Lindsay D Nelson1, Nancy R Temkin2, Sureyya Dikmen2, Jason Barber2, Joseph T Giacino3,4, Esther Yuh5, Harvey S Levin6, Michael A McCrea1, Murray B Stein7,8, Pratik Mukherjee5, David O Okonkwo9, Claudia S Robertson10, Ramon Diaz-Arrastia11, Geoffrey T Manley5, Opeolu Adeoye12, Neeraj Badjatia13, Kim Boase14, Yelena Bodien4, M Ross Bullock15, Randall Chesnut16, John D Corrigan17, Karen Crawford18, Ann-Christine Duhaime19, Richard Ellenbogen16, V Ramana Feeser20, Adam Ferguson21, Brandon Foreman12, Raquel Gardner22, Etienne Gaudette18, Luis Gonzalez23, Shankar Gopinath24, Rao Gullapalli13, J Claude Hemphill22, Gillian Hotz15, Sonia Jain7, Frederick Korley25, Joel Kramer22, Natalie Kreitzer12, Chris Lindsell26, Joan Machamer14, Christopher Madden27, Alastair Martin28, Thomas McAllister29, Randall Merchant30, Florence Noel31, Eva Palacios28, Daniel Perl32, Ava Puccio33, Miri Rabinowitz34, Jonathan Rosand4, Angelle Sander10, Gabriela Satris35, David Schnyer36, Seth Seabury18, Mark Sherer23, Sabrina Taylor21, Arthur Toga18, Alex Valadka37, Mary J Vassar21,35, Paul Vespa38, Kevin Wang39, John K Yue35, Ross Zafonte40. 1. Medical College of Wisconsin, Milwaukee. 2. University of Washington, Seattle. 3. Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts. 4. Massachusetts General Hospital, Boston. 5. University of California, San Francisco. 6. Baylor College of Medicine, Houston, Texas. 7. University of California, San Diego, La Jolla. 8. Veterans Affairs San Diego Healthcare System, San Diego, California. 9. University of Pittsburgh, Pittsburgh, Pennsylvania. 10. Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas. 11. University of Pennsylvania, Philadelphia. 12. University of Cincinnati, Cincinnati, Ohio. 13. University of Maryland, College Park. 14. Department of Rehabilitation Medicine, University of Washington, Seattle. 15. University of Miami, Coral Gables, Florida. 16. Department of Neurological Surgery, University of Washington, Seattle. 17. Ohio State University, Columbus. 18. University of Southern California, Los Angeles. 19. MassGeneral Hospital for Children, Boston, Massachusetts. 20. Department of Emergency Medicine, Virginia Commonwealth University, Richmond. 21. Department of Neurological Surgery, University of California, San Francisco. 22. Department of Neurology, University of California, San Francisco. 23. TIRR Memorial Hermann, Houston, Texas. 24. Department of Neurosurgery, Baylor College of Medicine, Houston, Texas. 25. Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor. 26. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee. 27. Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas. 28. Department of Radiology & Biomedical Imaging, University of California, San Francisco. 29. Department of Psychiatry, Indiana University School of Medicine, Indianapolis. 30. Department of Anatomy and Neurobiology, Virginia Commonwealth University, Richmond. 31. Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas. 32. Department of Pathology, Uniformed Services University, Bethesda, Maryland. 33. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 34. Department of Neurology, University of Pennsylvania, Philadelphia. 35. Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California. 36. Department of Psychology, University of Texas at Austin, Austin. 37. Department of Neurosurgery, Virginia Commonwealth University, Richmond. 38. Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles. 39. Department of Psychiatry, University of Florida, Gainesville. 40. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
Abstract
IMPORTANCE: Most traumatic brain injuries (TBIs) are classified as mild (mTBI) based on admission Glasgow Coma Scale (GCS) scores of 13 to 15. The prevalence of persistent functional limitations for these patients is unclear. OBJECTIVES: To characterize the natural history of recovery of daily function following mTBI vs peripheral orthopedic traumatic injury in the first 12 months postinjury using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, and, using clinical computed tomographic (CT) scans, examine whether the presence (CT+) or absence (CT-) of acute intracranial findings in the mTBI group was associated with outcomes. DESIGN, SETTING, AND PARTICIPANTS: TRACK-TBI, a cohort study of patients with mTBI presenting to US level I trauma centers, enrolled patients from February 26, 2014, to August 8, 2018, and followed up for 12 months. A total of 1453 patients at 11 level I trauma center emergency departments or inpatient units met inclusion criteria (ie, mTBI [n = 1154] or peripheral orthopedic traumatic injury [n = 299]) and were enrolled within 24 hours of injury; mTBI participants had admission GCS scores of 13 to 15 and clinical head CT scans. Patients with peripheral orthopedic trauma injury served as the control (OTC) group. EXPOSURES: Participants with mTBI or OTC. MAIN OUTCOMES AND MEASURES: The Glasgow Outcome Scale Extended (GOSE) scale score, reflecting injury-related functional limitations across broad life domains at 2 weeks and 3, 6, and 12 months postinjury was the primary outcome. The possible score range of the GOSE score is 1 (dead) to 8 (upper good recovery), with a score less than 8 indicating some degree of functional impairment. RESULTS: Of the 1453 participants, 953 (65.6%) were men; mean (SD) age was 40.9 (17.1) years in the mTBI group and 40.9 (15.4) years in the OTC group. Most participants (mTBI, 87%; OTC, 93%) reported functional limitations (GOSE <8) at 2 weeks postinjury. At 12 months, the percentage of mTBI participants reporting functional limitations was 53% (95% CI, 49%-56%) vs 38% (95% CI, 30%-45%) for OTCs. A higher percentage of CT+ patients reported impairment (61%) compared with the mTBI CT- group (49%; relative risk [RR], 1.24; 95% CI, 1.08-1.43) and a higher percentage in the mTBI CT-group compared with the OTC group (RR, 1.28; 95% CI, 1.02-1.60). CONCLUSIONS AND RELEVANCE: Most patients with mTBI presenting to US level I trauma centers report persistent, injury-related life difficulties at 1 year postinjury, suggesting the need for more systematic follow-up of patients with mTBI to provide treatments and reduce the risk of chronic problems after mTBI.
