Outcome Prediction after Mild and Complicated Mild Traumatic Brain Injury: External Validation of Existing Models and Identification of New Predictors Using the TRACK-TBI Pilot Study

Abstract

Although the majority of patients with mild traumatic brain injury (mTBI) recover completely, some still suffer from disabling ailments at 3 or 6 months. We validated existing prognostic models for mTBI and explored predictors of poor outcome after mTBI. We selected patients with mTBI from TRACK-TBI Pilot, an unselected observational cohort of TBI patients from three centers in the United States. We validated two prognostic models for the Glasgow Outcome Scale Extended (GOS-E) at 6 months after injury. One model was based on the CRASH study data and another from Nijmegen, The Netherlands. Possible predictors of 3-and 6-month GOS-E were analyzed with univariate and multi-variable proportional odds regression models. Of the 386 of 485 patients included in the study (median age, 44 years; interquartile range, 27-58), 75% (n = 290) presented with a Glasgow Coma Score (GCS) of 15. In this mTBI population, both previously developed models had a poor performance (area under the receiver operating characteristic curve, 0.49-0.56). In multivariable analyses, the strongest predictors of lower 3-and 6-month GOS-E were older age, pre-existing psychiatric conditions, and lower education. Injury caused by assault, extracranial injuries, and lower GCS were also predictive of lower GOS-E. Existing models for mTBI performed unsatisfactorily. Our study shows that, for mTBI, different predictors are relevant as for moderate and severe TBI. These include age, pre-existing psychiatric conditions, and lower education. Development of a valid prediction model for mTBI patients requires further research efforts.

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

“…A considerable part of both the hospitalized and non-hospitalized patients were seen by surgeons and physical therapists, indicating that physical injuries might require attention up to six months after injury. The mean ISS was comparable with findings of the TRACK-TBI study, demonstrating that physical problems and related treatments are part of the heterogeneous mTBI spectrum [15]. Most outpatient contacts declined over time, however, those with psychiatrists/psychologists showed a consult rate of approximately 10% after six months, a figure which was also observed in a recent study among moderate and severe TBI patients [16].…”

“…Yet, non-hospitalized patients were more often anxious, which might be related to uncertainty regarding the persistence of complaints [23]. The non-hospitalized patients, who are expected to make a full recovery and are not scheduled for regular follow-up, might feel a lack in opportunity to ask additional questions on expected recovery, despite the fact that an information leaflet was provided on discharge from the ED [10,15]. Whether intensified follow-up could help dealing with this uncertainty towards recovery is largely uninvestigated.…”

“…[15] A recent study suggested that the relatively worse outcome for patients with mTBI, when compared to moderate TBI, is explained by sickness awareness [27]; patients with mTBI are more aware of cognitive and behavioural disabilities and are therefore less satisfied with their outcome in comparison to more severely injured patients, who might be less aware of their problems. These mechanisms could also explain the unfavourable outcome in one in five of non-hospitalized patients; the awareness of their disabilities in combination with expectation of full recovery, which causes dissatisfaction with current levels of functioning.…”

Chronic effects of exposure to high-intensity blasts: Results on tests of central auditory processing

“…Another relevant factor that may affect test results following head injury, according to the work of Lingma et al [20], is PTSD. The number of participants in each group with a diagnosis of PTSD in their medical records is shown in Table 1.…”

Traumatic Penumbra: Opportunities for Neuroprotective and Neurorestorative Processes

“…Notwithstanding the previous characterization of the pathophysiologic responses to TBI, these biologic responses occur in individuals who possess biologic differences that can modify their response to injury [53,108]. Over the last years, evidence has showed that the brain is capable of significant structural and functional repair, plasticity, and regeneration.…”