12-months Post Injury Research Articles

Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury.

Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury.

Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury.

Patients with traumatic brain injury (TBI) experience a variety of physical, cognitive, and affective symptoms. However, the evolution of symptoms, especially during the 3- to 12-month convalescence period (when recovery of function is still possible), is understudied. This study aims to identify symptoms and the relationships with functional outcomes that occur during the 3- to 12-month period after a TBI. Participants who were 3 to 12months post-TBI were recruited from a South Florida TBI clinic from May 2022 to June 2023. Clinical data were obtained from the electronic health record. Participants completed the Brain Injury Association of Virginia Symptom Checklist, Neuro-Quality of Life Cognitive Function, Anxiety, Depression, and Sleep Disturbance assessments to report symptoms, and the Disability Rating Scale and Satisfaction with Life Scale. Descriptive statistics were used to characterize demographics and symptoms. Linear regression was performed to analyze the relationships between symptoms and outcomes. A total of N =39 patients participated in the study. Memory problems and difficulty concentrating were the most common symptoms. Hospital length of stay, intensive care unit length of stay, cognitive, and physical symptoms were significantly associated with the Disability Rating Scale score. Physical, cognitive, depressive, and anxiety symptoms had significant associations with the Satisfaction with Life Scale. Cognitive symptoms should be integrated into the clinical care of rehabilitating TBI patients. Nurses should monitor for physical, affective, and cognitive symptoms during the recovery phase of TBI.

Health Care Utilization After Nonfatal Firearm Injuries.

Despite the high incidence of firearm injuries, little is known about health care utilization after nonfatal childhood firearm injuries. This study aimed to describe health care utilization and costs after a nonfatal firearm injury among Medicaid and commercially insured youth using a propensity score matched analysis. We conducted a propensity score matched cohort analysis using 2015 to 2018 Medicaid and Commercial Marketscan data comparing utilization in the 12-months post firearm injury for youth aged 0 to 17. We matched youth with a nonfatal firearm injury 1:1 to comparison noninjured youth on demographic and preindex variables. Outcomes included inpatient hospitalizations, emergency department (ED) visits, and outpatient visits as well as health care costs. Following propensity score matching, regression models estimated relative risks of the health care utilization outcomes, adjusting for demographic and clinical covariates. We identified 2110 youth with nonfatal firearm injury. Compared with matched noninjured youth, firearm injured youth had a 5.31-fold increased risk of inpatient hospitalization (95% confidence interval [CI] 3.93-7.20), 1.49-fold increased risk of ED visit (95% CI 1.37-1.62), and 1.06-fold increased risk of outpatient visit (95% CI 1.03-1.10) 12-months postinjury. Adjusted 12-month postindex costs were $7581 (95% CI $7581-$8092) for injured youth compared with $1990 (95% CI $1862-2127) for comparison noninjured youth. Youth who suffer nonfatal firearm injury have a significantly increased risk of hospitalizations, ED visits, outpatient visits, and costs in the 12 months after injury when compared with matched youth. Applied to the 11 258 US youth with nonfatal firearm injuries in 2020, estimates represent potential population health care savings of $62.9 million.

The Temporal Relationship Between Moderate to Vigorous Physical Activity and Secondary Conditions During the First Year After Moderate to Severe Traumatic Brain Injury

ObjectiveTo determine the cross-sectional and temporal relationships between minutes per week of moderate to vigorous physical activity (MVPA) as measured by a wrist-worn accelerometer and secondary conditions in the first year after moderate to severe traumatic brain injury (TBI). DesignProspective longitudinal cohort study. SettingFour inpatient rehabilitation centers. ParticipantsIndividuals (N = 180) with moderate-severe TBI enrolled in the TBI Model Systems Study. InterventionsParticipants wore a wrist accelerometer for 7 days immediately post discharge, and for 7 consecutive days at 6- and 12-months post injury. Main Outcome MeasuresMinutes per week of MVPA from daily averages based on wrist worn accelerometer. Secondary conditions included depression (Patient Health Questionnaire-9), fatigue (PROMIS Fatigue), Pain (Numeric Rating Scale), Sleep (Pittsburgh Sleep Quality Index), and cognition (Brief Test of Adult Cognition by Telephone). ResultsAt baseline, 6 and 12 months, 61%, 70% and 79% of the sample achieved at least 150 minutes per week of MVPA. The correlations between minutes of MVPA between baseline, 6 and 12 months were significant (r = 0.53-0.73), as were secondary conditions over these time points. However, no significant correlations were observed between minutes of MVPA and any secondary outcomes cross-sectionally or longitudinally at any time point. ConclusionsGiven the robust relationships physical activity has with outcomes in the general population, further research is needed to understand the effect of physical activity in individuals with moderate-severe TBI.

