Duration of Posttraumatic Amnesia Predicts Neuropsychological and Global Outcome in Complicated Mild Traumatic Brain Injury

Hart, Tessa; Novack, Thomas A.; Temkin, Nancy; Barber, Jason; Dikmen, Sureyya; Ricker, Joseph H.; Hesdorffer, Dale C.; Jallo, Jack; Hsu, Nancy H.; Zafonte, Ross

doi:10.1097/htr.0000000000000210

Cited by 31 publications

(17 citation statements)

References 39 publications

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“…This study adds to the literature supporting the hypothesis that prolonged PTA duration significantly increases the burden of care (10–13, 36, 37) and this burden of care continues to affect patients up to 5 years post-injury. Individuals with esPTA show lower FIM total scores at each time point from rehabilitation admission to 5 years post-injury compared to those without esPTA.…”

Section: Discussionmentioning

confidence: 60%

“…The cognitive sequelae following TBI often includes post-traumatic amnesia (PTA) characterized by disorientation, confusion, restlessness, inability to recall events, poor attention, and agitated behavior (6–9). In individuals with complicated mild TBI, Hart et al found that shorter PTA duration (≤1 week) predicted greater cognitive performance and less disability at 6 months post-injury vs. patients with a PTA duration >1 week (10). Eastvold et al used PTA duration as a predictor for outcomes after TBI and found that patients with PTA <30 days were more than three times as likely to be living independently 1 year after injury when compared to patients with PTA duration >30 days (11).…”

Section: Introductionmentioning

confidence: 99%

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Burden of Care Implications and Association of Intracranial Hypertension With Extremely Severe Post-traumatic Amnesia After Traumatic Brain Injury: A 5-Year Retrospective Longitudinal Study

et al. 2019

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Post-traumatic amnesia (PTA) is characterized by a state of disorientation and confusion following traumatic brain injury (TBI). Few studies have looked at the effect of prolonged PTA on the functional outcomes beyond 1 year post-injury. This study aims to evaluate the burden of care in individuals with extremely severe PTA (esPTA; PTA >28 days) from acute inpatient rehabilitation admission to 5 years post-injury as well as the association between intracranial hypertension (ICH; Intracranial pressure (ICP) ≥20 mmHg) and esPTA status. Three hundred and forty-two individuals with moderate to severe TBI enrolled in the Northern California TBI Model System (TBIMS) of Care were included in this study. The FIM® instrument was chosen as the outcome measurement as it is a widely used functional assessment in the rehabilitation community. Repeated measure ANOVA revealed greater burden of care based on FIM® total scores (p < 0.001) from admission to 5-year follow-up for the esPTA group compared to the non-esPTA group (PTA ≤ 28 days). Unlike the non-esPTA group where FIM® total score plateaued 1 year post-injury, FIM® total score continued to improve up to 2 years post-injury for the esPTA group. The odds of developing esPTA was ~3 times higher for individuals with ICH vs. individuals without ICH (p < 0.001). In conclusion, individuals with esPTA have increased short- and long-term burden of care and the presence of ICH during hospitalization increased the odds of experiencing esPTA. These results may help the rehabilitation team and family in planning care post rehabilitation discharge.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Burden of Care Implications and Association of Intracranial Hypertension With Extremely Severe Post-traumatic Amnesia After Traumatic Brain Injury: A 5-Year Retrospective Longitudinal Study

et al. 2019

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“…The predictive value of GCS has been found to be modest (9, 22). PTA duration greater than 7 days was found to be predictive of residual moderate disability at 6 months postinjury in patients with complicated MTBI (i.e., intracranial injuries) (23). Adding to the heterogeneity, imaging studies have demonstrated that brain pathology, as indicated by CT, is not a strong predictor of outcome with regard to symptoms or global function according to the GOSE in MTBI (11, 24–26).…”

Section: Introductionmentioning

confidence: 99%

Predicting Outcome 12 Months after Mild Traumatic Brain Injury in Patients Admitted to a Neurosurgery Service

