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Incomplete Recovery Common 6 Months After Mild TBI

More than half of patients with mild traumatic brain injury (TBI) and a negative head CT scan have not recovered completely 6 months after sustaining their injury, new data from the TRACK-TBI study shows.

“Seeing that more than half of the GCS [Glasgow Coma Score] 15, CT-negative TBI cohort in our study were not back to their pre-injury baseline at 6 months was surprising, and impacts the millions of Americans who suffer from concussions annually,” lead author Debbie Madhok, MD, with Department of Emergency Medicine, University of California San Francisco, told Medscape Medical News.

“These results highlight the importance of improving care pathways for concussion, particularly from the emergency department,” Madhok said.

The findings were published online August 17 in JAMA Network Open.

Life-Changing Injury

The short- and long-term outcomes in the large group of patients who come into the ED with TBI, a GCS of 15, and without acute intracranial traumatic injury (defined as a negative head CT scan) remain poorly understood, the investigators note.

To investigate further, they evaluated outcomes at 2 weeks and 6 months in 991 of these patients (mean age, 38 years; 64% men) from the TRACK-TBI study.

Among the 751 (76%) participants followed up at 2 weeks post-injury, only 204 (27%) had functional recovery — with a Glasgow Outcome Scale-Extended (GOS-E) score of 8. The remaining 547 (73%) had incomplete recovery (GOS-E scores < 8).

Among the 659 patients (66%) followed up at 6 months after the injury, 287 (44%) had functional recovery and 372 (56%) had incomplete recovery.

Most patients who failed to recover completely reported they had not returned to their preinjury life (88%). They described trouble returning to social activities outside the home and disruptions in family relationships and friendships.

The researchers note that the study population had a high rate of preinjury psychiatric comorbidities, and these patients were more likely to have incomplete recovery than those without psychiatric comorbidities. This aligns with results from previous studies, they add.

The investigators also note that patients with mild TBI without acute intracranial trauma are typically managed by ED personnel.

“These findings highlight the importance of ED clinicians being aware of the risk of incomplete recovery for patients with a mild TBI (ie, GCS score of 15 and negative head CT scan) and providing accurate education and timely referral information before ED discharge,” they write.

The study was funded by grants from the National Foundation of Emergency Medicine, the National Institute of Neurological Disorders and Stroke, and the US Department of Defense Traumatic Brain Injury Endpoints Development Initiative. Madhok has reported no relevant financial relationships. All disclosures for the other TRACK-TBI investigators are listed in the original article.

JAMA Netw Open. Published August 17, 2022. Full text

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