Outcome Prediction in Mild Traumatic Brain Injury: Age and Clinical Variables Are Stronger Predictors than CT Abnormalities

Abstract

Mild traumatic brain injury (mTBI) is a common heterogeneous neurological disorder with a wide range of possible clinical outcomes. Accurate prediction of outcome is desirable for optimal treatment. This study aimed both to identify the demographic, clinical, and computed tomographic (CT) characteristics associated with unfavorable outcome at 6 months after mTBI, and to design a prediction model for application in daily practice. All consecutive mTBI patients (Glasgow Coma Scale [GCS] score: 13-15) admitted to our hospital who were age 16 or older were included during an 8-year period as part of the prospective Radboud University Brain Injury Cohort Study (RUBICS). Outcome was assessed at 6 months post-trauma using the Glasgow Outcome Scale-Extended (GOSE), dichotomized into unfavorable (GOSE score 1-6) and favorable (GOSE score 7-8) outcome groups. The predictive value of several variables was determined using multivariate binary logistic regression analysis. We included 2784 mTBI patients and found CT abnormalities in 20.7% of the 1999 patients that underwent a head CT. Age, extracranial injuries, and day-of-injury alcohol intoxication proved to be the strongest outcome predictors. The presence of facial fractures and the number of hemorrhagic contusions emerged as CT predictors. Furthermore, we showed that the predictive value of a scheme based on a modified Injury Severity Score (ISS), alcohol intoxication, and age equalled the value of one that also included CT characteristics. In fact, it exceeded one that was based on CT characteristics alone. We conclude that, although valuable for the identification of the individual mTBI patient at risk for deterioration and eventual neurosurgical intervention, CT characteristics are imperfect predictors of outcome after mTBI.

Apolipoprotein E epsilon 4 (APOE‐ε4) genotype is associated with decreased 6‐month verbal memory performance after mild traumatic brain injury

“…There is a known association between increasing age and decreasing performance (Delis et al., 2000; Wiens, Tindall, & Crossen, 1994; Paolo, Troster, & Ryan, 1997) and hence the CVLT‐II manual recommends controlling for age when analyzing CVLT‐II performance (Delis et al., 2000). In our sample, age was a statistically significant independent predictor of poorer verbal memory performance across all CVLT‐II subscales, which may be due to a combination of normal cerebral aging processes leading to slower verbal memory processing—a finding consistent with prior reports in mTBI (Jacobs et al., 2010). It should be noted that in our sample, APOE‐ ε 4(+) patients were on average 10 years older than ε 4(−) patients, which may further compound their decreased verbal memory performance of the ε 4 ‐carriers.…”

“…Multivariable linear regression was performed to assess the association between APOE‐ ε 4 genotype and each of the five CVLT‐II outcome measures. Demographic and injury variables were selected based on recommendations and cited predictive value in large studies and systematic reviews in mTBI to include age in years (scalar), education in years (scalar), sex (male vs. female), race (dichotomized to Caucasian vs. other due to small samples of other races), loss of consciousness (LOC; no vs. yes/unknown), posttraumatic amnesia (PTA; no vs. yes/unknown), and presence of intracranial pathology on initial head computed tomography (CT) scan (Jacobs et al., 2010; Kashluba, Hanks, Casey, & Millis, 2008; Van der Naalt, 2001; Carroll et al., 2004). A history of seizures has been correlated with decreased verbal memory performance in the neurology literature and hence prior medical history (PMH) of seizures was included to serve as a surrogate for baseline cognitive burden (Blake, Wroe, Breen, & McCarthy, 2000; Schefft et al., 2008; Berl et al., 2005).…”

Screening for Post-Traumatic Stress Disorder in a Civilian Emergency Department Population with Traumatic Brain Injury

“…As recent reports indicate, behavioral variables may be more accurate in estimating functional outcomes of mTBI than injury severity ratings. 8,19,42 The relationship between PTSD symptom reporting and disability status following mTBI merits development of better PTSD clinical screening practices aimed at identifying patients and ameliorating For each iterative step, variables that did not achieve the pre-determined level of significance ( p-entry £0.25) were not added to the model. Variables entered, but which did not remain significant within each iterative step ( p-remain £0.15) were eliminated from the model (Caucasian race, married marital status).…”

“…17,18 Specifically, up to 87% of service members with TBI meeting PTSD symptom screening criteria demonstrate concurrent moderate disability on the GOS-E (£ 6). 17 While reports of moderate disability range from 13-23% after mTBI, 19,20 in civilian populations, the proportion of patients who develop PTSD symptoms and thus may benefit from symptom alleviation through PTSD-based therapy has yet to be characterized and/or validated.…”

Postconcussion syndrome: demographics and predictors in 221 patients

“…Other predictors include learning disabilities, 44 migraine headaches, 19 females, 1,[4][5][6]10,12,13,26,32,39 older age, 18,21,39 and children and adolescents. 15,27 Lastly, those with previous concussions are believed to have an increased risk of PCS, 3,7,13,19,27,32,44 although the exact number required to increase the risk is unknown.…”