Risk factors for recurrent neurotrauma: a population-based study in Southeastern Michigan

Hayward, R. David; Fessler, Mary; Buck, Joseph R.; Fessler, Richard D.

doi:10.1080/02699052.2018.1487584

Cited by 4 publications

(4 citation statements)

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“…Repetitive experiences of TBI, and both neurological and psychiatric conditions have been demonstrated to confer greater risk of hospital re-entry for TBI. 29 Additionally, given the emergency/trauma center environment, the cases analyzed here do not have pre-injury functional status data available to assess change in functional status from before hospital admission. Further, the cross-sectional data here do not delineate when patients were diagnosed with PECs, precluding our ability establish direct causality of specific PECs on either chronological acquisition of systemically related PECs or injury specifically.…”

Section: Limitations and Future Directionsmentioning

confidence: 99%

“…Patients with moderate-to-severe TBI (msTBI) with a greater total disease burden reported reduced levels of functioning and life satisfaction up to 10 years following injury. 28 Together, these studies add to the growing literature examining the impacts of both psychiatric 1,10,13,14,[20][21][22][23]29 and other medical conditions 24,[30][31][32][33][34] on outcomes following TBI. Such multimorbidity adds complexity to the care required for these TBI patients in comparison to individuals with singular or no reported PECs and provides evidence for a systemic disease burden on the individual.…”

Section: Introductionmentioning

confidence: 99%

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A Population-Based Study of Pre-Existing Health Conditions in Traumatic Brain Injury

Dell

Grossner

Staph

et al. 2021

Neurotrauma Reports

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Health factors impacting both the occurrence of, and recovery from traumatic brain injury (TBI) vary in complexity, and present genuine challenges to researchers and healthcare professionals seeking to characterize injury consequences and determine prognosis. However, attempts to clarify causal links between injury characteristics and clinical outcomes (including mortality) often compel researchers to exclude pre-existing health conditions (PECs) in their samples, including psychiatric history, medication usage, and other comorbid conditions. In this pre-registered population-based study (total starting n = 939,123 patients), we examined trends in PEC incidence over 22 years in the state of Pennsylvania (1997Pennsylvania ( -2019 in individuals sustaining TBI (n = 169,452) and individuals with orthopedic injury (n = 87,637). The goal was to determine how PECs interact with age and injury severity to influence short-term outcomes. A further goal was to determine whether number of PECs, or specific PEC clusters contributed to worse outcomes within the TBI cohort, compared with orthopedic injury alone. Primary findings indicate that PECs significantly influenced mortality within the TBI cohort; patients having four or more PECs were associated with approximately a two times greater likelihood of dying in acute care (odds ratio [OR] 1.9). Additionally, cluster analyses revealed four distinct PEC clusters that are age and TBI severity dependent. Overall, the likelihood of zero PECs hovers at *25%, which is critical to consider in TBI outcomes work and could potentially contribute to the challenges facing intervention science with regard to reproducibility of findings.

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Section: Limitations and Future Directionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Population-Based Study of Pre-Existing Health Conditions in Traumatic Brain Injury

Dell

Grossner

Staph

et al. 2021

Neurotrauma Reports

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“…Traumatic brain injury (TBI) is a leading cause of death and disability in the US and worldwide, generating 2.8 million annual TBI-related emergency department (ED) visits, 280 000 hospitalizations, and 64 000 deaths in the US alone . Individuals who sustain 1 TBI are at a significantly increased risk of sustaining another . Repetitive TBI is frequently studied in contact-sport athletes and military personnel.…”

Section: Introductionmentioning

confidence: 99%

“… 1 , 2 , 3 Individuals who sustain 1 TBI are at a significantly increased risk of sustaining another. 4 , 5 , 6 , 7 Repetitive TBI is frequently studied in contact-sport athletes and military personnel. History of multiple concussions is correlated with depression, 8 , 9 delayed recovery, 10 , 11 cognitive impairment, 12 , 13 and chronic traumatic encephalopathy.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Recovery Following Repetitive Traumatic Brain Injury

