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. 2023 Mar 1;6(3):e233660.
doi: 10.1001/jamanetworkopen.2023.3660.

Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury

Lindsay D Nelson  1 , Nancy R Temkin  2 , Jason Barber  2 , Benjamin L Brett  1 , David O Okonkwo  3 , Michael A McCrea  1 , Joseph T Giacino  4   5 , Yelena G Bodien  4   5 , Claudia Robertson  6 , John D Corrigan  7 , Ramon Diaz-Arrastia  8 , Amy J Markowitz  9 , Geoffrey T Manley  9 ; TRACK-TBI Investigators
Affiliations

Functional Recovery, Symptoms, and Quality of Life 1 to 5 Years After Traumatic Brain Injury

Lindsay D Nelson et al. JAMA Netw Open. .

Abstract

Importance: Many level I trauma center patients experience clinical sequelae at 1 year following traumatic brain injury (TBI). Longer-term outcome data are needed to develop better monitoring and rehabilitation services.

Objective: To examine functional recovery, TBI-related symptoms, and quality of life from 1 to 5 years postinjury.

Design, setting, and participants: This cohort study enrolled trauma patients across 18 US level I trauma centers between 2014 and 2018. Eligible participants were enrolled within 24 hours of injury and followed up to 5 years postinjury. Data were analyzed January 2023.

Exposures: Mild TBI (mTBI), moderate-severe TBI (msTBI), or orthopedic traumatic controls (OTC).

Main outcomes and measures: Functional independence (Glasgow Outcome Scale-Extended [GOSE] score 5 or higher), complete functional recovery (GOSE score, 8), better (ie, lower) TBI-related symptom burden (Rivermead Post Concussion Symptoms Questionnaire score of 15 or lower), and better (ie, higher) health-related quality of life (Quality of Life After Brain Injury Scale-Overall Scale score 52 or higher); mortality was analyzed as a secondary outcome.

Results: A total 1196 patients were included in analysis (mean [SD] age, 40.8 [16.9] years; 781 [65%] male; 158 [13%] Black, 965 [81%] White). mTBI and OTC groups demonstrated stable, high rates of functional independence (98% to 100% across time). While odds of independence were lower among msTBI survivors, the majority were independent at 1 year (72%), and this proportion increased over time (80% at 5 years; group × year, P = .005; independence per year: odds ratio [OR] for msTBI, 1.28; 95% CI, 1.03-1.58; OR for mTBI, 0.81; 95% CI, 0.64-1.03). For other outcomes, group differences at 1 year remained stable over time (group × year, P ≥ .44). Odds of complete functional recovery remained lower for persons with mTBI vs OTC (OR, 0.39; 95% CI, 0.28-0.56) and lower for msTBI vs mTBI (OR, 0.34; 95% CI, 0.24-0.48). Odds of better TBI-related symptom burden and quality of life were similar for both TBI subgroups and lower than OTCs. Mortality between 1 and 5 years was higher for msTBI (5.5%) than mTBI (1.5%) and OTC (0.7%; P = .02).

Conclusions and relevance: In this cohort study, patients with previous msTBI displayed increased independence over 5 years; msTBI was also associated with increased mortality. These findings, in combination with the persistently elevated rates of unfavorable outcomes in mTBI vs controls imply that more monitoring and rehabilitation are needed for TBI.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Nelson reported grants from the National Institutes of Health (NIH), the US Department of Defense (DoD), US Centers for Disease Control and Prevention (CDC), and the Medical College of Wisconsin (MCW) Advancing a Healthier Wisconsin Endowment outside the submitted work. Dr Brett reported receiving grants from National Institute on Aging and grants from National Institute of Neurological Disorders and Stroke (NINDS) outside the submitted work; and honoraria and travel reimbursement as conference speaker. Dr McCrea reported grants from DoD and the NIH to Medical College of Wisconsin during the conduct of the study; consulting work with Neurotrauma Sciences outside the submitted work; he reported researching funding from NIH, DoD, CDC, National Collegiate Athletics Association (NCAA), National Football League (NFL), and Abbott Laboratories paid to his institution outside the submitted work; he reported receiving book royalties from Oxford University Press; he reported service as a clinical consultant with the Milwaukee Bucks, Milwaukee Brewers, and Green Bay Packers, and as codirector of the NFL Neuropsychology Consultants without compensation. Dr Bodien reported receiving grants from Spaulding Rehabilitation Hospital and Massachusetts General Hospital both during the conduct of the study and outside the submitted work. Dr Robertson reported receiving grants from NIH, DoD, and NFL Charities during the conduct of the study. Dr Corrigan reported grants from University of California San Francisco (UCSF) during the conduct of the study; he reported receiving grant funding from National Institute on Independent Living and Rehabilitation Research, NIH, and Administration on Community Living outside the submitted work. Dr Diaz-Arrastia reported receiving grants from BrainBox, consulting work with MesoScale Discoveries Ischemix Inc, and NeurAegis, and equity held with NovaSignal outside the submitted work. Dr Manley reported receiving grant funding from DoD/Medical Technology Enterprise Consortium Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Network, grants from National Football League Scientific Advisory Board, US Department of Energy, NeuroTruama Sciences LLC, and One Mind Funding during the conduct of the study; he reported that Abbott Laboratories has provided funding for add-in TRACK-TBI clinical studies; he reported receiving an unrestricted gift from the NFL to the UCSF Foundation to support research efforts of the TRACK-TBI NETWORK. Dr Mukherjee reported grants from NIH and DoD during the conduct of the study; in addition, Dr Mukherjee had a patent (No. USPTO 62/269778) issued to the University of California Regents. Dr Ngwenya reported grants from Abbott Laboratories and grants from Biogen outside the submitted work. Dr Schneider reported serving as associate editor for Neurology, and grants from NIH/NINDS and DoD outside the submitted work. Dr Yuh reported receiving grants from NIH and grants from DoD during the conduct of the study; in addition, Dr Yuh had a patent (No. US PTO 62/269778) issued to University of California Regents. Dr Zafonte reported receiving royalties from Springer/Demos publishing for serving as coeditor of text Brain Injury Medicine. Dr Zafonte serves on the scientific advisory board of Myomo, Kisbee, and NanoDiagnostics. He reported receives funding from the NIH and the DOD. He reported service as principal investigator on a grant entitled the Football Players Health Study at Harvard University, which is funded by the NFL Players Association, and he also evaluates patients in the MGH Brain and Body-TRUST Program, which is funded by the NFL Players Association. Dr Zafonte also evaluates patients for the Massachusetts General Hospital Brain and Body TRUST Center, sponsored in part by the NFLPA, and serves on the Mackey White health committee. No other disclosures were reported.

Figures

Figure.
Figure.. Unweighted Mean Percentages of Patients With Better Outcomes From 1 to 5 Years Postinjury by Group
GCS indicates Glasgow Coma Scale; GOSE, Glasgow Outcome Scale-Extended; QOLIBRI-OS, Quality of Life After Brain Injury Scale-Overall Scale; RPQ, Rivermead Post Concussion Symptoms Questionnaire; TBI, traumatic brain injury.
See this image and copyright information in PMC

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