Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study

Abstract

Mild Traumatic Brain Injury (mTBI), or concussion, is a major public health concern. There is controversy in the literature regarding the true incidence of postconcussion syndrome (PCS), with the constellation of physical, cognitive, emotional, and sleep symptoms after mTBI. In the current study, we report on the incidence and evolution of PCS symptoms and patient outcomes after mTBI at 3, 6, and 12 months in a large, prospective cohort of mTBI patients. Participants were identified as part of the prospective, multi-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study. The study population was mTBI patients (Glasgow Coma Scale score of 13-15) presenting to the emergency department, including patients with a negative head computed tomography discharged to home without admission to hospital; 375 mTBI subjects were included in the analysis. At both 6 and 12 months after mTBI, 82% (n=250 of 305 and n=163 of 199, respectively) of patients reported at least one PCS symptom. Further, 44.5 and 40.3% of patients had significantly reduced Satisfaction With Life scores at 6 and 12 months, respectively. At 3 months after injury, 33% of the mTBI subjects were functionally impaired (Glasgow Outcome Scale-Extended score ≤6); 22.4% of the mTBI subjects available for follow-up were still below full functional status at 1 year after injury. The term "mild" continues to be a misnomer for this patient population and underscores the critical need for evolving classification strategies for TBI for targeted therapy.

Trial registration: ClinicalTrials.gov NCT01565551.

Fig. 1.

Mean number of reported PCS symptoms at 3-, 6-, and 12-month follow-up by CT-positive and CT-negative patients. Significantly more symptoms were reported by CT-negative patients, compared to CT-positive patients at both 6 (8.0±6.1 and 6.4±5.9, respectively; p=0.019) and at 12 months (7.6±6.1 and 5.9±5.8, respectively; p=0.04), as indicated by the black diamond. PCS, postconcussion syndrome; CT, computed tomography.

Fig. 2.

Graphs display the percent distribution of patients with each GOSE, BSI-18, or SWLS score, respectively. Solid line indicates the cut-off value used for each score, indicating clinically significant impairment (GOSE ≤6), distress (BSI-18 ≥63), or dissatisfaction (SWLS ≤19). GOSE, Glasgow Outcome Scale-Extended; BSI, Brief Symptom Inventory; SWLS, Satisfaction With Life Scale.