Factors associated with racial and ethnic disparities in chronic pain after acute traumatic injury

BackgroundChronic pain represents a substantial health burden and source of disability following traumatic injury. This study investigates factors associated with racial and ethnic disparities in chronic pain.MethodsProspective, longitudinal, panel study....

Association of neurostructural biomarkers with secondary attention-deficit/hyperactivity disorder (ADHD) symptom severity in children with traumatic brain injury: a prospective cohort study.

Despite a well-established link between childhood traumatic brain injury (TBI) and elevated secondary attention-deficit/hyperactivity disorder (s-ADHD) symptomology, the neurostructural correlates of these symptoms are largely unknown. Based on the influential 'triple-network model' of ADHD, this prospective longitudinal investigation aimed to (i) assess the effect of childhood TBI on brain morphometry of higher-order cognitive networks proposed to play a key role in ADHD pathophysiology, including the default-mode network (DMN), salience network (SN) and central executive network (CEN); and (ii) assess the independent prognostic value of DMN, SN and CEN morphometry in predicting s-ADHD symptom severity after childhood TBI. The study sample comprised 155 participants, including 112 children with medically confirmed mild-severe TBI ascertained from consecutive hospital admissions, and 43 typically developing (TD) children matched for age, sex and socio-economic status. High-resolution structural brain magnetic resonance imaging (MRI) sequences were acquired sub-acutely in a subset of 103 children with TBI and 34 TD children. Parents completed well-validated measures of ADHD symptom severity at 12-months post injury. Relative to TD children and those with milder levels of TBI severity (mild, complicated mild, moderate), children with severe TBI showed altered brain morphometry within large-scale, higher-order cognitive networks, including significantly diminished grey matter volumes within the DMN, SN and CEN. When compared with the TD group, the TBI group showed significantly higher ADHD symptomatology and higher rates of clinically elevated symptoms. In multivariable models adjusted for other well-established risk factors, altered DMN morphometry independently predicted higher s-ADHD symptomatology at 12-months post-injury, whilst SN and CEN morphometry were not significant independent predictors. Our prospective study findings suggest that neurostructural alterations within higher-order cognitive circuitry may represent a prospective risk factor for s-ADHD symptomatology at 12-months post-injury in children with TBI. High-resolution structural brain MRI has potential to provide early prognostic biomarkers that may help early identification of high-risk children with TBI who are likely to benefit from early surveillance and preventive measures to optimise long-term neuropsychiatric outcomes.

A registry-based observational cohort study examining patterns of pain and mental health symptoms and their impact on work or other activities after injury.

This registry-based observational cohort study included all people ≥ 16 years old hospitalized for unintentional injuries from 2007 to 2014 who were included in the Victorian State Trauma Registry or Victorian Orthopaedic Trauma Outcomes Registry, survived to 12-months postinjury and did not have severe brain injury or spinal cord injury (N = 31,073). Symptoms and related impacts were measured with pain Numerical Rating Scale, EuroQol Five Dimensions Three Level questionnaire (EQ-5D-3L), and 12-item Short Form Health Survey (SF-12) pain and mental health items at 6-, 12-, and 24-months postinjury. Symptom patterns over time, and their predictors, were examined using Latent Class and Transition Analyses and multinomial logistic regression. Four classes were identified: (1) Low pain and mental health problems (49-54%); (2) mental health problems only (11-12%); (3) pain problems only (18-23%); and (4) pain and mental health problems (16-17%). Most people stayed within the same class over time, or transitioned to fewer problems. People who transitioned to lower problems had higher socioeconomic status (e.g., higher education level, higher neighborhood-level advantage, and employment), better preinjury health (e.g., no disability or substance use condition) and noncompensable injuries. Reduced pain and mental health symptoms and related impairments were primarily associated with nonmodifiable biological, social, or economic characteristics. People with persistent symptoms were often already living with social disadvantage preinjury, and may have benefited from risk screening and proactive interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Do expectations of recovery improve risk assessment for people with whiplash-associated disorders? Secondary analysis of a prospective cohort study

