Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study

doi:10.1089/neu.2021.0348

. 2022 Mar;39(5-6):358-370.

doi: 10.1089/neu.2021.0348. Epub 2022 Feb 9.

Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study

Joan Machamer¹, Nancy Temkin^{1

2}, Sureyya Dikmen³, Lindsay D Nelson⁴, Jason Barber¹, Phillip Hwang⁵, Kim Boase¹, Murray B Stein⁶, Xiaoying Sun⁷, Joseph Giacino⁸, Michael A McCrea⁹, Sabrina R Taylor^{10

11}, Sonia Jain⁷, Geoff Manley^{10

11}; TRACK-TBI Investigators

Collaborators, Affiliations

Collaborators

Affiliations

¹ Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
² Department of Biostatistics, University of Washington, Seattle, Washington, USA.
³ Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
⁴ Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁵ Department of Anatomy and Neurobiology, Boston University, Boston, Massachusetts, USA.
⁶ Department of Psychiatry and Herbert Wertheim School of Public Health, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA.
⁷ Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA.
⁸ Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
⁹ Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁰ Brain and Spinal Injury Center, San Francisco, California, USA.
¹¹ Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.

PMID: 35078327
PMCID: PMC8892966
DOI: 10.1089/neu.2021.0348

Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study

Joan Machamer et al. J Neurotrauma. 2022 Mar.

. 2022 Mar;39(5-6):358-370.

doi: 10.1089/neu.2021.0348. Epub 2022 Feb 9.

Authors

Collaborators

Affiliations

¹ Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
² Department of Biostatistics, University of Washington, Seattle, Washington, USA.
³ Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA.
⁴ Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁵ Department of Anatomy and Neurobiology, Boston University, Boston, Massachusetts, USA.
⁶ Department of Psychiatry and Herbert Wertheim School of Public Health, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA.
⁷ Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA.
⁸ Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
⁹ Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
¹⁰ Brain and Spinal Injury Center, San Francisco, California, USA.
¹¹ Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.

PMID: 35078327
PMCID: PMC8892966
DOI: 10.1089/neu.2021.0348

Abstract

Symptom endorsement after traumatic brain injury (TBI) is common acutely post-injury and is associated with other adverse outcomes. Prevalence of persistent symptoms has been debated, especially in mild TBI (mTBI). A cohort of participants ≥17 years with TBI (n = 2039), 257 orthopedic trauma controls (OTCs), and 300 friend controls (FCs) were enrolled in the TRACK-TBI study and evaluated at 2 weeks and 3, 6, and 12 months post-injury using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). TBI participants had significantly higher symptom burden than OTCs or FCs at all times, with average scores more than double. TBI cases showed significant decreases in RPQ score between each evaluation (p < 0.001), decreasing ∼1.7 points per month between 2 weeks and 3 months and 0.2 points per month after that. More than 50% of the TBI sample, including >50% of each of the mild and moderate/severe TBI subsamples, continued to endorse three or more symptoms as worse than pre-injury through 12 months post-injury. A majority of TBI participants who endorsed a symptom at 3 months or later did so at the next evaluation as well. Contrary to reviews that report symptom resolution by 3 months post-injury among those with mTBI, this study of participants treated at level 1 trauma centers and having a computed tomography ordered found that persistent symptoms are common to at least a year after TBI. Additionally, although symptom endorsement was not specific to TBI given that they were also reported by OTC and FC participants, TBI participants endorsed over twice the symptom burden compared with the other groups.

Keywords: TRACK-TBI; post-concussion symptoms; post-traumatic symptoms; traumatic brain injuries.

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Conflict of interest statement

No competing financial interests exist.

Figures

**FIG. 1.**
Participant flow. No RPQ—cog.impaired=RPQ was not done because the participant was administered an abbreviated battery because of cognitive impairment. FC, friend control group; OTC, orthopedic trauma control group; RPQ, Rivermead Post-Concussion Symptoms Questionnaire; TBI, traumatic brain injury group.

**FIG. 2.**
Number of symptoms endorsed at any severity by group and time. FC, friend control group; OTC, orthopedic trauma control group; TBI, traumatic brain injury group. Color image is available online.

**FIG. 3.**
Number of symptoms endorsed at any severity by traumatic brain injury (TBI) severity subgroup and time. mTBI, mild TBI (admission Glasgow Coma Scale score 13–15); msTBI, moderate or severe TBI (admission Glasgow Coma Scale score 3–12). Color image is available online.

**FIG. 4.**
Percentage of participants endorsing individual symptoms at any severity level by group and time. (A) Somatic symptoms. (B) Sleep difficulty, fatigue, and restlessness. (C) Cognitive symptoms. (D) Emotional symptoms. (E) Visual symptoms. FC, friend control group; OTC, orthopedic trauma control group; TBI, traumatic brain injury group. Color image is available online.

