Abstract
ObjectiveTo analyze fatigue after mild traumatic brain injury (TBI) with latent class growth analysis (LCGA) to determine distinct recovery trajectories and investigate influencing factors, including emotional distress and coping styles. DesignAn observational cohort study design with validated questionnaires assessing fatigue, anxiety, depression, posttraumatic stress, and coping at 2 weeks and 3 and 6 months postinjury. SettingThree level 1 trauma centers. ParticipantsPatients with mild TBI (N=456). InterventionsNot applicable. Main Outcome MeasuresFatigue was measured with the fatigue severity subscale of the Checklist Individual Strength, including 8 items (sum score, 8-56). Subsequently, 3 clinical categories were created: high (score, 40-56), moderate (score, 26-38), and low (score, 8-25). ResultsFrom the entire mild TBI group, 4 patient clusters with distinct patterns for fatigue, emotional distress, and coping styles were found with LCGA. Clusters 1 and 2 showed favorable recovery from fatigue over time, with low emotional distress and the predominant use of active coping in cluster 1 (30%) and low emotional distress and decreasing passive coping in cluster 2 (25%). Clusters 3 and 4 showed unfavorable recovery, with persistent high fatigue and increasing passive coping together with low emotional distress in cluster 3 (27%) and high emotional distress in cluster 4 (18%). Patients with adverse trajectories were more often women and more often experiencing sleep disturbances and pain. ConclusionsThe prognosis for recovery from posttraumatic fatigue is favorable for 55% of mild TBI patients. Patients at risk for chronic fatigue can be signaled in the acute phase postinjury based on the presence of high fatigue, high passive coping, and, for a subgroup of patients, high emotional distress. LCGA proved to be a highly valuable and multipurpose statistical method to map distinct courses of disease-related processes over time.
Highlights
This group of patients was comparable to the total patient group included in the UPFRONT study (n=1169; the fatigue questionnaire was not completed by 409 participants at 2 weeks, 197 participants at 3 months, and 107 participants at 6 months), on sex, education level, and Glasgow Coma Scale (GCS) score, but were somewhat older
Fatigue was significantly strongly correlated with anxiety and depression and significantly moderately correlated with posttraumatic stress and passive coping
Patients at risk for chronic high fatigue can be signaled early in the acute phase postinjury based on the presence of high fatigue, high passive coping and, for one cluster, high anxiety, depression, and posttraumatic stress
Summary
Design and settingPresent data originated from a larger prospective longitudinal study (UPFRONT study). Patients were admitted at 3 level 1 trauma centers in the Netherlands. Present data originated from a larger prospective longitudinal study (UPFRONT study).. Patients were admitted at 3 level 1 trauma centers in the Netherlands. The Glasgow Coma Scale (GCS) score and posttraumatic amnesia were determined during a neurologic examination at the emergency department (ED). Patients completed questionnaires at 2 weeks and 3 and 6 months postinjury. Data obtainment occurred in compliance with ethical regulations of the University Medical Center Groningen, following the Declaration of Helsinki, and patients signed informed consent. List of abbreviations: BIC Bayesian information criterion CBT cognitive behavioral therapy
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