BackgroundWhipPredict, which includes prognostic factors of pain-related disability, age and hyperarousal symptoms, was developed and validated for prediction of outcome in people with whiplash associated disorders (WAD). Patient expectations of recovery was not an included factor, though is known to mediate outcomes. The aim of this study was to determine whether the addition of expectations of recovery could improve the accuracy of WhipPredict.MethodsTwo hundred twenty-eight participants with acute WAD completed questionnaires (WhipPredict and expectations of recovery) at baseline. Health outcomes (neck disability index (NDI) and Global Perceived Recovery (GPR)) were assessed at 6- and 12-months post injury. Cut-off points for expectations of recovery predictive of both full recovery (NDI ≤10 % , GPR ≥ 4) and poor outcome (NDI ≥30 % , GPR ≤ − 3) were determined, and multivariate logistic regression analyses were used to compare models with and without this variable.ResultsExpectations of recovery improved or maintained the accuracy of predictions of poor outcome (6-months: sensitivity 78 to 83%, specificity maintained at 79.5%; 12-months: sensitivity maintained at 80%, specificity 69 to 73%). The sensitivity of predictions of full recovery improved (6-months: 68 to 76%; 12-months: 57 to 81%), though specificity did not change appreciably at 6 months (80 to 81%) and declined at 12 (83 to 76%). ROC curves indicated a larger and more consistent improvement in model performance when expectations of recovery were added to the pathway predictive of full recovery.ConclusionsThe addition of expectations of recovery may improve the accuracy of WhipPredict, though further validation is required.

An evaluation of the representativeness of a national spinal cord injury registry: a population-based cohort study.

Population-based cohort study for the western part of Quebec. To determine the impact of declining to participate in a national spinal cord injury (SCI) registry on patient outcomes and continuum of care. Level-1 trauma center specialized in SCI care in Montreal, Canada. This cohort study compared the outcomes of 444 patients who were enrolled in the Rick Hansen SCI registry and 140 patients who refused. Logistic regression analyses were performed to assess the association between voluntary participation and the outcomes, while adjusting for confounding factors. The main outcomes were: attendance to follow-up 6- to 12-month post injury, 1-year mortality, and the occurrence of pressure injury during acute care. Declining to be enrolled in the registry was a significant predictor of lower attendance to specialized follow-up (adjusted odds ratio [OR] 0.04, 95% confidence interval [CI] 0.02-0.08). It was also associated with a higher 1-year mortality rate (OR 12.50, CI 4.50-33.30) and higher occurrence of pressure injury (OR 2.56, CI 1.56-4.17). This study sheds invaluable insight on individuals that researchers and clinicians are usually blind to in SCI cohort studies. This study suggests that decline to participate in a registry during the care hospitalization may be associated with worsened health, poorer outcomes, and reduced follow-up to specialized care. Declining the enrollment to voluntary registry could represent a potential prognostic factor for future research.

Confirming the geography of fatty infiltration in the deep cervical extensor muscles in whiplash recovery

Previous preliminary work mapped the distribution of neck muscle fat infiltration (MFI) in the deep cervical extensor muscles (multifidus and semispinalis cervicis) in a small cohort of participants with chronic whiplash associated disorders (WAD), recovered, and healthy controls. While MFI was reported to be concentrated in the medial portion of the muscles in all participants, the magnitude was significantly greater in those with chronic WAD. This study aims to confirm these results in a prospective fashion with a larger cohort and compare the findings across a population of patients with varying levels of WAD-related disability one-year following the motor vehicle collision. Sixty-one participants enrolled in a longitudinal study: Recovered (n = 25), Mild (n = 26) and Severe WAD (n = 10) were studied using Fat/Water magnetic resonance imaging, 12-months post injury. Bilateral measures of MFI in four quartiles (Q1–Q4; medial to lateral) at cervical levels C4 through C7 were included. A linear mixed model was performed, controlling for covariates (age, sex, body mass index), examining interaction effects, and comparing MFI distribution between groups. The recovered group had significantly less MFI in Q1 compared to the two symptomatic groups. Group differences were not found in the more lateral quartiles. Results at 12 months are consistent with the preliminary study, indicating that MFI is spatially concentrated in the medial portions of the deep cervical extensors regardless of WAD recovery, but the magnitude of MFI in the medial portions of the muscles is significantly larger in those with severe chronic WAD.

