Identification of patients at risk for poor outcome after mTBI

Lingsma, Hester F.; Cnossen, Maryse C.

doi:10.1016/s1474-4422(17)30171-0

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…Although many studies have reported an association of head CT positive for any acute traumatic intracranial finding with poorer outcome, others have shown no association, a weak association that does not endure in multivariable models that include demographic and other clinical factors, an association at 3 months but not at 6 months, or even an association with a better outcome . Recently, van der Naalt et al found that CT abnormalities were not associated with the 6-month outcome in either an emergency department model based on baseline factors nor an emergency department–plus model that included additional information (indicators of emotional distress and coping mechanisms) collected at a 2-week postinjury visit.…”

Section: Discussionmentioning

confidence: 99%

Pathological Computed Tomography Features Associated With Adverse Outcomes After Mild Traumatic Brain Injury

et al. 2021

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IMPORTANCE A head computed tomography (CT) with positive results for acute intracranial hemorrhage is the gold-standard diagnostic biomarker for acute traumatic brain injury (TBI). In moderate to severe TBI (Glasgow Coma Scale [GCS] scores 3-12), some CT features have been shown to be associated with outcomes. In mild TBI (mTBI; GCS scores 13-15), distribution and co-occurrence of pathological CT features and their prognostic importance are not well understood. OBJECTIVE To identify pathological CT features associated with adverse outcomes after mTBI. DESIGN, SETTING, AND PARTICIPANTS The longitudinal, observational Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study enrolled patients with TBI, including those 17 years and older with GCS scores of 13 to 15 who presented to emergency departments at 18 US level 1 trauma centers between February 26, 2014, and August 8, 2018, and underwent head CT imaging within 24 hours of TBI. Evaluations of CT imaging used TBI Common Data Elements. Glasgow Outcome Scale-Extended (GOSE) scores were assessed at 2 weeks and 3, 6, and 12 months postinjury. External validation of results was performed via the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Data analyses were completed from February 2020 to February 2021. EXPOSURES Acute nonpenetrating head trauma. MAIN OUTCOMES AND MEASURES Frequency, co-occurrence, and clustering of CT features; incomplete recovery (GOSE scores <8 vs 8); and an unfavorable outcome (GOSE scores <5 vs Ն5) at 2 weeks and 3, 6, and 12 months. RESULTS In 1935 patients with mTBI (mean [SD] age, 41.5 [17.6] years; 1286 men [66.5%]) in the TRACK-TBI cohort and 2594 patients with mTBI (mean [SD] age, 51.8 [20.3] years; 1658 men [63.9%]) in an external validation cohort, hierarchical cluster analysis identified 3 major clusters of CT features: contusion, subarachnoid hemorrhage, and/or subdural hematoma; intraventricular and/or petechial hemorrhage; and epidural hematoma. Contusion, subarachnoid hemorrhage, and/or subdural hematoma features were associated with incomplete recovery (odds ratios [ORs] for GOSE scores <8 at 1 year: TRACK-TBI, 1.80 [95% CI, 1.39-2.33]; CENTER-TBI, 2.73 [95% CI, 2.18-3.41]) and greater degrees of unfavorable outcomes (ORs for GOSE scores <5 at 1 year: TRACK-TBI, 3.23 [95% CI, 1.59-6.58]; CENTER-TBI, 1.68 [95% CI, 1.13-2.49]) out to 12 months after injury, but epidural hematoma was not. Intraventricular and/or petechial hemorrhage was associated with greater degrees of unfavorable outcomes up to 12 months after injury (eg, OR for GOSE scores <5 at 1 year in ). Some CT features were more strongly associated with outcomes than previously validated variables (eg, ORs for GOSE scores <5 at 1 year in TRACK-TBI: neuropsychiatric history, 1.43 [95% CI .98-2.10] vs contusion, subarachnoid hemorrhage, and/or subdural hematoma, 3.23 [95% CI 1.59-6.58]). Findings were externally validated in 2594 patients with mTBI enrolled in the CENTER-TBI study. C...

