Outcomes in Patients With Mild Traumatic Brain Injury Without Acute Intracranial Traumatic Injury

פוסט זה זמין גם ב: עברית

Key PointsQuestion  What are the 2-week and 6-month functional outcomes of patients with traumatic brain injury (TBI) who presented in the emergency department with a Glasgow Coma Scale (GCS) score of 15 and without acute intracranial traumatic injury detected on computed tomography (ie, negative head CT scan)?

Findings  In this cohort study of 991 participants with TBI with GCS score of 15 and negative head CT scan, 27% had functional recovery and 73% had incomplete recovery 2 weeks after the injury. At 6 months after the injury, 44% had functional recovery and 56% had incomplete recovery.

Meaning  Findings of this study suggest that emergency department clinicians recommend a 2-week follow-up for patients with TBI, a GCS score of 15, and a negative head CT scan to identify those with incomplete recovery and to facilitate their rehabilitation.

Abstract

Importance  Traumatic brain injury (TBI) affects millions of people in the US each year. Most patients with TBI seen in emergency departments (EDs) have a Glasgow Coma Scale (GCS) score of 15 and a head computed tomography (CT) scan showing no acute intracranial traumatic injury (negative head CT scan), yet the short-term and long-term functional outcomes of this subset of patients remain unclear.

Objective  To describe the 2-week and 6-month recovery outcomes in a cohort of patients with mild TBI with a GCS score of 15 and a negative head CT scan.

Design, Setting, and Participants  This cohort study analyzed participants who were enrolled from January 1, 2014, to December 31, 2018, in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a prospective, observational cohort study of patients with TBI that was conducted in EDs of 18 level I trauma centers in urban areas. Of the total 2697 participants in the TRACK-TBI study, 991 had a GCS score of 15 and negative head CT scan and were eligible for inclusion in this analysis. Data were analyzed from September 1, 2021, to May 30, 2022.

Main Outcomes and Measures  The primary outcome was the Glasgow Outcome Scale-Extended (GOS-E) score, which was stratified according to functional recovery (GOS-E score, 8) vs incomplete recovery (GOS-E score, <8), at 2 weeks and 6 months after the injury. The secondary outcome was severity of mild TBI–related symptoms assessed by the Rivermead Post Concussion Symptoms Questionnaire (RPQ) total score.

Results  A total of 991 participants (mean [SD] age, 38.5 [15.8] years; 631 male individuals [64%]) were included. Of these participants, 751 (76%) were followed up at 2 weeks after the injury: 204 (27%) had a GOS-E score of 8 (functional recovery), and 547 (73%) had a GOS-E scores less than 8 (incomplete recovery). Of 659 participants (66%) followed up at 6 months after the injury, 287 (44%) had functional recovery and 372 (56%) had incomplete recovery. Most participants with incomplete recovery reported that they had not returned to baseline or preinjury life (88% [479 of 546]; 95% CI, 85%-90%). Mean RPQ score was 16 (95% CI, 14-18; P < .001) points lower at 2 weeks (7 vs 23) and 18 (95% CI, 16-20; P < .001) points lower at 6 months (4 vs 22) in participants with a GOS-E score of 8 compared with those with a GOS-E score less than 8.

Conclusions and Relevance:  This study found that most participants with a GCS score of 15 and negative head CT scan reported incomplete recovery at 2 weeks and 6 months after their injury. The findings suggest that emergency department clinicians should recommend 2-week follow-up visits for these patients to identify those with incomplete recovery and to facilitate their rehabilitation.

השארת תגובה

חייבים להתחבר כדי להגיב.

גלילה לראש העמוד
Open chat
Scan the code
האיגוד הישראלי לרפואהה דחופה
שלום, קשר ישיר עם ההנהלת האתר איך אפשר לעזור?

Direct contact with the website management
How can we help?
דילוג לתוכן