IMPORTANCE: Most traumatic brain injuries (TBIs) are classified as mild (mTBI) based on admission Glasgow Coma Scale (GCS) scores of 13 to 15. The prevalence of persistent functional limitations for these patients is unclear. OBJECTIVES: To characterize the natural history of recovery of daily function following mTBI vs peripheral orthopedic traumatic injury in the first 12 months postinjury using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, and, using clinical computed tomographic (CT) scans, examine whether the presence (CT+) or absence (CT-) of acute intracranial findings in the mTBI group was associated with outcomes. DESIGN, SETTING, AND PARTICIPANTS: TRACK-TBI, a cohort study of patients with mTBI presenting to US level I trauma centers, enrolled patients from February 26, 2014, to August 8, 2018, and followed up for 12 months. A total of 1453 patients at 11 level I trauma center emergency departments or inpatient units met inclusion criteria (ie, mTBI [n = 1154] or peripheral orthopedic traumatic injury [n = 299]) and were enrolled within 24 hours of injury; mTBI participants had admission GCS scores of 13 to 15 and clinical head CT scans. Patients with peripheral orthopedic trauma injury served as the control (OTC) group. EXPOSURES: Participants with mTBI or OTC. MAIN OUTCOMES AND MEASURES: The Glasgow Outcome Scale Extended (GOSE) scale score, reflecting injury-related functional limitations across broad life domains at 2 weeks and 3, 6, and 12 months postinjury was the primary outcome. The possible score range of the GOSE score is 1 (dead) to 8 (upper good recovery), with a score less than 8 indicating some degree of functional impairment. RESULTS: Of the 1453 participants, 953 (65.6%) were men; mean (SD) age was 40.9 (17.1) years in the mTBI group and 40.9 (15.4) years in the OTC group. Most participants (mTBI, 87%; OTC, 93%) reported functional limitations (GOSE <8) at 2 weeks postinjury. At 12 months, the percentage of mTBI participants reporting functional limitations was 53% (95% CI, 49%-56%) vs 38% (95% CI, 30%-45%) for OTCs. A higher percentage of CT+ patients reported impairment (61%) compared with the mTBI CT- group (49%; relative risk [RR], 1.24; 95% CI, 1.08-1.43) and a higher percentage in the mTBI CT-group compared with the OTC group (RR, 1.28; 95% CI, 1.02-1.60). CONCLUSIONS AND RELEVANCE: Most patients with mTBI presenting to US level I trauma centers report persistent, injury-related life difficulties at 1 year postinjury, suggesting the need for more systematic follow-up of patients with mTBI to provide treatments and reduce the risk of chronic problems after mTBI.
Authors: Natalie Kreitzer; Sonia Jain; Jacob S Young; Xiaoying Sun; Murray B Stein; Michael A McCrea; Harvey S Levin; Joseph T Giacino; Amy J Markowitz; Geoffrey T Manley; Lindsay D Nelson Journal: J Neurotrauma Date: 2021-10-18 Impact factor: 5.269
Authors: Joan Machamer; Nancy Temkin; Sureyya Dikmen; Lindsay D Nelson; Jason Barber; Phillip Hwang; Kim Boase; Murray B Stein; Xiaoying Sun; Joseph Giacino; Michael A McCrea; Sabrina R Taylor; Sonia Jain; Geoff Manley Journal: J Neurotrauma Date: 2022-02-09 Impact factor: 5.269
Authors: Andrea L C Schneider; J Russell Huie; W John Boscardin; Lindsay Nelson; Jason K Barber; Kristine Yaffe; Ramon Diaz-Arrastia; Adam R Ferguson; Joel Kramer; Sonia Jain; Nancy Temkin; Esther Yuh; Geoffrey T Manley; Raquel C Gardner Journal: Neurology Date: 2022-02-16 Impact factor: 9.910
Authors: Donald V Bradshaw; Andrew K Knutsen; Alexandru Korotcov; Genevieve M Sullivan; Kryslaine L Radomski; Bernard J Dardzinski; Xiaomei Zi; Dennis P McDaniel; Regina C Armstrong Journal: Acta Neuropathol Commun Date: 2021-05-17 Impact factor: 7.801
Authors: Paul MacMullin; Nathaniel Hodgson; Ugur Damar; Henry Hing Cheong Lee; Mustafa Q Hameed; Sameer C Dhamne; Damon Hyde; Grace M Conley; Nicholas Morriss; Jianhua Qiu; Rebekah Mannix; Takao K Hensch; Alexander Rotenberg Journal: Cereb Cortex Date: 2020-11-03 Impact factor: 5.357
Authors: Lindsay D Nelson; Jason K Barber; Nancy R Temkin; Kristen Dams-O'Connor; Sureyya Dikmen; Joseph T Giacino; Mark D Kramer; Harvey S Levin; Michael A McCrea; John Whyte; Yelena G Bodien; John K Yue; Geoffrey T Manley Journal: J Neurotrauma Date: 2020-12-14 Impact factor: 5.269