et al. 2017

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ObjectiveAccurate outcome prediction models for patients with mild traumatic brain injury (MTBI) are key for prognostic assessment and clinical decision-making. Using multivariate machine learning, we tested the unique and added predictive value of (1) magnetic resonance imaging (MRI)-based brain morphometric and volumetric characterization at 4-week postinjury and (2) demographic, preinjury, injury-related, and postinjury variables on 12-month outcomes, including global functioning level, postconcussion symptoms, and mental health in patients with MTBI.MethodsA prospective, cohort study of patients (n = 147) aged 16–65 years with a 12-month follow-up. T1-weighted 3 T MRI data were processed in FreeSurfer, yielding accurate cortical reconstructions for surface-based analyses of cortical thickness, area, and volume, and brain segmentation for subcortical and global brain volumes. The 12-month outcome was defined as a composite score using a principal component analysis including the Glasgow Outcome Scale Extended, Rivermead Postconcussion Questionnaire, and Patient Health Questionnaire-9. Using leave-one-out cross-validation and permutation testing, we tested and compared three prediction models: (1) MRI model, (2) clinical model, and (3) MRI and clinical combined.ResultsWe found a strong correlation between observed and predicted outcomes for the clinical model (r = 0.55, p < 0.001). The MRI model performed at the chance level (r = 0.03, p = 0.80) and the combined model (r = 0.45, p < 0.002) were slightly weaker than the clinical model. Univariate correlation analyses revealed the strongest association with outcome for postinjury factors of posttraumatic stress (Posttraumatic Symptom Scale-10, r = 0.61), psychological distress (Hospital Anxiety and Depression Scale, r = 0.52), and widespread pain (r = 0.43) assessed at 8 weeks.ConclusionWe found no added predictive value of MRI-based measures of brain cortical morphometry and subcortical volumes over and above demographic and clinical features.

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“…This might explain why primary brain injury by initial GCS poorly predicts cognitive outcome and HRQoL in this study. The duration of post‐traumatic amnesia may be a more valid predictor of global outcome than GCS 15 . Unfortunately, we had no data on post‐traumatic amnesia in our cohort.…”

Section: Discussionmentioning

confidence: 94%

“…Prolonged delirium constitutes a risk for long‐term cognitive impairment after the ICU stay, 6 though this association was not found in a recent Danish cohort study 2 . Furthermore, prolonged post‐traumatic amnesia (PTA) in survivors of traumatic brain injury (TBI) is associated with poor cognitive outcomes 15 and development of dementia 16 . PTA is a memory disorder, often with symptoms such as disorientation, confusion and behavioural symptoms overlapping with the definition of delirium 17,18 .…”

Section: Introductionmentioning

confidence: 99%

Cognitive function and health‐related quality of life 1 year after acute brain injury: An observational study

Larsen

Møller

Petersen

et al. 2020

Acta Anaesthesiol Scand

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Background: Cognitive impairment and reduced health-related quality of life (HRQoL) are well-established sequelae of critical illness. Studies on survivors of critical illness have found delirium to be a predictor of these conditions, but evidence regarding survivors of acute brain injury is sparse. We aimed to explore if delirium duration was associated with 1-year cognitive impairment and reduced HRQoL in patients with acute brain injury. Method: Intensive care unit (ICU) delirium was assessed using the Intensive Care Delirium Screening Checklist. Cognitive status was assessed using the Repeatable Battery for Neuropsychological Status (RBANS) and HRQoL using the European Quality of Life 5-dimension questionnaire (EQ-5D). We used a multiple linear regression for testing the association of delirium duration with cognitive impairment and quality of life, respectively. Results: Forty-seven survivors of acute brain injury participated in follow-up and 35 completed RBANS. Delirium was present in 39 of 47 (83%) with a median duration of 4 days. Delirium duration did not predict cognitive impairment (95% CI −4.1 to 0.5) or lower HRQoL (95% CI −1.4 to 2.7). Moderate-to-severe cognitive impairment was present in 17 of 35 (49%) participants, and they had a mean EQ-5D health visual analogue scale of 70.9 vs 81.6 for the Danish age-matched norm. Conclusions: Our sample did not demonstrate an association between delirium and 1-year cognitive impairment or reduced HRQoL. Still, a large proportion of the participants were cognitively impaired, and their quality of life was lower compared to norm. Larger studies are necessary to explore these associations further.

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Duration of Posttraumatic Amnesia Predicts Neuropsychological and Global Outcome in Complicated Mild Traumatic Brain Injury

Cited by 31 publications

References 39 publications

Burden of Care Implications and Association of Intracranial Hypertension With Extremely Severe Post-traumatic Amnesia After Traumatic Brain Injury: A 5-Year Retrospective Longitudinal Study

Burden of Care Implications and Association of Intracranial Hypertension With Extremely Severe Post-traumatic Amnesia After Traumatic Brain Injury: A 5-Year Retrospective Longitudinal Study

Predicting Outcome 12 Months after Mild Traumatic Brain Injury in Patients Admitted to a Neurosurgery Service

Cognitive function and health‐related quality of life 1 year after acute brain injury: An observational study

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