Symptomatology and Functional Outcome in Mild Traumatic Brain Injury: Results from the Prospective TRACK-TBI Study

Abstract

Mild Traumatic Brain Injury (mTBI), or concussion, is a major public health concern. There is controversy in the literature regarding the true incidence of postconcussion syndrome (PCS), with the constellation of physical, cognitive, emotional, and sleep symptoms after mTBI. In the current study, we report on the incidence and evolution of PCS symptoms and patient outcomes after mTBI at 3, 6, and 12 months in a large, prospective cohort of mTBI patients. Participants were identified as part of the prospective, multi-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study. The study population was mTBI patients (Glasgow Coma Scale score of 13-15) presenting to the emergency department, including patients with a negative head computed tomography discharged to home without admission to hospital; 375 mTBI subjects were included in the analysis. At both 6 and 12 months after mTBI, 82% (n=250 of 305 and n=163 of 199, respectively) of patients reported at least one PCS symptom. Further, 44.5 and 40.3% of patients had significantly reduced Satisfaction With Life scores at 6 and 12 months, respectively. At 3 months after injury, 33% of the mTBI subjects were functionally impaired (Glasgow Outcome Scale-Extended score ≤6); 22.4% of the mTBI subjects available for follow-up were still below full functional status at 1 year after injury. The term "mild" continues to be a misnomer for this patient population and underscores the critical need for evolving classification strategies for TBI for targeted therapy.

Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand

“…2,10 Interestingly, the consult within 24 hours variable was not predictive of outcome, which suggests that those who do not immediately seek health care may still be at risk of ongoing difficulties. As New Zealand has a no-fault compensation injury scheme, compensation, which has previously been identified as a factor linked to outcome after mTBI, was not investigated in this study.…”

“…Although labelled as 'mild', increasing evidence suggests that the burden of mild TBI (mTBI) may be 'far from mild'. 2 The Diagnostic and Statistical Manual of Mental Disorders (IV) recognises clusters of these symptoms as post-concussion syndrome. 3 Diagnostic criteria include:…”

“…8 Longer-term studies suggest that symptoms may persist for up to 3 years after injury. 2,9,10 Further longitudinal studies are required, however, to improve understanding of the extent of difficulties experienced after mTBI and the recovery trajectory.…”

Randomized Placebo-Controlled Trial of Methylphenidate or Galantamine for Persistent Emotional and Cognitive Symptoms Associated with PTSD and/or Traumatic Brain Injury

“…Individuals who suffer mTBI have acute cognitive effects, and a significant number of them have persistent symptoms (McMahon et al, 2014).…”

Diagnostic History of Traumatic Axonal Injury in Patients with Cerebral Concussion and Mild Traumatic Brain Injury

“…Sharp and Jenkins [18] insisted that mild TBI is not always a benign condition as its name implies and patients sometimes fail to recover. They proposed that the term "concussion" should be avoided because it has no clear definition and no pathological meaning, therefore, at worst it encourages an apathetic diagnostic approach [18] et al [29] insisted that the term "mild TBI" is a misnomer for patients with severe postconcussion syndrome. Rapp and Curley [30] reported that mild TBI is a category mistake because of the heterogeneity of the clinical population and clinical presentations, the absence of a unitary etiology of post injury deficits, and the complex idiosyncratic time course of the appearance of these deficits in mild TBI.…”