Mortality and health-related quality of life following injuries and associated factors: a cohort study in Chandigarh, North India

IntroductionInjuries are among the 10 leading causes of deaths worldwide. In recent years, the quality and reporting of injury mortality has improved but little or no data are available on...

A Longitudinal Investigation of Sleep and Daytime Wakefulness in Children and Youth With Concussion.

A high proportion of adults who sustain a concussion identify changes in their sleep during the acute stage, typically reporting an increased need for sleep or nonrestful sleep. Our understanding of sleep following concussion is less well understood within a pediatric population. In this study, we investigated the trajectory of sleep and daytime sleepiness in a prospective cohort of 40 children and youth (6–18 years old) with concussion, 40 age-and sex-matched healthy children and youth, and 40 with upper-extremity orthopedic injury. Evaluations occurred during the acute stage (<2 weeks) and at 3-, 6-, and 12-month postinjury using the Sleep Disturbance Scale for Children and the Postconcussion Symptom Scale. There were no significant differences within- or between-group differences in sleep across all four time points with analysis of the groups as a whole. When groups were divided by age (6–11 and 12– < 18 years), there was a significant difference in the ability to initiate sleep for the younger concussed group during the acute stage, compared with healthy controls, as well as significantly greater daytime nap duration that decreased over time. Significant correlations were also found between the frequency and duration of daytime naps and Postconcussion Symptom Scale total score and subscores (cognitive, physical/migraine, mood, and sleep) in the concussed group during the acute stage. Our results suggest that in a group with noncomplicated concussion, children and youth have transient alterations in daytime sleepiness that are related to concussion symptoms. Younger children may be more vulnerable to disturbances in sleep and daytime wakefulness.

Examining age-related differences in functional domain impairment following traumatic brain injury.

To examine differences in the functional recovery trajectories between younger and older adults with mild-moderate traumatic brain injury (TBI) in the first year postinjury as well as health-related quality of life. Observational cohort. Level one trauma centre in the State of Washington. Adults with mild-moderate TBI (N=34; younger adults, n=19, and older adults, n=15). None. Functional Status Examination (FSE) and health-related quality of life (HRQOL; SF-12v2). Older adults consistently showed significantly worse functional performance than younger adults following TBI in the following FSE domains: mobility, ability to travel, home maintenance and overall functional status. For both groups, preinjury physical health was significantly correlated with ability to travel and social integration at 12-month postinjury. Older participants' preinjury physical and mental health had significant and negative correlation with their functional status. Our study provides insights and implications into adults' specific functional impairments following TBI, and which domains have persistent deficits. Early intervention and rehabilitation should focus on improving older adults' physical functioning and mobility. Our study may also inform future research and design of post-TBI interventions for older adults.

Return to Pre-Injury Work Following Mild Traumatic Brain Injury

Objective: Adults are at risk for unemployment following a moderate-severe traumatic brain injury (TBI). Less is known about employment patterns following mild TBI. This study aims to examine patterns of return to pre-injury job in adults following mild TBI over a 12-month post injury period, and to investigate factors associated with return to work. Methods: It is a prospective longitudinal study of 205 adults (aged ≥16 years at injury) identified as part of a larger population-based incidence study in the Waikato, New Zealand. In-person assessments were completed at baseline (within 14 days) and 1-, 6-, and 12-month post-injury. Results: A total of 159 (77.6%) adults returned to their pre-injury job at baseline and 185 (90.2%) returned within 12 months. Of those who did not return to their pre-injury job at baseline (n= 46), younger age at injury (≤30 years,p= .02) and poor overall neurocognitive functioning at 1-month (p= .02) was associated with non-return to pre-injury job at 12 months. Conclusion: In a sample of employed adults, the majority returned to their pre-injury job shortly after injury. Cognitive functioning and younger age at time of injury may be associated with delayed return to work. Interventions to support younger workers may facilitate their return to work.

