Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study

Yue, John K.; Cnossen, Maryse C.; Winkler, Ethan A.; Deng, Hansen; Phelps, Ryan R.L.; Coss, Nathan; Sharma, Sourabh; Robinson, Caitlin; Suen, Catherine G; Vassar, Mary J.; Schnyer, David M.; Puccio, Ava M.; Gardner, Raquel C.; Yuh, Esther L.; Mukherjee, Pratik; Valadka, Alex B.; Okonkwo, David O.; Lingsma, Hester F.; Manley, Geoffrey T.; Investigators, Track-Tbi

doi:10.3389/fneur.2019.00343

Cited by 62 publications

(57 citation statements)

References 42 publications

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“…Like other acute mTBI studies in adults presenting to the ED, we observed a high prevalence of previously identified risk factors for the development of PCS, including comorbid mental health conditions, prior concussions, and alcohol and drug use. [32][33][34] The largest prior study was a prospective, multicenter longitudinal study, known symptoms at 3 and months. 33,34 Preinjury psychiatric history and preinjury headache/migraine symptoms, both prevalent in our cohort, were predictive of worse functional and postconcussive outcomes.…”

Section: Discussionmentioning

confidence: 99%

A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury

Varner

Thompson

Wit

et al. 2021

Academic Emergency Medicine

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Background: There is a paucity of effective management strategies to prevent prolonged symptoms following mild traumatic brain injury (mTBI), and emerging evidence suggesting possible benefits of exercise. The objective of this trial was to determine whether adult patients presenting to the emergency department (ED) with a diagnosis of acute mTBI prescribed light exercise were less likely to develop persistent postconcussion symptoms (PCS).Methods: This was a randomized controlled trial conducted in three Canadian EDs.Consecutive, adult (18-64 years) ED patients with an mTBI sustained within the preceding 48 hours were eligible for enrollment. The intervention group received discharge instructions prescribing 30 minutes of daily light exercise, and the control group was given standard mTBI instructions advising gradual return to exercise following symptom resolution. The primary outcome was the proportion of patients with PCS at 30 days, defined as the presence of three or more symptoms on the Rivermead Post-concussion Symptoms Questionnaire (RPQ).Results: A total of 367 patients were enrolled (control group, n = 184; intervention, n = 183). Median age was 32 years and 201 (57.6%) were female. There was no difference in the proportion of patients with PCS at 30 days (control, 13.4% vs intervention, 14.6%; ∆1.2%, 95% confidence interval [CI] = −6.2 to 8.5). There were no differences in median change of RPQ scores, median number of return health care provider visits, median number of missed school or work days, or unplanned return ED visits within 30 days. Participants in the control group reported fewer minutes of light exercise at 7 days (30 vs 35; ∆5, 95% CI = 2 to 15). Conclusion:In this trial of prescribed early light exercise for acute mTBI, there were no differences in recovery or health care utilization outcomes. Results suggest that early light exercise may be encouraged as tolerated at ED discharge following mTBI, but this guidance is not sufficient to prevent PCS.

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Section: Discussionmentioning

confidence: 99%

A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury

Varner

Thompson

Wit

et al. 2021

Academic Emergency Medicine

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“…This may simply be explained by the relative ease with which patients can return to part-time rather than full-time work. RTW at three months predicted RTW at six 46 our data suggests that patients should be screened at or prior to three months for risk of delayed RTW, and at-risk patients should be directed to vocational rehabilitation services as quickly as possible. Finally, it is worth noting that history of illicit substance use was a predictor for inability to RTW at six months.…”

Section: Discussionmentioning

confidence: 74%

Predictors of six-month inability to return to work in previously employed subjects after mild traumatic brain injury: A TRACK-TBI pilot study

Yue

Phelps

Hemmerle

et al. 2021

Journal of Concussion

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Introduction Return to work (RTW) is an important milestone of mild traumatic brain injury (mTBI) recovery. The objective of this study was to evaluate whether baseline clinical variables, three-month RTW, and three-month postconcussional symptoms (PCS) were associated with six-month RTW after mTBI. Methods Adult subjects from the prospective multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot study with mTBI (Glasgow Coma Scale 13–15) who were employed at baseline, with completed three- and six-month RTW status, and three-month Acute Concussion Evaluation (ACE), were extracted. Univariate and multivariable analyses were performed for six-month RTW, with focus on baseline employment, three-month RTW, and three-month ACE domains (physical, cognitive, sleep, and/or emotional postconcussional symptoms (PCS)). Odds ratios (OR) and 95% confidence intervals [CI] were reported. Significance was assessed at p < 0.05. Results In 152 patients aged 40.7 ± 15.0 years, 72% were employed full-time at baseline. Three- and six-month RTW were 77.6% and 78.9%, respectively. At three months, 59.2%, 47.4%, 46.1% and 31.6% scored positive for ACE physical, cognitive, sleep, and emotional PCS domains, respectively. Three-month RTW predicted six-month RTW (OR = 19.80, 95% CI [7.61–51.52]). On univariate analysis, scoring positive in any three-month ACE domain predicted inability for six-month RTW (OR = 0.10–0.11). On multivariable analysis, emotional symptoms predicted inability to six-month RTW (OR = 0.19 [0.04–0.85]). Subjects who scored positive in all four ACE domains were more likely to be unable to RTW at six months (4 domains: 58.3%, vs. 0-to-3 domains: 9.5%; multivariable OR = 0.09 [0.02–0.33]). Conclusions Three-month post-injury is an important time point at which RTW status and PCS should be assessed, as both are prognostic markers for six-month RTW. Clinicians should be particularly vigilant of patients who present with emotional symptoms, and patients with symptoms across multiple PCS categories, as these patients are at further risk of inability to RTW and may benefit from targeted evaluation and support.

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“…Women seem to have a higher incidence of sleep disorders after one incidence of mild TBI; however, with recurrent injuries, both males and females report sleep disorders equally (89). Pre-injury co-morbidities, such as headache or migraine, seem to increase risk of post-injury sleep disorders in adults (90). Some of these co-morbidities may be expressed in sexually dimorphic patterns, and this likely impacts the sleep disorder incidence post-TBI based on sex.…”

Section: Sleep Disordersmentioning

confidence: 99%

Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward

2020

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Neuroendocrine dysfunction can occur as a consequence of traumatic brain injury (TBI), and disruptions to the hypothalamic-pituitary axis can be especially consequential to children. The purpose of our review is to summarize current literature relevant to studying sex differences in pediatric post-traumatic hypopituitarism (PTHP). Our understanding of incidence, time course, and impact is constrained by studies which are primarily small, are disadvantaged by significant methodological challenges, and have investigated limited temporal windows. Because hormonal changes underpin the basis of growth and development, the timing of injury and PTHP testing with respect to pubertal stage gains particular importance. Reciprocal relationships among neuroendocrine function, TBI, adverse childhood events, and physiological, psychological and cognitive sequelae are underconsidered influencers of sexually dimorphic outcomes. In light of the tremendous heterogeneity in this body of literature, we conclude with the common path upon which we must collectively arrive in order to make progress in understanding PTHP.

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Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study

Cited by 62 publications

References 42 publications

A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury

A randomized trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury

Predictors of six-month inability to return to work in previously employed subjects after mild traumatic brain injury: A TRACK-TBI pilot study

Evidence Limitations in Determining Sexually Dimorphic Outcomes in Pediatric Post-Traumatic Hypopituitarism and the Path Forward

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