Association between concomitant traumatic brain injury and unfavorable 1-year outcomes in patients with traumatic spinal cord injury.

IF 3.1 2区 医学 Q2 CLINICAL NEUROLOGY
Vikas N Vattipally, Carlos A Aude, Kathleen R Ran, Kelly Jiang, Sruthi Ranganathan, Carly Weber-Levine, Jawad Khalifeh, Liam P Hughes, Jacob Jo, Saad Javeed, James P Byrne, Timothy Chryssikos, Gary Schwartzbauer, Daniel Lubelski, Ali Bydon, Timothy Witham, Nicholas Theodore, Tej D Azad
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引用次数: 0

Abstract

Objective: Traumatic spinal cord injury (tSCI) can cause lasting functional impairment. Concomitant traumatic brain injury (cTBI) is a common injury constellation, but the impact of tandem traumatic brain injury (TBI) and tSCI on long-term patient outcomes requires further study. The objective of this study was to compare outcomes among tSCI patients with and without TBI.

Methods: Patients with tSCI were identified from the Spinal Cord Injury Model System (SCIMS) database. Patients with cTBI and tSCI were 1:1 propensity score matched to those with tSCI only on demographic and injury characteristics. TBI severity was stratified in the SCIMS as mild (loss of consciousness [LOC] < 30 minutes), moderate (LOC 31 minutes to 24 hours), or severe (LOC > 24 hours). Multivariable linear and logistic regression models were specified to assess relationships between cTBI severity and 1-year follow-up outcome metrics including rehospitalization, functional recovery, and quality of life (QOL).

Results: Among the 1442 patients included (median age 36 [IQR 24-52] years), 44% (n = 636) presented with cTBI. After propensity score matching, 601 patients with cTBI were compared to 601 with tSCI only. Patients with cTBI had increased rehospitalization rates, reduced functional Craig Handicap Assessment and Reporting Technique mobility and occupational scores, and increased pain severity at 1-year follow-up (all p < 0.05). Additionally, patients with severe cTBI specifically exhibited significantly lower functional independence measure (FIM) scores, Satisfaction with Life Scale scores, and a higher incidence of new-onset depression (all p < 0.05) compared to those without cTBI. Multivariable analyses confirmed that moderate and severe cTBI were independently associated with worse outcomes across 8 of 10 assessed metrics, including increased rehospitalization, new-onset depression, lower FIM scores, and greater pain severity (all p < 0.05).

Conclusions: Patients with tSCI and cTBI experience worse functional outcomes and have reduced QOL 1 year after injury. Targeted rehabilitation programs could benefit patients with cTBI in the setting of tSCI.

外伤性脊髓损伤患者伴发外伤性脑损伤与1年不良预后的关系。
目的:外伤性脊髓损伤(tSCI)可引起持续性功能损害。伴随性创伤性脑损伤(cTBI)是一种常见的损伤类型,但继发性创伤性脑损伤(TBI)和tSCI对患者长期预后的影响有待进一步研究。本研究的目的是比较合并和不合并TBI的tSCI患者的预后。方法:从脊髓损伤模型系统(SCIMS)数据库中识别tSCI患者。cTBI和tSCI患者在人口学特征和损伤特征上与仅tSCI患者的倾向评分匹配为1:1。在SCIMS中,TBI严重程度分为轻度(意识丧失[LOC] < 30分钟)、中度(LOC 31分钟至24小时)或重度(LOC bb0 24小时)。多变量线性和逻辑回归模型用于评估cTBI严重程度与1年随访结果指标(包括再住院、功能恢复和生活质量)之间的关系。结果:纳入的1442例患者(中位年龄36 [IQR 24-52]岁)中,44% (n = 636)出现cTBI。倾向评分匹配后,601例cTBI患者与601例单纯tSCI患者进行比较。cTBI患者在1年随访中再次住院率增加,功能克雷格残疾评估和报告技术活动能力和职业得分降低,疼痛严重程度增加(均p < 0.05)。此外,与没有cTBI的患者相比,重度cTBI患者的功能独立性(FIM)评分、生活满意度评分显著降低,新发抑郁症的发生率更高(均p < 0.05)。多变量分析证实,中度和重度cTBI与10项评估指标中的8项较差的结果独立相关,包括再住院率增加、新发抑郁症、较低的FIM评分和更严重的疼痛程度(均p < 0.05)。结论:tSCI和cTBI患者的功能预后较差,损伤后1年的生活质量降低。有针对性的康复计划可以使tSCI背景下的cTBI患者受益。
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
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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