女性现役军人轻度创伤性脑损伤后的脑震荡后症状报告：性别、创伤后应激障碍、损伤严重程度及相关身体损伤的影响
Postconcussion Symptom Reporting After Mild Traumatic Brain Injury in Female Service Members: Impact of Gender, Posttraumatic Stress Disorder, Severity of Injury, and Associated Bodily Injuries.
作者信息
Lippa Sara M, Brickell Tracey A, Bailie Jason M, French Louis M, Kennedy Jan E, Lange Rael T
机构信息
Defense and Veterans Brain Injury Center, Silver Spring, Maryland (Drs Lippa, Brickell, Bailie, French, Kennedy, and Lange); Walter Reed National Military Medical Center, Bethesda, Maryland (Drs Lippa, Brickell, French, and Lange); National Intrepid Center of Excellence, Bethesda, Maryland (Drs Lippa, Brickell, French, and Lange); Uniformed Services University of the Health Sciences, Bethesda, Maryland (Drs Brickell and French); Naval Hospital Camp Pendleton, Oceanside, California (Dr Bailie); Center for Neuroscience and Regenerative Medicine, Bethesda, Maryland (Dr French); San Antonio Military Medical Center, San Antonio, Texas (Dr Kennedy); and The University of British Columbia, Vancouver, British Columbia, Canada (Dr Lange).
出版信息
J Head Trauma Rehabil. 2018 Mar/Apr;33(2):101-112. doi: 10.1097/HTR.0000000000000353.
OBJECTIVE
Examine effects of diagnostically relevant posttraumatic stress disorder (PTSD) symptoms, mild traumatic brain injury (TBI) severity, and associated bodily injury severity on postconcussion symptom reporting in female service members (SM) compared with a matched sample of male SM.
SETTING
Six US military medical treatment facilities.
PARTICIPANTS
A total of 158 SM (79 females, 79 males) evaluated within 30 months after mild TBI. Men and women were matched by age, days postinjury, PTSD symptom status, mild TBI severity, and bodily injury severity. All passed a measure of symptom validity.
DESIGN
Compare reported postconcussion symptoms for men and women stratified by PTSD diagnostic symptoms (present/absent), mild TBI severity (alteration of consciousness/loss of consciousness), and bodily injury severity (mild/moderate-severe).
MAIN MEASURES
Neurobehavioral Symptom Inventory, PTSD Checklist, Abbreviated Injury Scale.
RESULTS
Overall postconcussion symptom reporting increased with PTSD but did not significantly differ based on severity of mild TBI or associated bodily injury. Females reported more somatosensory and/or vestibular symptoms than males under some circumstances. Females in the PTSD-Present group, Alteration of Consciousness Only group, and Moderate-Severe Bodily Injury group reported more somatosensory symptoms than males in those groups. Females in the Alteration of Consciousness Only group and Minor Bodily Injury group reported more vestibular symptoms than males in those groups.
CONCLUSION
Diagnostically relevant PTSD symptoms, mild TBI severity, and bodily injury severity differentially impact somatosensory and vestibular postconcussion symptom reporting for male and female SM after mild TBI. Controlling for PTSD and symptom validity resulted in fewer gender-based differences in postconcussive symptoms than previously demonstrated in the literature.
目的
研究与诊断相关的创伤后应激障碍（PTSD）症状、轻度创伤性脑损伤（TBI）严重程度以及相关身体损伤严重程度对女性服役人员（SM）脑震荡后症状报告的影响，并与匹配的男性SM样本进行比较。
设置
美国六家军事医疗设施。
参与者
共有158名SM（79名女性，79名男性）在轻度TBI后30个月内接受评估。男性和女性在年龄、受伤后天数、PTSD症状状态、轻度TBI严重程度和身体损伤严重程度方面进行匹配。所有人都通过了症状效度测量。
设计
比较按PTSD诊断症状（存在/不存在）、轻度TBI严重程度（意识改变/意识丧失）和身体损伤严重程度（轻度/中度-重度）分层的男性和女性报告的脑震荡后症状。
主要测量指标
神经行为症状量表、PTSD检查表、简明损伤量表。
结果
总体而言，脑震荡后症状报告随PTSD增加，但基于轻度TBI或相关身体损伤的严重程度没有显著差异。在某些情况下，女性报告的体感和/或前庭症状比男性更多。PTSD存在组、仅意识改变组和中度-重度身体损伤组中的女性报告的体感症状比这些组中的男性更多。仅意识改变组和轻度身体损伤组中的女性报告的前庭症状比这些组中的男性更多。
结论
与诊断相关的PTSD症状、轻度TBI严重程度和身体损伤严重程度对轻度TBI后男性和女性SM的体感和前庭脑震荡后症状报告有不同影响。控制PTSD和症状效度后，脑震荡后症状中基于性别的差异比文献中先前显示的要少。
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