Research Reports - Non-hospitalized patients with mild traumatic brain injury: The forgotten minority

J Neurotrauma. 2016 May 9. [Epub ahead of print]

de Koning ME(1), Scheenen ME(2), van der Horn HJ(1), Hageman G(3), Roks G(4),
Spikman JM(2), van der Naalt J(1).

Non-hospitalized mild traumatic brain injury (mTBI) patients comprise a
substantial part of the trauma population. For these patients, guidelines
recommend specialized follow-up only in the case of persistent complaints or
problems in returning to previous activities. This study describes injury and
outcome characteristics of non-hospitalized mTBI patients, and the possibility of
predicting which of the non-hospitalized patients will return to the outpatient
neurology clinic. Data from all non-hospitalized mTBI patients (Glasgow Coma
Scale [GCS] score 13-15, n = 462) from a prospective follow-up study on mTBI
(UPFRONT-study) conducted in three level 1 trauma centers were analyzed. At 2
weeks, and 3 and 6 months after injury, patients completed questionnaires on
post-traumatic complaints, depression, anxiety, outpatient follow-up, and
resumption of activities. Most patients were male (57%), with a mean age of 40
years (range 16-91 years). Injuries were most often caused by traffic accidents
(32%) or falls (39%). Six months after injury, 36% showed incomplete recovery as
defined by the Glasgow Outcome Scale - Extended (GOS-E). Twenty-five percent of
the non-hospitalized patients returned to the outpatient neurology clinic within
6 months after injury, of which one third had not completely resumed pre-injury
activities. Regression analyses showed an increased risk for outpatient follow-up
for patients scoring above the cutoff value for anxiety (odds ratio [OR] = 3.0),
depression (OR = 3.5), or both (OR = 3.7) 2 weeks after injury. Our findings
underline that clinicians and researchers should be aware of recovery for all
mTBI patients, preventing their transition into a forgotten minority. 

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