Postconcussion syndrome: demographics and predictors in 221 patients.
Postconcussion syndrome: demographics and predictors in 221 patients.
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脑震荡后综合症：221 名患者的人口统计数据和预测因素。
DOI：
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发表时间：
2016
影响因子：
4.1
通讯作者：
Carmen Hiploylee
中科院分区：
文献类型：
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作者：
Charles H. Tator;Hannah S Davis;Paul A Dufort;M. Tartaglia;Karen D. Davis;Ahmed Ebraheem;Carmen Hiploylee
目的 本研究的目的是使用 PCS 的新定义来确定大量患者的人口统计学特征和脑震荡后综合征 (PCS) 的预测因素。方法 作者对 284 名连续脑震荡患者进行了一项回顾性队列研究，其中 221 名患者因至少 3 种症状持续至少 1 个月而患有 PCS。 PCS 的这一定义得到了统一采用，其独特之处在于接受了更多的症状，将脑震荡后间隔从 3 个月缩短到 1 个月，以及排除了出血和挫伤等局灶性损伤的患者。结果221例PCS的临床特征表现出相当大的异质性。他们平均遭受 3.3 次脑震荡，其中脑震荡次数为 0 至 12 次或更多，其中 62.4% 发生在运动和娱乐期间。检查时 PCS 的中位持续时间为 7 个月，其中 11.8% 持续时间超过 2 年，23.1% 的 PCS 仅出现过 1 次脑震荡。患者平均年龄为 27 岁（范围 10-74 岁）。持续症状的平均数量为 8.1； 26.2% 的人既往患有精神疾病、注意力缺陷障碍/注意力缺陷多动障碍、学习障碍或既往偏头痛。 PCS 中蛛网膜囊肿和 Chiari 畸形的患病率超过了一般人群。此外，参与诉讼、存在颅外损伤、健忘症和/或意识丧失以及女性是报告大量症状的预测因素。既往精神疾病或偏头痛病史、受伤原因、既往脑震荡次数和年龄并不能显着预测症状数量。只有报告的症状数量才能预测 PCS 的持续时间。根据《国际疾病分类》第 10 版 (ICD-10) 和《精神疾病诊断与统计手册》第 4 版 (DSM-IV)，为了预测符合 PCS 标准的患者的症状数量，之前发生脑震荡的次数是显着的。结论 PCS 通常与多次脑震荡相关，但本系列中 23.1% 的患者仅在 1 次脑震荡后发生。大多数 PCS 患者有多种症状，持续数月或数年。 PCS 的中位病程为 7 个月，最长可达 26 年。只有 11.3% 的人在咨询时 PCS 已经结束。并非文献中常见的所有预测因素都与本研究的结果一致。这可能是由于研究中使用的 PCS 定义存在差异。这些结果表明，使用 ICD-10 和 DSM-IV 来诊断 PCS 可能会偏向那些易受脑震荡或更严重的 PCS 患者。因此，基于循证医学重新定义 PCS 非常重要。
OBJECTIVE The objective of this study was to determine the demographics and predictors of postconcussion syndrome (PCS) in a large series of patients using a novel definition of PCS. METHODS The authors conducted a retrospective cohort study of 284 consecutive concussed patients, 221 of whom had PCS on the basis of at least 3 symptoms persisting at least 1 month. This definition of PCS was uniformly employed and is unique in accepting an expanded list of symptoms, in shortening the postconcussion interval to 1 month from 3 months, and in excluding those with focal injuries such as hemorrhages and contusions. RESULTS The 221 cases showed considerable heterogeneity in clinical features of PCS. They averaged 3.3 concussions, with a range of 0 to 12 or more concussions, and 62.4% occurred during sports and recreation. The median duration of PCS was 7 months at the time of examination, with 11.8% lasting more than 2 years, and 23.1% with PCS had only 1 concussion. The average patient age was 27 years (range 10-74 years). The average number of persistent symptoms was 8.1; 26.2% had a previous psychiatric condition, attention-deficit disorder/attention-deficit hyperactivity disorder, a learning disability, or previous migraine headaches. The prevalence of arachnoid cysts and Chiari malformation in PCS exceeded the general population. Additionally, involvement in litigation, presence of extracranial injuries, amnesia and/or loss of consciousness, and female sex were predictive of reporting a high number of symptoms. A prior history of psychiatric conditions or migraines, cause of injury, number of previous concussions, and age did not significantly predict symptom number. Only the number of symptoms reported predicted the duration of PCS. To predict the number of symptoms for those who fulfilled PCS criteria according to the International Classification of Diseases, 10th Revision (ICD-10), and the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), the number of previous concussions was significant. CONCLUSIONS PCS is commonly associated with multiple concussions, but 23.1% in the present series occurred after only 1 concussion. Most patients with PCS had multiple symptoms persisting for months or years. The median duration of PCS was 7 months, with a range up to 26 years. In only 11.3%, the PCS had ended at the time of consultation. Not all predictors commonly cited in the literature align with the findings in this study. This is likely due to differences in the definitions of PCS used in research. These results suggest that the use of ICD-10 and DSM-IV to diagnose PCS may be biased toward those who are vulnerable to concussions or with more severe forms of PCS. It is thus important to redefine PCS based on evidence-based medicine.
影响因子：
3.3
作者：
Nelson, Lindsay D.;Guskiewicz, Kevin M.;McCrea, Michael A.
通讯作者：
McCrea, Michael A.
影响因子：
4.2
作者：
Bazarian, Jeffrey J.;Blyth, Brian;McDermott, Michael P.
通讯作者：
McDermott, Michael P.