Clinical Predictors of 3- and 6-Month Outcome for Mild Traumatic Brain Injury Patients with a Negative Head CT Scan in the Emergency Department: A TRACK-TBI Pilot Study.

Debbie Madhok,Nathan Coss,Catherine Suen,Geoffrey Manley,John Yue,Sonia Jain,Xiaoying Sun

doi:10.3390/brainsci10050269

Abstract

A considerable subset of mild traumatic brain injury (mTBI) patients fail to return to baseline functional status at or beyond 3 months postinjury. Identifying at-risk patients for poor outcome in the emergency department (ED) may improve surveillance strategies and referral to care. Subjects with mTBI (Glasgow Coma Scale 13–15) and negative ED initial head CT < 24 h of injury, completing 3- or 6-month functional outcome (Glasgow Outcome Scale-Extended; GOSE), were extracted from the prospective, multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study. Outcomes were dichotomized to full recovery (GOSE = 8) vs. functional deficits (GOSE < 8). Univariate predictors with p < 0.10 were considered for multivariable regression. Adjusted odds ratios (AOR) were reported for outcome predictors. Significance was assessed at p < 0.05. Subjects who completed GOSE at 3- and 6-month were 211 (GOSE < 8: 60%) and 185 (GOSE < 8: 65%). Risk factors for 6-month GOSE < 8 included less education (AOR = 0.85 per-year increase, 95% CI: (0.74–0.98)), prior psychiatric history (AOR = 3.75 (1.73–8.12)), Asian/minority race (American Indian/Alaskan/Hawaiian/Pacific Islander) (AOR = 23.99 (2.93–196.84)), and Hispanic ethnicity (AOR = 3.48 (1.29–9.37)). Risk factors for 3-month GOSE < 8 were similar with the addition of injury by assault predicting poorer outcome (AOR = 3.53 (1.17–10.63)). In mTBI patients seen in urban trauma center EDs with negative CT, education, injury by assault, Asian/minority race, and prior psychiatric history emerged as risk factors for prolonged disability.

Highlights

In 2014, at least 2.5 million people were treated for traumatic brain injury (TBI) in U.S emergency departments (ED), of which 80%–90% were classified as “mild” with a Glasgow Coma Scale (GCS) score of 13–15 [1]
We found that the proportion of participants with functional deficits did not decrease from 3 to 6 months in patients who returned for follow-up
Commonly cited risk factors for poor outcome in severe TBI such as pre-hospital hypoxia and hypotension [42,43,44,45], were rarely seen in this cohort of patients who inherently have “milder” injuries, and factors used in ED guidelines such as loss of consciousness (LOC) and post traumatic amnesia (PTA) [46] were not associated with outcome

Summary

Introduction

In 2014, at least 2.5 million people were treated for traumatic brain injury (TBI) in U.S emergency departments (ED), of which 80%–90% were classified as “mild” (mTBI) with a Glasgow Coma Scale (GCS) score of 13–15 [1]. The frequency of mTBI-related emergency department visits increased from. While all-cause mortality for mTBI is low (1.4%) [3], patients are at significant risk of psychiatric sequelae [4] and cognitive impairment postinjury [5]. It is estimated that 20%–70% of mTBI patients suffer from persistent functional, cognitive and/or neuropsychological symptoms at or beyond 3 months postinjury [6,7]. MTBI patients often suffer disruptions to functional and social wellbeing postinjury and require greater use of healthcare resources [8]—upwards of $17 billion annually in the U.S [9]. Identifying the predictors of negative outcomes for patients with mTBI and using this information to inform ED management strategies could improve patient outcomes and decrease ED utilization

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Discussion

Conclusion