Identification of patients at risk for poor outcome after mTBI

Abstract

The study by Joukje van der Naalt and colleagues 1 van der Naalt J Timmermans ME de Koning ME et al. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort study. Lancet Neurol. 2017; 16: 532-540 Summary Full Text Full Text PDF PubMed Scopus (179) Google Scholar in The Lancet Neurology aimed to develop a prognostic model for 6-month functional outcome in 679 patients with mild traumatic brain injury (mTBI). In their model, the authors used a multifactorial approach by including sociodemographic, injury-related, and pre-injury factors, as well as indicators of stress after injury and coping strategies. Of the factors measured on admission to the emergency department, lower education, female sex, mental health problems before injury, neck pain, lower Glasgow Coma Scale scores, shorter post-traumatic amnesia, and the absence of alcohol intoxication were found to be associated with incomplete recovery at 6 months. Of factors measured 2 weeks after injury, depression, anxiety, post-traumatic complaints, and passive and avoidant coping styles were also associated with worse 6-month outcome. These were combined in two prognostic models to predict 6-month functional outcome: one applicable using only information recorded on admission to the emergency department, and one using admission information and data collected at 2 weeks after injury. Early predictors of outcome after mild traumatic brain injury (UPFRONT): an observational cohort studyPsychological factors (ie, emotional distress and maladaptive coping experienced early after injury) in combination with pre-injury mental health problems, education, and age are important predictors for recovery at 6 months following mTBI. These findings provide targets for early interventions to improve outcome in a subgroup of patients at risk of incomplete recovery from mTBI, and warrant validation. Full-Text PDF