Clinical Predictors of 3- and 6-Month Outcome for Mild Traumatic Brain Injury Patients with a Negative Head CT Scan in the Emergency Department: A TRACK-TBI Pilot Study

Abstract

A considerable subset of mild traumatic brain injury (mTBI) patients fail to return to baseline functional status at or beyond 3 months postinjury. Identifying at-risk patients for poor outcome in the emergency department (ED) may improve surveillance strategies and referral to care. Subjects with mTBI (Glasgow Coma Scale 13–15) and negative ED initial head CT < 24 h of injury, completing 3- or 6-month functional outcome (Glasgow Outcome Scale-Extended; GOSE), were extracted from the prospective, multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study. Outcomes were dichotomized to full recovery (GOSE = 8) vs. functional deficits (GOSE < 8). Univariate predictors with p < 0.10 were considered for multivariable regression. Adjusted odds ratios (AOR) were reported for outcome predictors. Significance was assessed at p < 0.05. Subjects who completed GOSE at 3- and 6-month were 211 (GOSE < 8: 60%) and 185 (GOSE < 8: 65%). Risk factors for 6-month GOSE < 8 included less education (AOR = 0.85 per-year increase, 95% CI: (0.74–0.98)), prior psychiatric history (AOR = 3.75 (1.73–8.12)), Asian/minority race (American Indian/Alaskan/Hawaiian/Pacific Islander) (AOR = 23.99 (2.93–196.84)), and Hispanic ethnicity (AOR = 3.48 (1.29–9.37)). Risk factors for 3-month GOSE < 8 were similar with the addition of injury by assault predicting poorer outcome (AOR = 3.53 (1.17–10.63)). In mTBI patients seen in urban trauma center EDs with negative CT, education, injury by assault, Asian/minority race, and prior psychiatric history emerged as risk factors for prolonged disability.

A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury

“…Like other acute mTBI studies in adults presenting to the ED, we observed a high prevalence of previously identified risk factors for the development of PCS, including comorbid mental health conditions, prior concussions, and alcohol and drug use 32‐34 . The largest prior study was a prospective, multicenter longitudinal study, known as the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK‐TBI) study.…”

“…In the pilot TRACK‐TBI study, three urban, level I trauma centers in the United States prospectively enrolled 271 mTBI patients and completed in‐person or phone interviews at 3 and 6 months. Although limited by attrition, outcomes were documented for 215 and 185 participants at 3 and 6 months, respectively, and 30% of participants continued to have postconcussive symptoms at 3 and 6 months 33,34 . Preinjury psychiatric history and preinjury headache/migraine symptoms, both prevalent in our cohort, were predictive of worse functional and postconcussive outcomes.…”

“…Like other acute mTBI studies in adults presenting to the ED, we observed a high prevalence of previously identified risk factors for the development of PCS, including comorbid mental health conditions, prior concussions, and alcohol and drug use. [32][33][34] The largest prior study was a prospective, multicenter longitudinal study, known symptoms at 3 and months. 33,34 Preinjury psychiatric history and preinjury headache/migraine symptoms, both prevalent in our cohort, were predictive of worse functional and postconcussive outcomes.…”

“…However, we believe that patients enrolled in our study are representative of the typical mTBI patient presenting to most EDs. [31][32][33][34][35] Participants were not blinded to treatment; thus, intervention bias is possible. In addition, given that adults may present to the ED alone following mTBI, verbal discharge instruc-…”

“…It is unknown how an exercise intervention would impact a more symptomatic cohort. However, we believe that patients enrolled in our study are representative of the typical mTBI patient presenting to most EDs 31‐35 . Participants were not blinded to treatment; thus, intervention bias is possible.…”