Abstract
The objective of this study was to provide a comprehensive examination of the relation of complicated and uncomplicated mild traumatic brain injury (mTBI) with multidimensional outcomes at three- and six-months after TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) research project. Patients after mTBI (Glasgow Coma scale (GCS) score of 13–15) enrolled in the study were differentiated into two groups based on computed tomography (CT) findings: complicated mTBI (presence of any traumatic intracranial injury on first CT) and uncomplicated mTBI (absence of any traumatic intracranial injury on first CT). Multidimensional outcomes were assessed using seven instruments measuring generic and disease-specific health-related quality of life (HRQoL) (SF-36 and QOLIBRI), functional outcome (GOSE), and psycho-social domains including symptoms of post-traumatic stress disorder (PTSD) (PCL-5), depression (PHQ-9), and anxiety (GAD-7). Data were analyzed using a multivariate repeated measures approach (MANOVA-RM), which inspected mTBI groups at three- and six-months post injury. Patients after complicated mTBI had significantly lower GOSE scores, reported lower physical and mental component summary scores based on the SF-36 version 2, and showed significantly lower HRQoL measured by QOLIBRI compared to those after uncomplicated mTBI. There was no difference between mTBI groups when looking at psychological outcomes, however, a slight improvement in PTSD symptoms and depression was observed for the entire sample from three to six months. Patients after complicated mTBI reported lower generic and disease specific HRQoL and worse functional outcome compared to individuals after uncomplicated mTBI at three and six months. Both groups showed a tendency to improve from three to six months after TBI. The complicated mTBI group included more patients with an impaired long-term outcome than the uncomplicated group. Nevertheless, patients, clinicians, researchers, and decisions-makers in health care should take account of the short and long-term impact on outcome for patients after both uncomplicated and complicated mTBI.
Highlights
In the European Union, 1.5 million hospitalizations result from traumatic brain injury (TBI) annually [1,2]
Patients were recruited in three strata: emergency room (ER; patients evaluated at the ER and discharged afterwards), admission (ADM; patients admitted to hospital ward), and intensive care unit (ICU; patients who were primarily admitted to the ICU) [23]
The total CENTER-TBI cohort included 2955 patients after mild TBI (mTBI) and our study sample consisted of 1104 patients (37.4%) who were interviewed at both time points (3- and 6-months after mTBI) and completed all seven outcomes
Summary
In the European Union, 1.5 million hospitalizations result from traumatic brain injury (TBI) annually [1,2]. Williams et al elaborated further on this description of mTBI and proposed that intracranial abnormalities on computed tomography (CT) at presentation should be taken into account. This resulted in distinguishing patients after complicated (presence of trauma-related intracranial abnormalities and/or depressed skull fracture on CT) and uncomplicated (absence of intracranial abnormalities and/or depressed skull fracture on CT) mTBI [3]. The presence or absence of intracranial abnormalities is seen as relevant to prognosis, since complicated mTBI has been associated with cognitive and functional outcome comparable to patients after moderate TBI (GCS 9–13) [3,4,5,6]. A few studies even found no significant differences between the two groups [7,9]
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