Etemad,

Yue,

Barber

et al. 2023

JAMA Netw Open

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ImportanceOne traumatic brain injury (TBI) increases the risk of subsequent TBIs. Research on longitudinal outcomes of civilian repetitive TBIs is limited.ObjectiveTo investigate associations between sustaining 1 or more TBIs (ie, postindex TBIs) after study enrollment (ie, index TBIs) and multidimensional outcomes at 1 year and 3 to 7 years.Design, Setting, and ParticipantsThis cohort study included participants presenting to emergency departments enrolled within 24 hours of TBI in the prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study (enrollment years, February 2014 to July 2020). Participants who completed outcome assessments at 1 year and 3 to 7 years were included. Data were analyzed from September 2022 to August 2023.ExposuresPostindex TBI(s).Main Outcomes and MeasuresDemographic and clinical factors, prior TBI (ie, preindex TBI), and functional (Glasgow Outcome Scale–Extended [GOSE]), postconcussive (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]), psychological distress (Brief Symptom Inventory-18 [BSI-18]), depressive (Patient Health Questionnaire-9 [PHQ-9]), posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5 [PCL-5]), and health-related quality-of-life (Quality of Life After Brain Injury–Overall Scale [QOLIBRI-OS]) outcomes were assessed. Adjusted mean differences (aMDs) and adjusted relative risks are reported with 95% CIs.ResultsOf 2417 TRACK-TBI participants, 1572 completed the outcomes assessment at 1 year (1049 [66.7%] male; mean [SD] age, 41.6 [17.5] years) and 1084 completed the outcomes assessment at 3 to 7 years (714 [65.9%] male; mean [SD] age, 40.6 [17.0] years). At 1 year, a total of 60 participants (4%) were Asian, 255 (16%) were Black, 1213 (77%) were White, 39 (2%) were another race, and 5 (0.3%) had unknown race. At 3 to 7 years, 39 (4%) were Asian, 149 (14%) were Black, 868 (80%) were White, 26 (2%) had another race, and 2 (0.2%) had unknown race. A total of 50 (3.2%) and 132 (12.2%) reported 1 or more postindex TBIs at 1 year and 3 to 7 years, respectively. Risk factors for postindex TBI were psychiatric history, preindex TBI, and extracranial injury severity. At 1 year, compared with those without postindex TBI, participants with postindex TBI had worse functional recovery (GOSE score of 8: adjusted relative risk, 0.57; 95% CI, 0.34-0.96) and health-related quality of life (QOLIBRI-OS: aMD, −15.9; 95% CI, −22.6 to −9.1), and greater postconcussive symptoms (RPQ: aMD, 8.1; 95% CI, 4.2-11.9), psychological distress symptoms (BSI-18: aMD, 5.3; 95% CI, 2.1-8.6), depression symptoms (PHQ-9: aMD, 3.0; 95% CI, 1.5-4.4), and PTSD symptoms (PCL-5: aMD, 7.8; 95% CI, 3.2-12.4). At 3 to 7 years, these associations remained statistically significant. Multiple (2 or more) postindex TBIs were associated with poorer outcomes across all domains.Conclusions and RelevanceIn this cohort study of patients with acute TBI, postindex TBI was associated with worse symptomatology across outcome domains at 1 year and 3 to 7 years postinjury, and there was a dose-dependent response with multiple postindex TBIs. These results underscore the critical need to provide TBI prevention, education, counseling, and follow-up care to at-risk patients.

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Patterns of Psychotropic Medication Use among Individuals with Traumatic Brain Injury

Albrecht

Wickwire

Mullins

et al. 2020

Journal of Neurotrauma

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Risk factors for recurrent neurotrauma: a population-based study in Southeastern Michigan

Abstract: This study validated the hypothesis that comorbid psychiatric conditions are a significant risk factor for recurrent neurotrauma and validate prior studies showing gender and race as significant risk factors.

Cited by 4 publications

References 14 publications

A Population-Based Study of Pre-Existing Health Conditions in Traumatic Brain Injury

A Population-Based Study of Pre-Existing Health Conditions in Traumatic Brain Injury

Longitudinal Recovery Following Repetitive Traumatic Brain Injury

Patterns of Psychotropic Medication Use among Individuals with Traumatic Brain Injury

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