Research Reports - Prevalence of incomplete functional and symptomatic recovery among patients with head injury

J Neurotrauma. 2017 Apr 15;34(8):1531-1538. doi: 10.1089/neu.2016.4723. Epub 2016
Dec 20.

Korley FK(1), Diaz-Arrastia R(2), Falk HJ(3), Peters ME(4), Leoutsakos JS(4), Roy
D(4), Rao V(4), Sair HI(5), Ofoche U(3), Hall AJ(3), Akbari F(3), Van Meter
TE(6), Everett AD(7), Van Eyk JE(8), Bechtold KT(9).

Head injury patients not meeting the American Congress of Rehabilitation Medicine
(ACRM)'s criteria for mild traumatic brain injury (mTBI), referred to hereafter
as HIBRID (Head Injury BRain Injury Debatable), are often excluded from studies.
The prognostic importance of HIBRID is unclear. We investigated the differences
in functional and symptomatic recovery at 1 month post-injury among TBI patients
classified as: HIBRID, ACRM+ cranial computed tomography (CT)-, and cranial CT+;
and trauma and healthy controls. Subjects were enrolled in an ongoing prospective
cohort (Head Injury Serum Markers for Assessing Response to Trauma; HeadSMART).
Outcomes measured at 1 month post-injury include: incomplete functional recovery
(Glasgow Outcome Scale Extended <8); moderate/severe post-concussive symptoms
(PCS), defined according to the International Statistical Classification of
Diseases and Related Health Problems, Tenth Revision definition; and
moderate/severe depressive symptoms (Patient Health Questionnaire 9 ≥ 10).
Between April 2014 and May 2016, 500 TBI and 100 control subjects were enrolled
and 376 TBI and 78 control subjects completed outcome assessment. The HIBRID
group, constituting 23.9% of study population, had a lower incidence of
incomplete functional recovery (36.7% [33 of 90]) than ACRM+, CT- (60.7% [125 of
206]; p < 0.01) and CT+ (78.8% [63 of 80]; p < 0.01) groups. However, the
incidence of delayed functional recovery within the HIBRID group was higher than
in trauma (9.3% [5 of 54]; p < 0.01) and healthy controls (0% [0 of 24];
p < 0.01). Compared to trauma/healthy controls, the HIBRID group had a higher
incidence of moderate/severe depressive symptoms and a similar incidence of
moderate/severe PCS. Subjects in the HIBRID group are at high risk for adverse
outcomes following head injury and warrant further investigation. 

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