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

Abstract

ImportanceMany 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.ObjectiveTo examine functional recovery, TBI-related symptoms, and quality of life from 1 to 5 years postinjury.Design, Setting, and ParticipantsThis 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.ExposuresMild TBI (mTBI), moderate-severe TBI (msTBI), or orthopedic traumatic controls (OTC).Main Outcomes and MeasuresFunctional 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.ResultsA 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 RelevanceIn 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.

Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury

“…TBI patients experience numerous affective, cognitive, and physical symptoms even a year post-injury, and nurses should monitor for adverse effects and symptoms. Our study confirms a recent study (Transforming Research and Clinical Knowledge in Traumatic Brain Injury, or TRACK-TBI) (Nelson et al, 2023) that symptoms significantly impact patient functioning. Studies of symptoms in TBI typically focus on the first few weeks postinjury (e.g., Brett et al, 2021).…”

Effectiveness of biomedical interventions on the chronic stage of traumatic brain injury: a systematic review of randomized controlled trials

“…Initial severities of TBI often determine the procedures for acute triage and care. However, severities of TBI begin to intersect after several months to years, with an example of some moderate TBI patients can recover quickly ( 68 ), whereas ( 68 ), whereas mild TBI does not mean patients recover patients recover rapidly, in fact some patients can develop lingering symptoms, whereas mild TBI does not mean patients recover rapidly, in fact some patients can develop lingering symptoms for months to years ( 69 ). Therefore, initial severities of TBI in the selected RCTs may be less relevant when interpreting the effectiveness of interventions for chronic TBI cases.…”

Network analysis and relationship of symptom factors to functional outcomes and quality of life following mild traumatic brain injury: a TRACK-TBI study

“…There is a growing appreciation that mTBI can be linked to long-term consequences. For example, Nelson et al ( 3 ) reported that 53% of mTBI patients evaluated at U.S. Level 1 trauma center emergency departments (EDs) report injury-related functional impairments 1-year post-injury. Functional impairments can have a direct impact on life quality and satisfaction and are often linked to persistent injury-related symptoms, such as psychological distress ( 3 , 4 ).…”