Key Hospital Anxiety and Depression Scale (HADS) items associated with DSM-IV depressive and anxiety disorder 12-months post traumatic brain injury

BackgroundAnxiety and depression are common problems following traumatic brain injury (TBI), warranting routine screening. Self-report rating scales including the Hospital Anxiety and Depression Scale (HADS) are associated with depression and anxiety diagnoses in individuals with TBI. The relationship between individual HADS symptoms and structured clinical interview methods (SCID) requires further investigation, particularly in regard to identifying a small number of key items that can potentially be recognised by clinicians and carers of individuals with TBI. Methods138 individuals sustaining a complicated-mild to severe TBI completed the HADS, and the Structured Clinical Interview for DSM-IV, Research Version (SCID) at 12-months post-injury. The associations between individual HADS items, separately and in combination, as well as overall depression and anxiety subscale scores, and SCID-diagnosed depressive and anxiety disorders were analysed. ResultsCART (Classification and Regression Tree) analysis found HADS depression item 2 “I still enjoy the things I used to enjoy” and a combination of two anxiety items, 3 “I get a sort of frightened feeling as if something awful is about to happen” and 5 “worrying thoughts go through my mind”, performed similarly to total depression and anxiety subscales in terms of their association with depressive and anxiety disorders respectively, at 12-months post-injury. LimitationsPatients were predominantly injured in motor vehicle accidents and received comprehensive care within a no-fault accident compensation system and so may not be representative of the wider TBI population. ConclusionsAlthough validation is required, a small number of self-report items are highly associated with 12-month post-injury diagnoses.

Level of agreement between patient-reported EQ-5D responses and EQ-5D responses mapped from the SF-12 in an injury population.

BackgroundComparing health-related quality of life (HRQL) outcomes between studies is difficult due to the wide variety of instruments used. Comparing study outcomes and facilitating pooled data analyses requires valid “crosswalks” between HRQL instruments. Algorithms exist to map 12-item Short Form Health Survey (SF-12) responses to EQ-5D item responses and preference weights, but none have been validated in populations where disability is prevalent, such as injury.MethodsData were extracted from the Validating and Improving injury Burden Estimates Study (Injury-VIBES) for 10,166 adult, hospitalized trauma patients, with both the three-level EQ-5D (EQ-5D-3L) and SF-12 data responses at six and 12-months postinjury. Agreement between actual (patient-reported) and estimated (mapped from SF-12) EQ-5D-3L item responses and preference weights was assessed using Kappa, Prevalence-Adjusted Bias-Adjusted Kappa statistics and Bland-Altman plots.ResultsModerate agreement was observed for usual activities, pain/discomfort, and anxiety/depression. Agreement was substantial for mobility and self-care items. The mean differences in preference weights were -0.024 and -0.012 at six and 12 months (p < 0.001), respectively. The Bland-Altman plot limits of agreement were large compared to the range of valid preference weight values (-0.56 to 1.00). Estimated EQ-5D-3L responses under-reported disability for all items except pain/discomfort.ConclusionsCaution should be taken when using EQ-5D-3L responses mapped from the SF-12 to describe patient outcomes or when undertaking economic evaluation, due to the underestimation of disability associated with mapped values. The findings from this study could be used to adjust expected EQ-5D-3L preference weights when estimated from SF-12 item responses when combining data from studies that use either instrument.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-015-0047-z) contains supplementary material, which is available to authorized users.

