Olfactory impairment and traumatic brain injury in blast-injured combat troops
Olfactory impairment and traumatic brain injury in blast-injured combat troops
复制标题
爆炸受伤战斗部队的嗅觉障碍和创伤性脑损伤
作者：
Michael S. Xydakis;Lisa P. Mulligan;A. B. Smith;C. Olsen;Dina M Lyon;L. Belluscio
目的：确定爆炸伤创伤性脑损伤（TBI）组和人口统计学上相当的爆炸伤对照组之间识别的嗅觉表现差异的结构化和定量评估是否可以作为临床前检测的可靠先行标记物。颅内神经损伤。研究方法：我们前瞻性地连续招募了231名多发性创伤住院患者，他们在阿富汗或伊拉克的战斗行动中因爆炸而急性受伤，需要立即撤离美国本土，并在2年半的时间内连续入住我们的三级医疗中心。本研究将嗅觉评分与同期神经影像学检查结果以及TBI的临床诊断相关联，将人群特异性发病率数据制成表格，并调查嗅觉功能的恢复。结果如下：嗅觉评分预测异常神经影像学显著优于单独的机会（曲线下面积= 0.78，95%置信区间[CI] 0.70-0.87）。在所有轻度TBI的部队中均存在正常体温（即，脑震荡）和所有对照受试者。有额叶损伤的放射学证据的士兵比其他脑区损伤的士兵嗅觉障碍的可能性高3倍（相对危险度3.0，95%CI 0.98-9.14）。在所有可用于随访测试的嗅觉缺失部队中，评分均正常化。结论：定量识别嗅觉测量作为检测创伤急性结构性神经病理学的标志物具有有限的灵敏度，但具有高特异性。当考虑是否订购先进的神经影像学，中枢嗅觉障碍的功能障碍应被视为一个重要的工具，告知决策过程。证据分类：本研究提供了III类证据，证明中枢嗅觉功能障碍可识别颅内放射学异常的TBI患者，敏感性为35%（95% CI 20.6%-51.7%），特异性为100%（95% CI 97.7%-100.0%）。
Objective: To determine whether a structured and quantitative assessment of differential olfactory performance—recognized between a blast-injured traumatic brain injury (TBI) group and a demographically comparable blast-injured control group—can serve as a reliable antecedent marker for preclinical detection of intracranial neurotrauma. Methods: We prospectively and consecutively enrolled 231 polytrauma inpatients, acutely injured from explosions during combat operations in either Afghanistan or Iraq and requiring immediate stateside evacuation and sequential admission to our tertiary care medical center over a 2½-year period. This study correlates olfactometric scores with both contemporaneous neuroimaging findings as well as the clinical diagnosis of TBI, tabulates population-specific incidence data, and investigates return of olfactory function. Results: Olfactometric score predicted abnormal neuroimaging significantly better than chance alone (area under the curve = 0.78, 95% confidence interval [CI] 0.70–0.87). Normosmia was present in all troops with mild TBI (i.e., concussion) and all control subjects. Troops with radiographic evidence of frontal lobe injuries were 3 times more likely to have olfactory impairment than troops with injuries to other brain regions (relative risk 3.0, 95% CI 0.98–9.14). Normalization of scores occurred in all anosmic troops available for follow-up testing. Conclusion: Quantitative identification olfactometry has limited sensitivity but high specificity as a marker for detecting acute structural neuropathology from trauma. When considering whether to order advanced neuroimaging, a functional disturbance with central olfactory impairment should be regarded as an important tool to inform the decision process. Classification of evidence: This study provides Class III evidence that central olfactory dysfunction identifies patients with TBI who have intracranial radiographic abnormalities with a sensitivity of 35% (95% CI 20.6%–51.7%) and specificity of 100% (95% CI 97.7%–100.0%).
闭合性头部损伤后嗅觉识别受损。
DOI：
10.1093/brain/108.3.579
发表时间：
1985
期刊：
Brain : a journal of neurology
影响因子：
--
作者：
Levin,HS;High,WM;Eisenberg,HM
通讯作者：
Eisenberg,HM
影响因子：
120.7
作者：
Murphy, C;Schubert, CR;Nondahl, DM
通讯作者：
Nondahl, DM
影响因子：
3.5
作者：
Doty, RL;McKeown, DA;Shaman, P
通讯作者：
Shaman, P