One year outcome in mild to moderate head injury: the predictive value of acute injury characteristics related to complaints and return to work

Abstract

Objectives-To determine the prognostic value of characteristics of acute injury and duration of post-traumatic amnesia (PTA) for long term outcome in patients with mild to moderate head injury in terms of complaints and return to work. Methods-Patients with a Glasgow coma score (GCS) on admission of 9-14 were included. Post-traumatic amnesia was assessed prospectively. Follow up was performed at 1, 3, 6, and 12 months after injury. Outcome was determined by the Glasgow outcome scale (GOS) 1 year after injury and compared with a more detailed outcome scale (DOS) comprising cognitive and neurobehavioural aspects. Results-Sixty seven patients were included, mean age 33.2 (SD 14.7) years and mean PTA 7.8 (SD 7.3) days. One year after injury, 73% of patients had resumed previous work although most (84%) still reported complaints. The most frequent complaints were headache (32%), irritability (34%), forgetfulness and poor concentration (42%), and fatigue (45%). According to the GOS good recovery (82%) or moderate disability (18%) was seen. Application of the DOS showed more cognitive (40%) and behavioural problems (48%), interfering with return to work. Correlation between the GOS and DOS was high (r=0.87, p<0.01). Outcome correlated with duration of PTA (r=−0.46) but not significantly with GCS on admission (r=0.19). In multiple regression analysis, PTA and the number of complaints 3 months after injury explained 49% of variance on outcome as assessed with the GOS, and 60% with the DOS. Conclusions-In mild to moderate head injury outcome is determined by duration of PTA and not by GCS on admission. Most patients return to work despite having complaints. The application of a more detailed outcome scale will increase accuracy in predicting outcome in this category of patients with head injury. (J Neurol Neurosurg Psychiatry 1999;66:207-213)

Functional outcome 10 years after traumatic brain injury: Its relationship with demographic, injury severity, and cognitive and emotional status

“…GCS, used as the other measure of injury severity, did not significantly differentiate those with good from those with poor outcomes. Previous studies have also reported PTA duration to be a stronger predictor of outcome than GCS (Cattelani et al, 2002;Doig et al, 2001;Fleming et al, 1999;Sherer et al, 2002;Van der Naalt et al, 1999).…”

“…This variability has led to a focus on identifying factors predicting or indicating functional outcome. Studies conducted up to 3 years after injury have found that outcome may be influenced by injury severity, as measured by Glasgow Coma Scale (GCS) scores or duration of posttraumatic amnesia (PTA), demographic factors, including age, gender, and preinjury education and employment, as well as postinjury cognitive and social factors (Brown et al, 2005;Cattelani et al, 2002;Dikmen et al, 1995b;Fleming et al, 1999;Godfrey et al, 1993;Gollaher et al, 1998;Ip et al, 1995;Levin et al, 1990;Pastorek et al, 2004;Ponsford et al, 1995;Rothweiler et al, 1998;Van der Naalt et al, 1999;Van Zomeren & Van den Burg, 1985).…”

Neuropsychological and information processing deficits following mild traumatic brain injury

“…This raises the additional possibility that the deficits found in the mild TBI group may partially or completely resolve over time. Indeed, this may explain why studies often report a higher frequency of problems in the early stages after a mild TBI than in the later stages (Kibby & Long, 1996;Lishman, 1988;Van der Naalt et al, 1999). It remains to be seen whether measures designed to target the effects of diffuse damage are better able to predict which mild TBI patients will experience long-term residual problems than traditional neuropsychological tests.…”

Multivariate assessment of subjective and objective measures of social and family satisfaction in Veterans with history of traumatic brain injury

“…Those who sustain a TBI in the mild to moderate range often experience postconcussive symptoms such as sleep disturbance, fatigue, headache pain, irritability, mood disturbances, and cognitive symptoms [9][10][11]. Cognitive symptoms in this group tend to be related to concentration, attention, processing speed, learning, memory, prospective memory, and executive functioning [10,[12][13][14][15][16].…”