Early Detection of Poor Outcome after Mild Traumatic Brain Injury: Predictive Factors Using a Multidimensional Approach a Pilot Study

Abstract

Mild traumatic brain injury (MTBI) is a common condition within the general population, usually with good clinical outcome. However, in 10–25% of cases, a post-concussive syndrome (PCS) occurs. Identifying early prognostic factors for the development of PCS can ensure widespread clinical and economic benefits. The aim of this study was to demonstrate the potential value of a comprehensive neuropsychological evaluation to identify early prognostic factors following MTBI. We performed a multi-center open, prospective, longitudinal study that included 72 MTBI patients and 42 healthy volunteers matched for age, gender, and socioeconomic status. MTBI patients were evaluated 8–21 days after injury, and 6 months thereafter, with a full neurological and psychological examination and brain MRI. At 6 months follow-up, MTBI patients were categorized into two subgroups according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as having either favorable or unfavorable evolution (UE), corresponding to the presence of major or mild neurocognitive disorder due to traumatic brain injury. Univariate and multivariate logistical regression analysis demonstrated the importance of patient complaints, quality of life, and cognition in the outcome of MTBI patients, but only 6/23 UE patients were detected early via the multivariate logistic regression model. Using several variables from each of these three categories of variables, we built a model that assigns a score to each patient presuming the possibility of UE. Statistical analyses showed this last model to be reliable and sensitive, allowing early identification of patients at risk of developing PCS with 95.7% sensitivity and 77.6% specificity.

A Multidimensional Approach to Post-concussion Symptoms in Mild Traumatic Brain Injury

“…The identification of risk factors might be especially useful for clinical practice when combined into a prognostic model predicting patients at risk of poor outcome. However, current models are often based on small samples (9, 75) and lack internal and external validation (10, 45, 75, 76). In addition, no model is able to reliably predict outcomes at the individual patient level (45).…”

Efficacy of Psychoeducation and Cognitive Rehabilitation After Mild Traumatic Brain Injury for Preventing Post-concussional Syndrome in Individuals With High Risk of Poor Prognosis: A Randomized Clinical Trial

“…Ideally, management of mTBI ought to be performed in two stages: first, identification of patients with factors indicating a poor prognosis (with a risk of developing PCS) and, second, multidimensional management (MM) for the identified patients in order to reduce their handicaps and help them to return to a normal life. With this in mind, we previously developed a reliable (sensitive as well as specific) prognostic tool that enables early identification (within 15 days following injury) of at-risk patients (29). This prognostic tool is based on cognitive, somatic, mood, and quality of life (QoL) evaluation of each patient.…”

“…Using this prognostic tool (29), in this study, we sought to establish whether an MM program (including psychoeducation and cognitive rehabilitation) effectively improves the prognosis of the patients identified as having a poor clinical and neuropsychological prognosis. The main aim was to assess the efficacy of early MM in mTBI patients deemed to be at risk of a poor outcome at 6 months.…”

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

“…More specifically, the physical symptoms associated with mTBI were measured using the Rivermead Post-Concussion Symptoms Questionnaire (RMPCQ) [77]. This self-report measure, which has been used to evaluate PPCS in previous prognostic studies [37,[42][43][44][45][78][79][80][81][82], comprises of 16 symptoms that are commonly experienced following head injury. Respondents indicate the severity of their symptoms over the past 24 h (h) on a five-point Likert scale (0 = 'none', 4 = 'severe'), relative to their experience before sustaining their mTBI.…”