Improvement in Functional Outcome from 6 to 12 Months After Moderate and Severe Traumatic Brain Injury Is Frequent, But May Not Be Detected With the Glasgow Outcome Scale Extended.

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2024-02-29 eCollection Date: 2024-01-01 DOI:10.1089/neur.2023.0109
Rabea Iris Pantelatos, Jonas Stenberg, Turid Follestad, Oddrun Sandrød, Cathrine Elisabeth Einarsen, Anne Vik, Toril Skandsen
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Abstract

The aims of this study were (1) to report outcome and change in outcome in patients with moderate and severe traumatic brain injury (mo/sTBI) between 6 and 12 months post-injury as measured by the Glasgow Outcome Scale Extended (GOSE), (2) to explore if demographic/injury-related variables can predict improvement in GOSE score, and (3) to investigate rate of improvement in Disability Rating Scale (DRS) score, in patients with a stable GOSE. All surviving patients ≥16 years of age who were admitted with mo/sTBI (Glasgow Coma Scale [GCS] score ≤13) to the regional trauma center in Central Norway between 2004 and 2019 were prospectively included (n = 439 out of 503 eligible). GOSE and DRS were used to assess outcome. Twelve-months post-injury, 13% with moTBI had severe disability (GOSE 2-4) versus 27% in sTBI, 26% had moderate disability (GOSE 5-6) versus 41% in sTBI and 62% had good recovery (GOSE 7-8) versus 31% in sTBI. From 6 to 12 months post-injury, 27% with moTBI and 32% with sTBI had an improvement, whereas 6% with moTBI and 6% with sTBI had a deterioration in GOSE score. Younger age and higher GCS score were associated with improved GOSE score. Improvement was least frequent for patients with a GOSE score of 3 at 6 months. In patients with a stable GOSE score of 3, an improvement in DRS score was observed in 22 (46%) patients. In conclusion, two thirds and one third of patients with mo/sTBI, respectively, had a good recovery. Importantly, change, mostly improvement, in GOSE score between 6 and 12 months was frequent and argues against the use of 6 months outcome as a time end-point in research. The GOSE does, however, not seem to be sensitive to actual change in function in the lower categories and a combination of outcome measures may be needed to describe the consequences after TBI.

中度和重度创伤性脑损伤后 6 至 12 个月的功能性结果改善很常见,但格拉斯哥结果量表扩展版可能无法检测到。
本研究的目的是:(1) 报告中度和重度创伤性脑损伤(mo/sTBI)患者在伤后 6 至 12 个月期间的预后和预后变化情况,以格拉斯哥预后量表扩展版(GOSE)为衡量标准;(2) 探讨人口学/损伤相关变量是否能预测 GOSE 评分的改善情况;(3) 调查 GOSE 稳定的患者残疾评定量表(DRS)评分的改善率。2004年至2019年期间,挪威中部地区创伤中心收治的所有年龄≥16岁、患有mo/sTBI(格拉斯哥昏迷量表[GCS]评分≤13分)的存活患者均被纳入前瞻性研究(503名符合条件的患者中,n = 439名)。GOSE和DRS用于评估结果。伤后12个月,13%的moTBI患者有重度残疾(GOSE 2-4),而sTBI患者为27%;26%的患者有中度残疾(GOSE 5-6),而sTBI患者为41%;62%的患者恢复良好(GOSE 7-8),而sTBI患者为31%。在伤后 6 至 12 个月,27% 的莫氏创伤性脑损伤患者和 32% 的斯氏创伤性脑损伤患者的 GOSE 评分有所改善,而 6% 的莫氏创伤性脑损伤患者和 6% 的斯氏创伤性脑损伤患者的 GOSE 评分有所恶化。年龄越小、GCS 分数越高,GOSE 分数越高。在 6 个月时 GOSE 评分为 3 分的患者中,病情改善的频率最低。在 GOSE 评分稳定在 3 分的患者中,有 22 人(46%)的 DRS 评分有所改善。总之,分别有三分之二和三分之一的急性和慢性创伤性脑损伤患者恢复良好。重要的是,在 6 个月和 12 个月之间,GOSE 分数经常发生变化,大部分都有所改善,这就反对将 6 个月的结果作为研究的时间终点。不过,GOSE 似乎对较低类别功能的实际变化并不敏感,因此可能需要结合多种结果测量来描述创伤后的后果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.40
自引率
0.00%
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审稿时长
8 weeks
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