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- Title
Longitudinal Recovery Following Repetitive Traumatic Brain Injury.
- Authors
Etemad, Leila L.; Yue, John K.; Barber, Jason; Nelson, Lindsay D.; Bodien, Yelena G.; Satris, Gabriela G.; Belton, Patrick J.; Madhok, Debbie Y.; Huie, J. Russell; Hamidi, Sabah; Tracey, Joye X.; Coskun, Bukre C.; Wong, Justin C.; Yuh, Esther L.; Mukherjee, Pratik; Markowitz, Amy J.; Huang, Michael C.; Tarapore, Phiroz E.; Robertson, Claudia S.; Diaz-Arrastia, Ramon
- Abstract
Key Points: Question: What are the functional, postconcussive, mental health, and health-related quality-of-life outcomes at 1 year and 3 to 7 years postinjury among adults with postindex traumatic brain injuries (TBIs)? Findings: In this cohort study of 2417 patients with TBI, compared with those without postindex TBIs, individuals with postindex TBIs at 1 year and 3 to 7 years were more symptomatic across functional, postconcussive, mental health, and health-related quality of life domains, with greatest symptom burden observed in individuals with multiple postindex TBIs. Meaning: In this study, participants with postindex TBIs were a symptomatic cohort in long-term recovery, and prevention, education, counseling, and follow-up care is needed for these at-risk patients. This cohort study evaluates associations between sustaining 1 or more TBIs after study enrollment and functional, postconcussive, mental health, and health-related quality-of-life outcomes at 1 year and 3 to 7 years. Importance: One traumatic brain injury (TBI) increases the risk of subsequent TBIs. Research on longitudinal outcomes of civilian repetitive TBIs is limited. Objective: To investigate associations between sustaining 1 or more TBIs (ie, postindex TBIs) after study enrollment (ie, index TBIs) and multidimensional outcomes at 1 year and 3 to 7 years. Design, Setting, and Participants: This cohort study included participants presenting to emergency departments enrolled within 24 hours of TBI in the prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study (enrollment years, February 2014 to July 2020). Participants who completed outcome assessments at 1 year and 3 to 7 years were included. Data were analyzed from September 2022 to August 2023. Exposures: Postindex TBI(s). Main Outcomes and Measures: Demographic and clinical factors, prior TBI (ie, preindex TBI), and functional (Glasgow Outcome Scale–Extended [GOSE]), postconcussive (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]), psychological distress (Brief Symptom Inventory-18 [BSI-18]), depressive (Patient Health Questionnaire-9 [PHQ-9]), posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5 [PCL-5]), and health-related quality-of-life (Quality of Life After Brain Injury–Overall Scale [QOLIBRI-OS]) outcomes were assessed. Adjusted mean differences (aMDs) and adjusted relative risks are reported with 95% CIs. Results: Of 2417 TRACK-TBI participants, 1572 completed the outcomes assessment at 1 year (1049 [66.7%] male; mean [SD] age, 41.6 [17.5] years) and 1084 completed the outcomes assessment at 3 to 7 years (714 [65.9%] male; mean [SD] age, 40.6 [17.0] years). At 1 year, a total of 60 participants (4%) were Asian, 255 (16%) were Black, 1213 (77%) were White, 39 (2%) were another race, and 5 (0.3%) had unknown race. At 3 to 7 years, 39 (4%) were Asian, 149 (14%) were Black, 868 (80%) were White, 26 (2%) had another race, and 2 (0.2%) had unknown race. A total of 50 (3.2%) and 132 (12.2%) reported 1 or more postindex TBIs at 1 year and 3 to 7 years, respectively. Risk factors for postindex TBI were psychiatric history, preindex TBI, and extracranial injury severity. At 1 year, compared with those without postindex TBI, participants with postindex TBI had worse functional recovery (GOSE score of 8: adjusted relative risk, 0.57; 95% CI, 0.34-0.96) and health-related quality of life (QOLIBRI-OS: aMD, −15.9; 95% CI, −22.6 to −9.1), and greater postconcussive symptoms (RPQ: aMD, 8.1; 95% CI, 4.2-11.9), psychological distress symptoms (BSI-18: aMD, 5.3; 95% CI, 2.1-8.6), depression symptoms (PHQ-9: aMD, 3.0; 95% CI, 1.5-4.4), and PTSD symptoms (PCL-5: aMD, 7.8; 95% CI, 3.2-12.4). At 3 to 7 years, these associations remained statistically significant. Multiple (2 or more) postindex TBIs were associated with poorer outcomes across all domains. Conclusions and Relevance: In this cohort study of patients with acute TBI, postindex TBI was associated with worse symptomatology across outcome domains at 1 year and 3 to 7 years postinjury, and there was a dose-dependent response with multiple postindex TBIs. These results underscore the critical need to provide TBI prevention, education, counseling, and follow-up care to at-risk patients.
- Subjects
CONFIDENCE intervals; CONVALESCENCE; POST-traumatic stress disorder; HEALTH outcome assessment; DISEASE relapse; RISK assessment; POSTCONCUSSION syndrome; DESCRIPTIVE statistics; QUESTIONNAIRES; MENTAL depression; QUALITY of life; RESEARCH funding; BRAIN injuries; SOCIODEMOGRAPHIC factors; LONGITUDINAL method; PSYCHOLOGICAL distress; DISEASE risk factors
- Publication
JAMA Network Open, 2023, Vol 6, Issue 9, pe2335804
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.35804