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Section: Discussionmentioning

confidence: 99%

Pathological Computed Tomography Features Associated With Adverse Outcomes After Mild Traumatic Brain Injury

et al. 2021

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“…However, recent studies suggest that the prevalence of persistent symptoms may even be as high as 40% [4]. Patients reporting high levels of PCS 2–3 months after concussion are at risk of prolonged disability and reduced health-related quality of life 5, 6, 7. These are particularly serious and problematic prospects in relation to adolescents and young adults both in terms of personal suffering and socioeconomic implications [3].…”

Section: Introductionmentioning

confidence: 99%

“…In line with the considerations above, treatments for persistent PCS that aim to modify illness perceptions and related behaviours seem promising [7,18,19].…”

Section: Introductionmentioning

confidence: 99%

Novel interdisciplinary intervention, GAIN, vs. enhanced usual care to reduce high levels of post-concussion symptoms in adolescents and young adults 2–6 months post-injury: A randomised trial

et al. 2019

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Background: Evidence for effective interventions to prevent long-term sequelae after concussion is sparse. This study aimed to test the efficacy of Get going After concussIoN (GAIN), an interdisciplinary, individuallytailored intervention of 8 weeks duration based on gradual return to activities and principles from cognitive behavioural therapy. Methods: We conducted an open-label, parallel-group randomised trial in a hospital setting in Central Denmark Region. Participants were 15À30-year-old patients with high levels of post-concussion symptoms (PCS) 2À6 months post-concussion (i.e., a score 20 on the Rivermead Post-concussion Symptoms Questionnaire (RPQ)). They were randomly assigned (1:1) to either enhanced usual care (EUC) or GAIN+EUC. Masking of participants and therapists was not possible. The primary outcome was change in RPQ-score from baseline to 3-month FU. All analyses were done on an intention-to-treat basis using linear mixed-effects models. This trial is registered with ClinicalTrials.gov, number NCT02337101. Findings: Between March 1, 2015, and September 1, 2017, we included 112 patients. Patients allocated to GAIN+EUC (n=57) reported a significantly larger reduction of PCS than patients allocated to EUC (n=55) with a mean adjusted difference in improvement of 7¢6 points (95% confidence interval (CI) 2¢0À13¢1, p=0¢008), Cohen's d=0¢5 (95% CI 0¢1À0¢9). Number needed to treat for prevention of one additional patient with RPQ 20 at 3-month FU was 3¢6 (95% CI 2¢2À11¢3). No adverse events were observed. Interpretation: Compared with EUC, GAIN+EUC was associated with a larger reduction of post-concussion symptoms at 3-month FU. Funding: Central Denmark Region and the foundation "Public Health in Central Denmark Region-a collaboration between municipalities and the region".

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“…Therefore, it may be speculated that the fall injuries causing mTBI in majority of the individuals in GP group were less severe traumas than the injuries caused by the traffic accidents suffered by the majority of the cohort group. Furthermore, in a biopsychosocial understanding, the majority of individuals with persistent PCS also suffer from psychosocial difficulties/abnormalities including psychological distress 35 , 36 . Thus, they seek help from the GP as GP acts as a gatekeeper before further referral, which leads to more sick leave.…”

Section: Discussionmentioning

confidence: 99%

Characterization of persistent post-traumatic headache and management strategies in adolescents and young adults following mild traumatic brain injury

Kothari

Eggertsen²,

Frederiksen³

et al. 2022

Sci Rep

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Characteristics of persistent post-traumatic headache (PTH) in young individuals are poorly known leading to diagnostic problems and diverse management. We aimed to describe headache phenotypes and self-reported management strategies in young individuals with PTH following mild traumatic brain injury (mTBI). A comprehensive structured questionnaire was used to evaluate headache phenotypes/characteristics and management strategies to relieve headache in 107, 15–30-year-old individuals with PTH. Around 4 months post-injury, migraine-like headache in combination with tension-type like headache (40%) was the most commonly encountered headache phenotype followed by migraine-like headache (36%). Around 50% reported aura-like symptoms before/during the headache attack. Medication-overuse headache was diagnosed in 10%. Stress, sleep disturbances, and bright lights were the most common trigger factors. More than 80% reported that their headache was worsened by work-related activity and alleviated by rest/lying down. Simple analgesics were commonly used (88%) whereas prophylactic drugs were rarely used (5%). Bedrest and physiotherapy were also commonly used as management strategies by 56% and 34% of the participants, respectively. In conclusion, most young individuals with PTH after mTBI presented with combined migraine-like and tension-type-like headache followed by migraine-like headache, only. Preventive headache medication was rarely used, while simple analgesics and bedrest were commonly used for short-term headache relief.

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Identification of patients at risk for poor outcome after mTBI

Cited by 7 publications

References 8 publications

Pathological Computed Tomography Features Associated With Adverse Outcomes After Mild Traumatic Brain Injury

Pathological Computed Tomography Features Associated With Adverse Outcomes After Mild Traumatic Brain Injury

Novel interdisciplinary intervention, GAIN, vs. enhanced usual care to reduce high levels of post-concussion symptoms in adolescents and young adults 2–6 months post-injury: A randomised trial

Characterization of persistent post-traumatic headache and management strategies in adolescents and young adults following mild traumatic brain injury

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