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. 2019 Sep 1;76(9):1049-1059.
doi: 10.1001/jamaneurol.2019.1313.

Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study

Lindsay D Nelson  1 , Nancy R Temkin  2 , Sureyya Dikmen  2 , Jason Barber  2 , Joseph T Giacino  3   4 , Esther Yuh  5 , Harvey S Levin  6 , Michael A McCrea  1 , Murray B Stein  7   8 , Pratik Mukherjee  5 , David O Okonkwo  9 , Claudia S Robertson  10 , Ramon Diaz-Arrastia  11 , Geoffrey T Manley  5 ; and the TRACK-TBI Investigators; Opeolu Adeoye  12 , Neeraj Badjatia  13 , Kim Boase  14 , Yelena Bodien  4 , M Ross Bullock  15 , Randall Chesnut  16 , John D Corrigan  17 , Karen Crawford  18 , Ann-Christine Duhaime  19 , Richard Ellenbogen  16 , V Ramana Feeser  20 , Adam Ferguson  21 , Brandon Foreman  12 , Raquel Gardner  22 , Etienne Gaudette  18 , Luis Gonzalez  23 , Shankar Gopinath  24 , Rao Gullapalli  13 , J Claude Hemphill  22 , Gillian Hotz  15 , Sonia Jain  7 , Frederick Korley  25 , Joel Kramer  22 , Natalie Kreitzer  12 , Chris Lindsell  26 , Joan Machamer  14 , Christopher Madden  27 , Alastair Martin  28 , Thomas McAllister  29 , Randall Merchant  30 , Florence Noel  31 , Eva Palacios  28 , Daniel Perl  32 , Ava Puccio  33 , Miri Rabinowitz  34 , Jonathan Rosand  4 , Angelle Sander  10 , Gabriela Satris  35 , David Schnyer  36 , Seth Seabury  18 , Mark Sherer  23 , Sabrina Taylor  21 , Arthur Toga  18 , Alex Valadka  37 , Mary J Vassar  21   35 , Paul Vespa  38 , Kevin Wang  39 , John K Yue  35 , Ross Zafonte  40
Affiliations

Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study

Lindsay D Nelson et al. JAMA Neurol. .

Erratum in

  • Error in Byline.
    [No authors listed] [No authors listed] JAMA Neurol. 2019 Dec 1;76(12):1520. doi: 10.1001/jamaneurol.2019.3698. JAMA Neurol. 2019. PMID: 31633748 Free PMC article. No abstract available.

Abstract

Importance: Most traumatic brain injuries (TBIs) are classified as mild (mTBI) based on admission Glasgow Coma Scale (GCS) scores of 13 to 15. The prevalence of persistent functional limitations for these patients is unclear.

Objectives: To characterize the natural history of recovery of daily function following mTBI vs peripheral orthopedic traumatic injury in the first 12 months postinjury using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, and, using clinical computed tomographic (CT) scans, examine whether the presence (CT+) or absence (CT-) of acute intracranial findings in the mTBI group was associated with outcomes.

Design, setting, and participants: TRACK-TBI, a cohort study of patients with mTBI presenting to US level I trauma centers, enrolled patients from February 26, 2014, to August 8, 2018, and followed up for 12 months. A total of 1453 patients at 11 level I trauma center emergency departments or inpatient units met inclusion criteria (ie, mTBI [n = 1154] or peripheral orthopedic traumatic injury [n = 299]) and were enrolled within 24 hours of injury; mTBI participants had admission GCS scores of 13 to 15 and clinical head CT scans. Patients with peripheral orthopedic trauma injury served as the control (OTC) group.

Exposures: Participants with mTBI or OTC.

Main outcomes and measures: The Glasgow Outcome Scale Extended (GOSE) scale score, reflecting injury-related functional limitations across broad life domains at 2 weeks and 3, 6, and 12 months postinjury was the primary outcome. The possible score range of the GOSE score is 1 (dead) to 8 (upper good recovery), with a score less than 8 indicating some degree of functional impairment.

Results: Of the 1453 participants, 953 (65.6%) were men; mean (SD) age was 40.9 (17.1) years in the mTBI group and 40.9 (15.4) years in the OTC group. Most participants (mTBI, 87%; OTC, 93%) reported functional limitations (GOSE <8) at 2 weeks postinjury. At 12 months, the percentage of mTBI participants reporting functional limitations was 53% (95% CI, 49%-56%) vs 38% (95% CI, 30%-45%) for OTCs. A higher percentage of CT+ patients reported impairment (61%) compared with the mTBI CT- group (49%; relative risk [RR], 1.24; 95% CI, 1.08-1.43) and a higher percentage in the mTBI CT-group compared with the OTC group (RR, 1.28; 95% CI, 1.02-1.60).