See this image and copyright information in PMC

Comment in

Response to Machamer et al., "Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study" (doi: 10.1089/neu.2021.0348).
Zhang B, Daneshvar DH, Polich G, Glenn MB. Zhang B, et al. J Neurotrauma. 2023 Mar;40(5-6):595-596. doi: 10.1089/neu.2022.0292. Epub 2022 Dec 26. J Neurotrauma. 2023. PMID: 36352817 No abstract available.

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References

1. Polinder, S., Cnossen, M.C., Real, R.G.L., Covic, A., Gorbunova, A., Voormolen, D.C., Master, C.L., Haagsma, J.A., Diaz-Arrastia, R., and von Steinbuechel, N. (2018). A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Front. Neurol. 9, 1113. - PMC - PubMed
1. Dikmen, S., Machamer, J., Fann, J.R., and Temkin, N. (2010). Rates of symptom reporting following traumatic brain injury. J. Int. Neuropsychol. Soc. 16, 401–411. - PubMed
1. Ponsford, J.L., Downing, M.G., Olver, J., Ponsford, M., Acher, R., Carty, M., and Spitz, G. (2014). Longitudinal follow-up of patients with traumatic brain injury: outcome at two, five, and ten years post-injury. J. Neurotrauma 31, 64–77. - PubMed
1. Olver, J.H., Ponsford, J.L., and Curran, C.A. (1996). Outcome following traumatic brain injury: a comparison between 2 and 5 years after injury. Brain Inj. 10, 841–848. - PubMed
1. Ruet, A., Bayen, E., Jourdan, C., Ghout, I., Meaude, L., Lalanne, A., Pradat-Diehl, P., Nelson, G., Charanton, J., Aegerter, P., Vallat-Azouvi, C., and Azouvi, P. (2019). A detailed overview of long-term outcomes in severe traumatic brain injury eight years post-injury. Front. Neurol. 10, 120. - PMC - PubMed

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[1] Polinder, S., Cnossen, M.C., Real, R.G.L., Covic, A., Gorbunova, A., Voormolen, D.C., Master, C.L., Haagsma, J.A., Diaz-Arrastia, R., and von Steinbuechel, N. (2018). A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Front. Neurol. 9, 1113. - PMC - PubMed

[2] Polinder, S., Cnossen, M.C., Real, R.G.L., Covic, A., Gorbunova, A., Voormolen, D.C., Master, C.L., Haagsma, J.A., Diaz-Arrastia, R., and von Steinbuechel, N. (2018). A multidimensional approach to post-concussion symptoms in mild traumatic brain injury. Front. Neurol. 9, 1113. - PMC - PubMed

[3] Dikmen, S., Machamer, J., Fann, J.R., and Temkin, N. (2010). Rates of symptom reporting following traumatic brain injury. J. Int. Neuropsychol. Soc. 16, 401–411. - PubMed

[4] Dikmen, S., Machamer, J., Fann, J.R., and Temkin, N. (2010). Rates of symptom reporting following traumatic brain injury. J. Int. Neuropsychol. Soc. 16, 401–411. - PubMed

[5] Ponsford, J.L., Downing, M.G., Olver, J., Ponsford, M., Acher, R., Carty, M., and Spitz, G. (2014). Longitudinal follow-up of patients with traumatic brain injury: outcome at two, five, and ten years post-injury. J. Neurotrauma 31, 64–77. - PubMed

[6] Ponsford, J.L., Downing, M.G., Olver, J., Ponsford, M., Acher, R., Carty, M., and Spitz, G. (2014). Longitudinal follow-up of patients with traumatic brain injury: outcome at two, five, and ten years post-injury. J. Neurotrauma 31, 64–77. - PubMed

[7] Olver, J.H., Ponsford, J.L., and Curran, C.A. (1996). Outcome following traumatic brain injury: a comparison between 2 and 5 years after injury. Brain Inj. 10, 841–848. - PubMed

[8] Olver, J.H., Ponsford, J.L., and Curran, C.A. (1996). Outcome following traumatic brain injury: a comparison between 2 and 5 years after injury. Brain Inj. 10, 841–848. - PubMed

[9] Ruet, A., Bayen, E., Jourdan, C., Ghout, I., Meaude, L., Lalanne, A., Pradat-Diehl, P., Nelson, G., Charanton, J., Aegerter, P., Vallat-Azouvi, C., and Azouvi, P. (2019). A detailed overview of long-term outcomes in severe traumatic brain injury eight years post-injury. Front. Neurol. 10, 120. - PMC - PubMed

[10] Ruet, A., Bayen, E., Jourdan, C., Ghout, I., Meaude, L., Lalanne, A., Pradat-Diehl, P., Nelson, G., Charanton, J., Aegerter, P., Vallat-Azouvi, C., and Azouvi, P. (2019). A detailed overview of long-term outcomes in severe traumatic brain injury eight years post-injury. Front. Neurol. 10, 120. - PMC - PubMed

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Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study

Collaborators

Affiliations

Symptom Frequency and Persistence in the First Year after Traumatic Brain Injury: A TRACK-TBI Study

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Collaborators

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Abstract

Conflict of interest statement

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