C-36 * Pediatric Traumatic Brain Injury: Longitudinal Neurocognitive Outcomes

OBJECTIVE: The study explored the neurocognitive profiles of pediatric patients with moderate/severe traumatic brain injury (TBI) at 3 (Time-1) and 12 months (Time-2) post injury. Previous research suggests deficits in cognition, attention, working memory, and processing speed. The current study was done to further explore these neurocognitive concerns in children with TBI. METHOD: 69 moderate/severe pediatric TBI patients ages 6-16 (73% male, mean age Time-1 = 11yrs, SD = 3.9; mean age Time-2 = 12yrs, SD = 3.7) completed Children's Memory Scale (CMS), Test of Everyday Attention-Children (TEA-Ch), and Wechsler Abbreviated Scale of Intelligence (WASI) 3-months and 12-months post injury. RESULTS were compared to 69 age-matched healthy controls (73% male, mean age Time-1 = 12 years, SD = 3.4; mean age Time-2 = 13 years, SD = 3.3) assessed twice 12 months apart. RESULTS: Descriptive and Paired t-tests were conducted revealing no significant differences in cognitive summary scores, memory indices, or TEA-Ch scores across both time points within groups (see Table 1). However, trends revealed increase in scores from Time-1 to Time-2 with control group performance significantly better across all measures at both time points. CONCLUSION(S): Consistent with current literature, neurocognitive profiles in this Moderate/Severe TBI population exhibited lower IQ, Memory, and Attention scores than healthy Controls. A within subjects pattern was noted indicating that children's whose scores were lower at Time-1 demonstrated limited improvement at Time-2. Conversely, subjects whose scores that were higher at Time-1 were more likely to demonstrate stronger improvement at Time-2. acn;29/6/586-a/ACU038TB1T1ACU038TB1Table 1. TBI and Control Neurocognitive Indices/Scaled scores Full Scale IQ (FSIQ) Performance IQ (PIQ) Verbal IQ (VIQ) General Memory Verbal Immediate Verbal Delayed Visual Immediate Visual Delayed Learning Delayed Recognition 3 months post-injury, Time 1N = 57 M= 90.3(SD =13.5)M= 103.6(SD =18.6) M= 93.4(SD= 14.4)M= 105.9(SD =15.0) M = 89.1(SD =14.2)M= 102.1(SD =15.6) M= 92.6 (SD = 20.8)M= 109.5(SD =17.3) M= 91.3(SD = 18.9)M= 105.5(SD =16.3) M= 92.1 (SD = 19.8)M= 109.9(SD =17.2) M= 95.3 (SD = 17.8)M= 104.9(SD =12.2) M= 96.6(SD = 17.2)M= 104.8(SD =12.6) M= 93.5 (SD = 19.6)M= 104.9(SD =16.0) M= 92.8(SD = 17.3)M= 102.5(SD =14.4) 12 months post-injury,Time 2N = 57 M= 93.1(SD =12.8)M= 109.3(SD =14.6) M= 97.1(SD = 13.0)M= 108.3(SD =15.3) M= 91.9 (SD = 14.7)M= 107.8(SD =14.2) M= 103.9 (SD = 22.2)M= 120.5(SD =14.5) M= 96.1(SD = 19.0)M= 111.3(SD =16.9) M= 97.5 (SD = 18.9)M= 115.1(SD =15.6) M= 107.0 (SD = 18.9)M= 115(SD =12.8) M= 109.2 (SD = 16.2)M= 114.7(SD =11.9) M= 98.9 (SD = 19.3)M= 110.3(SD =14.6) M= 94.7(SD = 17.7)M= 104.9(SD =13.5) *WASI & CMS scores based on standard scores with M = 100, SD = 15 TEA-Ch:Correct Targets TEA-Ch:Time per Target TEA-Ch:Attention Score TEA-Ch:Score! TEA-Ch:Creature Counting TEA-Ch:Sky Search DT TEA-Ch:Map Mission TEA-Ch:Score DT TEA-Ch:Walk/Don't Walk 3 months post-injury, Time 1N = 57 M= 9.1(SD =3.5)M= 8.9(SD =4.2) M= 8.1(SD= 3.7)M= 9.3(SD =3.0) M = 8.9(SD =3.6)M= 9.2(SD =3.1) M= 8.4(SD = 3.2)M= 9.2(SD =3.0) M= 9.6(SD = 3.4)M= 12.1(SD =3.3) M= 6.7(SD = 4.2)M= 8.1(SD =3.7) M= 7.3(SD = 3.2)M= 7.6(SD =3.1) M= 7.8(SD = 3.3)M= 11.2(SD =3.4) M= 6.7(SD = 3.4)M= 9.6(SD =3.2) 12 months post-injury,Time 2N = 57 M= 9.8(SD =3.2)M= 13.2(SD =3.9) M= 9.8(SD = 3.5)M= 13.3(SD =3.4) M= 10.6 (SD = 3.7)M= 13.1(SD =3.3) M= 8.7 (SD = 3.5)M= 12.3(SD =3.0) M= 10.3(SD = 2.9)M= 14.4(SD =3.5) M= 8.6(SD = 3.7)M= 9.2(SD =3.6) M= 7.2(SD = 4.1)M= 10.1(SD =3.1) M= 8.0(SD = 3.6)M= 8.2(SD =4.1) M= 9.3(SD = 3.0)M= 10.3(SD =3.3) *TEA-Ch scores are based on scaled scores with M = 10, SD = 3 **Healthy Control scores are coded gray. Language: en

327 Predicting Probability of Return to Work After Moderate and Major Trauma in Hong Kong: A Preliminary, Prospective, Multicenter, Cohort Study

