Patterns and predictors of follow-up in patients with mild traumatic brain injury

Crandall, Marie; Rink, Richard A; Shaheen, Aisha; Butler, Bennett; Unger, Erin; Zollman, Felise S.

doi:10.3109/02699052.2014.919533

Cited by 11 publications

(14 citation statements)

References 18 publications

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“…Although the IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) and ICoMP (International Collaboration on Mild Traumatic Brain Injury Prognosis) delineate recommendations related to recruitment for TBI research, these recommendations are very general and related mainly to expanding inclusion criteria. Strict inclusion criteria can limit study eligibility and make it challenging to meet recruitment goals, which happened in the current study with patients ineligible due to premorbid medical conditions, contradictory medication use, social or environmental issues . While many of the contraindications for amitriptyline use are ignored or considered “relative” in clinical practice, strict observation resulted in many cases of ineligibility.…”

Section: Discussionmentioning

confidence: 99%

“…Strict inclusion criteria can limit study eligibility and make it challenging to meet recruitment goals, which happened in the current study with patients ineligible due to premorbid medical conditions, contradictory medication use, social or environmental issues. [27][28][29][30][31] While many of the contraindications for amitriptyline use are ignored or considered "relative" in clinical practice, strict observation resulted in many cases of ineligibility.…”

Section: Discussionmentioning

confidence: 99%

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Use of Amitriptyline in the Treatment of Headache After Traumatic Brain Injury: Lessons Learned From a Clinical Trial

et al. 2020

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Objectives The primary outcome of this study was to assess the efficacy and safety of preventive treatment with amitriptyline on headache frequency and severity after mild traumatic brain injury (mTBI). Background Despite the fact that headache is the most common and persistent physical symptom after TBI, there has been little research on the longitudinal course or pharmacologic treatment of this disorder. Of those who have headache after injury, about 60% continue to complain of headache at 3 months post injury, with higher levels of disability than those without headache. There have been no prospective, randomized, controlled trials of a pharmacologic agent for headache after TBI. Additionally, a brain‐injured population may be more susceptible to side effects of medication. Design This is a single‐center phase II trial of amitriptyline to prevent persistent headache after an mTBI. Medication dose was gradually increased from 10 to 50 mg daily. Results Fifty participants were enrolled and 33 who completed the 90‐day assessment were included in the final analysis. In order to detect a possible cognitive impact of the study drug, 24 participants were randomly assigned to start amitriptyline immediately after study enrollment and 26 were assigned to start 30 days after enrollment. Forty‐nine percent (18/37) of those assigned to take medication took none throughout the study period, with less compliance in younger participants with mean ages of 32.7 in those who did not take any medication, 33.4 who were less than 80% compliant, and 42.3 who were compliant (P = .013). Compliance in keeping a daily headache diary was low, with 29/50 participants (58%) meeting daily entry completion, and only 10 participants maintaining 100% diary completion. No differences were found between those who started medication immediately vs at day 30 in headache frequency or severity. Conclusions While headache is the most common symptom following mTBI, current evidence does not support a specific treatment. No differences were noted in headache frequency compared to our prior study. However, the current sample had significantly lower headache severity (15% vs 36% with pain rating of 6 or above, P = .015) compared to our prior study. Our current study was not able to determine whether there is any benefit for the use of amitriptyline as a headache preventive because of difficulty with study recruitment and compliance. The challenges with recruitment and retention in the mTBI population were instructive, and future research in this area will need to identify strategies to improve recruitment, diary compliance, and medication adherence in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Use of Amitriptyline in the Treatment of Headache After Traumatic Brain Injury: Lessons Learned From a Clinical Trial

et al. 2020

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“…One study of veterans with TBI used data from Veterans Health Administration (VHA) Decision Support System (DSS) and Vital Status files 18 . Three other studies enrolled participants based on the records from local hospitals or trauma centers including Northwestern Memorial Hospital (NMH), Northwestern level I trauma center and Neurology/Neurosurgery Intensive Care Unit (NNICU) 19–21 .…”

Section: Resultsmentioning

confidence: 99%

“…A majority of studies included all adult patients with a diagnosis of TBI as their study populations, while others used extra inclusion criteria according to their hypotheses. Patients enrolled in Crandall’s study had mild TBIs which were determined by symptoms and GCS score of 13 to 15 19 . Scheetz focused on older patients (≥ 65 years) admitted to hospitals with same level falls 17 .…”

Section: Resultsmentioning

confidence: 99%

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Disparities in Health Care Utilization of Adults With Traumatic Brain Injuries Are Related to Insurance, Race, and Ethnicity: A Systematic Review

Gao

Kumar

Wisniewski

et al. 2018

Journal of Head Trauma Rehabilitation

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Disparities in concussion diagnoses compared to ankle injuries

Marmor

Mcelheny

Lingor

et al. 2022

PM&R

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Background: Health disparities related to concussions have been reported in the literature for certain minority populations. Given the significant impact of concussions on long-and short-term function, the mitigation of barriers to accessing care is an important public health objective. Objective: To determine if racial and ethnic disparities exist in patients who seek care for concussions compared to a control group with orthopedic ankle injuries (sprains and fractures) to minimize confounding factors that predispose to injury. Design: Cohort study. Setting: Single institution between February 2016 and December 2020. Patients: A retrospective review of electronic medical records was completed for patients with International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes for concussion, ankle sprain, and ankle fracture. A total of 10,312 patients were identified: 1568 (15.2%) with concussion, 4871 (47.3%) with ankle sprain, and 3863 (37.5%) with ankle fracture. Interventions: Patients were stratified by demographic factors, including sex, ethnicity, race, and insurance type. Main Outcome Measures: Diagnosis of concussion. Results: The concussion group was the youngest (28.3 years AE 18.0) and had the fewest females (53.1%) compared to the ankle sprain (35.1 years AE 19.7; 58.7%) and fracture groups (44.1 years AE 21.3; 57.3%). The concussion group had a smaller proportion of Hispanic patients than the ankle sprain group (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.55-0.92, p = .010) and fracture group (OR 0.58, 95% CI 0.44-0.75, p = <.001). In addition, the concussion group was less likely to be Asian (OR 0.70, CI 0.52-0.95, p = .023) than the sprain group and less likely to be Black/African American than both sprain (OR 0.65, 95% CI 0.46-0.93, p = .017) and fracture groups (OR 0.62, 95% CI 0.43-0.89, p = .010). There were no differences across racial groups between ankle sprains and fractures. Patients with Medicaid/Medicare and self-pay had a higher likelihood of being in the concussion group than those with private insurance. Conclusion: Differences in concussion diagnosis may exist between certain demographic groups compared to those with ankle injuries. Efforts to mitigate disparities in concussion care are worthwhile with a focus on patient and caregiver education.

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Patterns and predictors of follow-up in patients with mild traumatic brain injury

Cited by 11 publications

References 18 publications

Use of Amitriptyline in the Treatment of Headache After Traumatic Brain Injury: Lessons Learned From a Clinical Trial

Use of Amitriptyline in the Treatment of Headache After Traumatic Brain Injury: Lessons Learned From a Clinical Trial

Disparities in Health Care Utilization of Adults With Traumatic Brain Injuries Are Related to Insurance, Race, and Ethnicity: A Systematic Review

Disparities in concussion diagnoses compared to ankle injuries

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