Conclusions and relevance: Most patients with mTBI presenting to US level I trauma centers report persistent, injury-related life difficulties at 1 year postinjury, suggesting the need for more systematic follow-up of patients with mTBI to provide treatments and reduce the risk of chronic problems after mTBI.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Nelson reported grants from Department of Defense (DoD) during the conduct of the study; grants from National Institutes of Health (NIH), grants from Medical College of Wisconsin Center for Patient Care and Outcomes Research, grants from Advancing a Healthier Wisconsin, and grants from the DoD outside the submitted work. Dr Temkin reported grants from NIH-National Institute of Neurological Disorders and Stroke (NINDS) during the conduct of the study. Dr Giacino reported grants from the NIH-NINDS during the conduct of the study. Dr Yuh reported grants from the University of California, San Francisco during the conduct of the study; in addition, Dr Yuh had a patent for USPTO No. 62/269,778 pending. Dr McCrea reported grants from the NIH and DoD during the conduct of the study. Dr Stein reported personal fees from Aptinyx, Bionomics, Janssen, and Neurocrine; as well as personal fees and stock options from Oxeia Biopharmaceuticals outside the submitted work. Dr Mukherjee reported grants from GE Healthcare and nonfinancial support from GE-NFL Head Health Initiative outside the submitted work; in addition, Dr Mukherjee had a patent for USPTO No. 62/269,778 pending. Dr Diaz-Arrastia reported personal fees and research funding from Neural Analytics Inc and travel reimbursement from Brain Box Solutions Inc outside the submitted work. Dr Manley reported grants from the NINDS during the conduct of the study; research funding from the US Department of Energy, grants from the DoD, research funding from Abbott Laboratories, grants from the National Football League Scientific Advisory Board, and research funding from One Mind outside the submitted work; in addition, Dr Manley had a patent for Interpretation and Quantification of Emergency Features on Head Computed Tomography issued. He served for 2 seasons as an unaffiliated neurologic consultant for home games of the Oakland Raiders; he was compensated $1500 per game for 6 games during the 2017 season but received no compensation for this work during the 2018 season. Dr Adeoye reported grants from the NIH/NINDS during the conduct of the study. Dr Boase reported grants from TRACK-TBI Grant during the conduct of the study. Dr Bodien reported grants from Spaulding Rehabilitation Hospital during the conduct of the study. Dr Corrigan reported grants from University of California, San Francisco during the conduct of the study. Dr Duhaime reported grants from the NIH during the conduct of the study. Dr Feeser reported grants from Virginia Commonwealth University during the conduct of the study. Drs Merchant and Dr Valadka are Track-TBI investigators at Virginia Commonwealth University. Dr Ferguson reported grants from the NIH/NINDS, the DoD, Veterans Affairs, Craig H. Neilsen Foundation, Wings for Life Foundation, and the Department of Energy during the conduct of the study. Dr Goldman reported grants from the NINDS and USC Schaeffer Center during the conduct of the study; personal fees from Amgen, Avanir Pharmaceuticals, Acadia Pharmaceuticals, Aspen Health Strategy Group, and Celgene outside the submitted work. Dr Gopinath reported grants from the NIH and DoD during the conduct of the study. Dr Kreitzer reported personal fees from Portola outside the submitted work. Dr Lindsell reported grants from the NIH during the conduct of the study. Dr Machamer reported grants from the NIH during the conduct of the study. Dr Madden reported grants from the NIH Track TBI Study and One Mind for Research during the conduct of the study. Dr McAllister reported grants from UCSF from the NIH and the National Collegiate Athletic Association and the DoD during the conduct of the study. Dr Robertson reported grants from the NIH and DoD during the conduct of the study. Dr Rosand reported grants from the NIH during the conduct of the study; personal fees from Boehringer Ingelheim and New Beta Innovations outside the submitted work. Dr Sander reported grants from the NIH during the conduct of the study. Dr Sherer reported receiving partial funding through a grant for this study. Dr Vespa reported grants from the NIH during the conduct of the study. Dr Zafonte received royalties from Oakstone for an educational CD (Physical Medicine and Rehabilitation: a Comprehensive Review) and Demos publishing for serving as coeditor of Brain Injury Medicine. Dr Zafonte serves or served on the scientific advisory boards of Myomo, Oxeia Biopharma, Biodirection, and Elminda. He also evaluates patients in the MGH Brain and Body-TRUST Program, which is funded by the National Football League Players Association. Dr Zafonte had served on the Mackey White Committee. No other disclosures were reported.

Figures

Figure.
Figure.. Percentage of Patients in the Mild Traumatic Brain Injury (mTBI) and Orthopedic Trauma Control (OTC) Groups Reporting Injury-Related Limitations With Day-to-Day Functioning From 2 Weeks to 12 Months Postinjury on the Glasgow Outcome Scale–Extended Score Interview
Rates decreased from 87% (mTBI) and 93% (OTC) at 2 weeks to 53% (mTBI) and 38% (OTC) at 12 months postinjury. Group differences were nonsignificant at 2 weeks (RR, 0.93; 95% CI, 0.89-0.98), 3 months (RR, 0.92; 95% CI, 0.84-1.02), and 6 months (RR, 1.14; 95% CI, 0.99-1.31) postinjury. At 12 months postinjury, the mTBI group reported significantly higher rates of continued limitations with day-to-day functioning (RR, 1.38; 95% CI, 1.12-1.71).
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References

    1. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):1-16. doi:10.15585/mmwr.ss6609a1 - DOI - PMC - PubMed
    1. Dikmen SS, Machamer JE, Powell JM, Temkin NR. Outcome 3 to 5 years after moderate to severe traumatic brain injury. Arch Phys Med Rehabil. 2003;84(10):1449-1457. doi:10.1016/S0003-9993(03)00287-9 - DOI - PubMed
    1. Colantonio A, Ratcliff G, Chase S, Kelsey S, Escobar M, Vernich L. Long-term outcomes after moderate to severe traumatic brain injury. Disabil Rehabil. 2004;26(5):253-261. doi:10.1080/09638280310001639722 - DOI - PubMed
    1. Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol. 2008;7(8):728-741. doi:10.1016/S1474-4422(08)70164-9 - DOI - PubMed
    1. Nelson LD, LaRoche AA, Pfaller AY, et al. . Prospective, head-to-head study of three computerized neurocognitive assessment tools (CNTs): reliability and validity for the assessment of sport-related concussion. J Int Neuropsychol Soc. 2016;22(1):24-37. doi:10.1017/S1355617715001101 - DOI - PMC - PubMed