Study Objective: There is very little published data on post-trauma return to work in the developed world, including Hong Kong. The aims of this preliminary study were firstly to investigate the 12-month return to work status in patients with moderate and major trauma in Hong Kong, and secondly to derive an early prediction score for return to work. Methods: From 1 January 2010 to 31 December 2011, a multi-centre prospective cohort study of trauma patients was conducted in Hong Kong. Patients admitted to the 3 Trauma Centres in Hong Kong were recruited. Adult patients aged ≥18 years with moderate or major trauma (defined as an injury severity score, ISS >8) and who were entered into the trauma registry were included. Return to work was defined as patients who had been working or were seeking employment before their injury. The primary outcome was return to work at 12-month post injury. Results: Of 400 patients initially recruited to the study (mean age 53.3 years; range 18-106; 69.5% male), the successful follow-up rates at 1, 6 and 12 months were 81.3%, 61.3% and 44.0%. 197 (49.3%) had been working or seeking employment prior to injury. The actual return to work was 20.9% at 1 month, and 37.5% at 12 months. Independent variables entered into a multiple logistic regression analysis included age, ISS, preexisting morbidity, ICU admission, head/neck injury, extremity injury, abdominal injury, one-month PCS and one-month MCS. No abdominal injury (OR 4.146, p=0.047), one-month PCS (Q4: OR 5.1, Q3: OR 4.6, Q2: OR 0.6, p=0.016) and one-month MCS (4Q: OR 9.1, Q3: OR 1.5, Q2: OR 1.5, p=0.023) significantly predicted return to work at 12 months. A scoring tool with scores from 0 to 20 was developed. At a cut off of >9, the sensitivity was 94%, and specificity was 65%, and the area under the ROC was 0.786. The overall correct classification rate was 69%. Patients with a score of 0 - 9 had a 12.2% chance of return to work by 12 months, whereas those patients with a score of 10 - 20 had a 50.8% chance of return to work. Conclusion: The 12-month post-trauma return to work rate for patients with the pre-injury potential to work was 37.5%. A score predicting 12-month return to work has been derived but needs refinement and validation in a much larger study. When validated it should aid patient care planning, rehabilitation, and guide medical assessment boards.

Quality of Life in Pediatric Mild Traumatic Brain Injury and its Relationship to Postconcussive Symptoms

Mild traumatic brain injury (TBI) and injury-related outcomes such as postconcussive symptoms (PCS) may influence health-related quality of life (HRQOL) in children. We evaluated HRQOL in 186 8- to 15-year-old children with mild TBI and 99 children with orthopedic injuries (OI). Parents rated the frequency and severity of PCS at an initial assessment within 2-weeks postinjury and rated HRQOL at 3- and 12-months postinjury. The mild TBI and OI groups did not differ in psychosocial HRQOL, but the mild TBI group showed lower physical HRQOL at the 12-month follow-up. Somatic PCS were a significant predictor of physical HRQOL over time, and both cognitive and somatic PCS were significant predictors of psychosocial HRQOL over time. Children with higher PCS at the initial assessment had lower HRQOL scores at later time points. Effective management of PCS may be associated with improvements in HRQOL following pediatric mild TBI.

Olfactory dysfunction, gambling task performance and intracranial lesions after traumatic brain injury.

To estimate the incidence of olfactory dysfunction across traumatic brain injury (TBI) severity and decision-making deficits with regard to intracranial lesions' location and laterality. A 1-year prospective study including 115 participants (16-55 years) with mild, moderate, and severe TBI. The Brief Smell Identification Test was used 3 months postinjury with a follow-up testing of olfactory dysfunction at 1 year. The Iowa Gambling Task (IGT) and 3 tasks of the Delis-Kaplan Executive Function System were administered 3-months postinjury. MRI was performed 1-year postinjury and TBI severity groups were then divided with respect to frontal, fronto-temporal, diffuse, and no lesions. The incidence of olfactory dysfunction was estimated to be 22.3% at 3 months and 13.5% at 1 year. No significant differences were found on olfactory dysfunction across TBI severity at either check. Anosmia was identified in 10% with severe TBI and 3% with mild TBI. Olfactory dysfunction was associated with verbal fluency tasks. Repeated-measures analysis of variance revealed no significant effect over blocks on IGT, and no main group or interaction effects regarding TBI severity, lesions' location, or laterality. IGT performance at 3-months postinjury was deficient in 83% of persons with intracranial lesions and 71% of those without lesions. Olfactory dysfunction is independent of TBI severity, showing improvements in one third of cases from 3- to 12-months postinjury. However, anosmia was related to TBI severity. There is evidence for marked decision-making deficits after TBI, all subgroups performed similarly and failed to develop an advantageous strategy over time.