Acute Clinical Predictors of Symptom Recovery in Emergency Department Patients with Uncomplicated Mild Traumatic Brain Injury or Non-Traumatic Brain Injuries

Abstract

There is a subset of patients with mild traumatic brain injury (mTBI) who report persistent symptoms that impair their functioning and quality of life. Being able to predict which patients will experience prolonged symptom recovery would help clinicians target resources for clinical follow-up to those most in need, and would facilitate research to develop precision medicine treatments for mTBI. The purpose of this study was to investigate the predictors of symptom recovery in a prospective sample of emergency department trauma patients with either mTBI or non-mTBI injuries. Subjects were examined at several time points from within 72 h to 45 days post-injury. We quantified and compared the value of a variety of demographic, injury, and clinical assessment (symptom, neurocognitive) variables for predicting self-reported symptom duration in both mTBI (n = 89) and trauma control (n = 73) patients. Several injury-related and neuropsychological variables assessed acutely (< 72 h) post-injury predicted symptom duration, particularly loss of consciousness (mTBI group), acute somatic symptom burden (both groups), and acute reaction time (both groups), with reasonably good model fit when including all of these variables (area under the receiver operating characteristic curve [AUC] = 0.76). Incorporating self-reported litigation involvement modestly increased prediction further (AUC = 0.80). The results highlight the multifactorial nature of mTBI recovery, and injury recovery more generally, and the need to incorporate a variety of variables to achieve adequate prediction. Further research to improve this model and validate it in new and more diverse trauma samples will be useful to build a neurobiopsychosocial model of recovery that informs treatment development.

Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers

“…Although it is well accepted that moderate to severe TBIs may cause permanent disability, [2][3][4] controversy exists surrounding the expected course of clinical recovery for patients with mTBI. In particular, although mTBI commonly causes acute symptoms, [5][6][7] cognitive dysfunction, 6,[8][9][10][11][12] and problems in day-to-day functioning, 13 findings vary as to whether patients continue to manifest sequelae of mTBI months to years postinjury. [14][15][16] Limitations in research methods have been proposed as a major factor explaining inconsistencies in the observed natural history of mTBI.…”

The Role of Speech-Language Pathology in an Interdisciplinary Care Model for Persistent Symptomatology of Mild Traumatic Brain Injury

“…Patients with persistent symptoms are treated at the MIBH for both TBI-related symptoms and changes in behavioral health, and the presence and expression of these symptoms can be understood through a neurobiopsychosocial model. 24 When considering persistent symptoms, there is a clear overlap of behaviors like impairment in sleep and memory in both concussion and psychological disorders. Sustaining an mTBI is tied to an increased risk of depression, sleep disorder, and memory dysfunction, just as depression, anxiety, and PTS are linked to changes in sleep and memory.…”

Towards the Development of an Integrative, Evidence-Based Suite of Indicators for the Prediction of Outcome Following Mild Traumatic Brain Injury: Results from a Pilot Study

“…For clinicians, prognostic models would assist in tailoring treatment plans to better suit the needs of the individual and, more importantly, facilitate the early provision of targeted treatment strategies to circumvent ongoing problems [20]. Moreover, researchers could use prediction models to help enrich clinical trials in order to accelerate the development of evidence-based therapies [21] that aim to prevent or ameliorate the effects of PPCS, as well as other neurodegenerative diseases that have been found to be associated with mTBI, such as Alzheimer's disease [22][23][24] and chronic traumatic encephalopathy [25][26][27][28][29][30].…”

“…A variety of neuropsychological measures have also been examined as possible predictors of PPCS because cognitive deficits have been observed in both individuals who have sustained a mTBI [39,40] and those suffering from PPCS [41]. In particular, individuals who perform poorly on tasks of executive function [42], memory [33,[43][44][45], and psychomotor function [21] have been found to be at a heightened risk of developing PPCS. However, the fidelity with which neuropsychological measures can prognosticate PPCS has been questioned, as individual performance can be confounded by extraneous factors such as age, socio-economic status, and prior education [46][47][48][49].…”

“…Given that PPCS is a complex multifactorial condition that affects several aspects of functioning, it is unlikely that any single factor will be sufficiently capable of predicting the disorder at the individual level. Moreover, the predictive power of models is found to increase when several measures of clinical assessment (e.g., symptom, neurocognitive, balance) are considered together [21]. This suggests that model accuracy is likely to be optimised when a multidimensional approach that acknowledges the neurobiopsychosocial aspects of PPCS is undertaken.…”