Temporal profile of care following mild traumatic brain injury: predictors of hospital admission, follow-up referral and six-month outcome

Brain Inj. 2017;31(13-14):1820-1829. doi: 10.1080/02699052.2017.1351000.

Abstract

Objective: To investigate the clinical management and medical follow-up of patients with mild traumatic brain injury (mTBI) presenting to emergency departments (EDs).

Methods: Overall, 168 adult patients with mTBI from the prospective, multicentre Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot study with Glasgow Coma Scale (GCS) 13-15, no polytrauma and alive at six months were included. Predictors for hospital admission, three-month follow-up referral and six-month functional disability (Glasgow Outcome Scale-Extended (GOSE) ≤ 6) were analysed using multivariable regression.

Results: Overall, 48% were admitted to hospital, 22% received three-month referral and 27% reported six-month functional disability. Intracranial pathology on ED head computed tomography (multivariable odds ratio (OR) = 81.08, 95% confidence interval (CI) [10.28-639.36]) and amnesia (>30-minutes: OR = 5.27 [1.75-15.87]; unknown duration: OR = 4.43 [1.26-15.62]) predicted hospital admission. Older age (per-year OR = 1.03 [1.01-1.05]) predicted three-month referral, while part-time/unemployment predicted lack of referral (OR = 0.17 [0.06-0.50]). GCS < 15 (OR = 2.46 [1.05-5.78]) and prior history of seizures (OR = 3.62 [1.21-10.89]) predicted six-month functional disability, while increased education (per-year OR = 0.86 [0.76-0.97]) was protective.

Conclusions: Clinical factors modulate triage to admission, while demographic/socioeconomic elements modulate follow-up care acquisition; six-month functional disability associates with both clinical and demographic/socioeconomic variables. Improving triage to acute and outpatient care requires further investigation to optimize resource allocation and outcome after mTBI. ClinicalTrials.gov registration: NCT01565551.

Keywords: Clinical evaluation; follow-up care; outcome assessment; rehabilitation; traumatic brain injury.

MeSH terms

  • Adult
  • Brain Injuries, Traumatic / therapy*
  • Disability Evaluation
  • Disabled Persons / psychology*
  • Disabled Persons / rehabilitation
  • Emergency Service, Hospital
  • Female
  • Follow-Up Studies
  • Glasgow Outcome Scale
  • Hospital Administration*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Treatment Outcome*
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT01565551