表（GOS）上均无显著差异。GCS 15 CT异常组仅在情景记忆和学习（选择性提醒回忆[SRCL]）和GOS指标上表现显着较差，而GCS 13-14 CT异常组在大多数神经心理学指标和GOS指标上表现显着较差。在伤后1年，除了GCS 13-14 CT异常组中SRCL的孤立困难外，在任何神经心理学测量和GOS上均未观察到差异。总创伤后症状的平均百分比被认为是新的或更糟的，并且百分比被认为是三个或更多症状的差异显著（p < 0.001），每个TBI亚组在1个月和1年时报告的症状显著多于创伤对照组。总之，该子分组改善了轻度TBI内的粒度。虽然大多数神经心理学和功能差异在1年后减弱，但报告三种或三种以上创伤后症状的人仍然有一半左右。
More than 75% of traumatic brain injuries (TBIs) seeking medical attention are mild, and outcome in that group is heterogeneous. Until sensitive and valid biomarkers are identified, methods are needed to classify mild TBI into more homogeneous subgroups. Four hundred twenty-one adults with mild TBI were divided into groups based on Glasgow Coma Scale (GCS) 13-15 without computed tomography (CT) abnormalities, GCS 15 with CT abnormalities, and GCS 13-14 with CT abnormalities, and were compared with 120 trauma controls on 1-month and 1-year outcomes. At 1 month post-injury, almost all neuropsychological variables differed significantly among the groups. Compared with trauma controls, the GCS 13-15 CT normal group showed no significant differences on any neuropsychological measure or Glasgow Outcome Scale (GOS). The GCS 15 CT abnormal group performed significantly worse on only a measure of episodic memory and learning (Selective Reminding Recall [SRCL]) and GOS, and the GCS 13-14 CT abnormal group performed significantly worse on most neuropsychological measures and GOS. At 1 year post-injury, except for an isolated difficulty on SRCL in the GCS 13-14 CT abnormal group, no differences were observed on any neuropsychological measures nor on GOS. Mean percent of total post-traumatic symptoms endorsed as new or worse and percent endorsing three or more symptoms differed significantly (p < 0.001), with each TBI subgroup reporting significantly more symptoms than the trauma controls at both 1 month and 1 year. In conclusion, this subgrouping improves granularity within mild TBI. While most neuropsychological and functional differences abate by 1 year, reporting three or more posttraumatic symptoms remain for about half of individuals.