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

John K Yue; Ethan A Winkler; Sourabh Sharma; Mary J Vassar; Jonathan J Ratcliff; Frederick K Korley; Seth A Seabury; Adam R Ferguson; Hester F Lingsma; Hansen Deng; Sacha Meeuws; Opeolu M Adeoye; Jonathan W Rick; Caitlin K Robinson; Siena M Duarte; Esther L Yuh; Pratik Mukherjee; Sureyya S Dikmen; Thomas W McAllister; Ramon Diaz-Arrastia; Alex B Valadka; Wayne A Gordon; David O Okonkwo; Geoffrey T Manley; the TRACK-TBI Investigators

doi:10.1080/02699052.2017.1351000

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.

Authors

John K Yue^{1

2}, Ethan A Winkler^{1

2}, Sourabh Sharma^{1

2}, Mary J Vassar^{1

2}, Jonathan J Ratcliff³, Frederick K Korley⁴, Seth A Seabury⁵, Adam R Ferguson^{1

2}, Hester F Lingsma^{1

2

6}, Hansen Deng, Sacha Meeuws⁷, Opeolu M Adeoye⁸, Jonathan W Rick^{1

2}, Caitlin K Robinson^{1

2}, Siena M Duarte^{1

2}, Esther L Yuh^{2

9}, Pratik Mukherjee^{2

9}, Sureyya S Dikmen¹⁰, Thomas W McAllister¹¹, Ramon Diaz-Arrastia^{12

13}, Alex B Valadka¹⁴, Wayne A Gordon¹⁵, David O Okonkwo¹⁶, Geoffrey T Manley^{1

2}; the TRACK-TBI Investigators

Affiliations

¹ a Department of Neurological Surgery , University of California, San Francisco , San Francisco , CA , USA.
² b Brain and Spinal Injury Center , San Francisco General Hospital , San Francisco , CA , USA.
³ c Departments of Emergency Medicine and Neurology , Emory University , Atlanta , GA , USA.
⁴ d Department of Emergency Medicine , University of Michigan , Ann Arbor , MI , USA.
⁵ e Leonard D. Schaeffer Center for Health Policy and Economics , University of Southern California , Los Angeles , CA , USA.
⁶ f Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands.
⁷ g Department of Neurological Surgery , University Hospital Antwerp , Edegem , Belgium.
⁸ h Department of Emergency Medicine , University of Cincinnati , Cincinnati , OH , USA.
⁹ i Department of Radiology , University of California, San Francisco , San Francisco , CA , USA.
¹⁰ j Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA.
¹¹ k Department of Psychiatry , Indiana University , Indianapolis , IN , USA.
¹² l Department of Neurology , Uniformed Services University of the Health Sciences , Bethesda , MD , USA.
¹³ m Center for Neuroscience and Regenerative Medicine , Bethesda , MD , USA.
¹⁴ n Seton Brain and Spine Institute , Austin , TX , USA.
¹⁵ o Department of Rehabilitation Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.
¹⁶ p Department of Neurological Surgery , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.

PMID: 29166203
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