Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage
Long-term cognitive, emotional, and functional outcomes in trauma intensive care unit survivors without intracranial hemorrhage
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DOI：
10.1097/ta.0b013e31802ce9bd
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发表时间：
2007-01-01
影响因子：
--
通讯作者：
Ely, E. Wesley
中科院分区：
文献类型：
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作者：
Jackson, James C.;Obremskey, William;Ely, E. Wesley
背景：没有颅内出血或局灶性神经功能障碍的创伤患者通常被认为是持续性神经心理和情绪障碍的低风险患者，这种后遗症可能被忽视，特别是在那些有颅骨骨折和脑震荡的患者。我们开展了这项研究，以确定无颅内出血的成人创伤重症监护病房幸存者的持续性认知障碍以及情绪和功能障碍的患病率和危险因素。方法：我们向Vander-Bilt大学创伤登记处查询2003年间收治的所有创伤严重程度评分为25且头部计算机断层扫描显示无颅内出血的患者。在确认的97名患者中，58名在出院后12至24个月期间接受了面对面的评估，使用了一系列综合的认知、情绪和功能测试工具。采用《老年人认知功能下降简式调查表》(IQCODE-SF)对创伤前疑似存在认知功能障碍的患者进行评估。结果：共有33例(57%)患者存在认知功能障碍，其中以注意力、执行功能/语言流利性最为明显。在这些患者中，有1例(3%)在创伤重症监护病房住院前被IQCODE-SF确定为认知障碍。在研究的58名患者中，21名(36.2%)有脑震荡或颅骨骨折，37名(63.8%)两者都没有。遭受脑震荡或颅骨骨折的患者发生认知障碍的可能性明显高于未遭受脑震荡或颅骨骨折的患者(81%对43%；p=0.006)。患者报告了显著的抑郁症状(56%)、显著的创伤后应激障碍症状(38%)和显著的焦虑症状(29%)。生活质量得分低于美国总体人口，就业困难普遍存在。共有34%的患者报告在随访时失业，与劳动力中的患者相比，这些患者中认知障碍更常见(p=0.03)。认知功能障碍和情感功能障碍与年龄、性别、种族、损伤严重程度评分、出血量、呼吸天数、髓内钉内固定长骨骨折无关。结论：大多数无颅内出血的创伤幸存者存在持续性认知功能障碍，而有颅骨骨折或脑震荡的患者这种可能性几乎是后者的两倍。这种认知障碍与功能缺陷、生活质量差和无法重返工作岗位有关。未来的研究必须描述这些不良结局的可改变的危险因素，特别是在颅骨骨折和脑震荡的患者中，以帮助改善长期的认知和功能状态。
Background: Trauma patients without intracranial hemorrhage or focal neurologic deficits are typically considered low risk for lasting neuropsychological and emotional deficits, and such sequela may be overlooked, especially in those with skull fractures and concussions. We undertook this study to determine the prevalence of and risk factors for persistent cognitive impairment and emotional and functional difficulties in a sample of adult trauma intensive care unit survivors without intracranial hemorrhage.Methods: We queried the Vander-bilt University Trauma Registry for all patients admitted during 2003 with an Injury Severity Score > 25 and a head computed tomography scan showing no intracranial hemorrhage. Of the 97 patients identified, 58 were evaluated, in person between 12 to 24 months after hospital discharge, with a comprehensive battery of cognitive, emotional, and functional instruments. The Informant Questionnaire of Cognitive Decline in the Elderly-Short Form (IQCODE-SF) was used to evaluate for pre-existing cognitive deficits in patients suspected of having cognitive impairment before their trauma.Results: A total of 33 (57%) patients were determined to have cognitive impairment, which was most pronounced in the domains of attention and executive functioning/verbal fluency. Of these patients, one (3%) was determined by the IQCODE-SF to be cognitively impaired before trauma intensive care unit hospitalization. Of the 58 patients studied, 21 (36.2%) had a concussion or skull fracture and 37 (63.8%) had neither. Cognitive impairment was significantly more likely to occur in patients who sustained a concussion or skull fracture than in trauma patients who did not (81% versus 43%; p = 0.006). Patients reported significant depressive symptoms (56%), significant symptoms of posttraumatic stress disorder (38%), and significant symptoms of anxiety (29%). Quality of life scores were lower than in the general United States population and employment difficulties were widespread. A total of 34% of patients reported being unemployed at follow-up, and cognitive impairment was more common among these patients compared with patients in the workforce (p = 0.03). Neither cognitive impairment nor emotional dysfunction was associated with age, sex, race, Injury Severity Score, blood loss, ventilatory days, or intramedullary nailing of long-bone fractures.Conclusions: The majority of trauma survivors without intracranial hemorrhage display persistent cognitive impairment, which is nearly twice as likely in those with skull fractures or concussions. This cognitive impairment was associated with functional defects, poor quality of life, and an inability to return to work. Future research must delineate modifiable risk factors for these poor outcomes, especially in patients with skull fractures and concussions, to help improve long-term cognitive and functional status.