Citation

Roy D, Peters ME, Everett AD, Leoutsakos JS, Yan H, Rao V, Bechtold KT, Sair HI, Van Meter T, Falk H, Vassila A, Hall A, Ofoche U, Akbari F, Lyketsos C, Korley F. J. Neuropsychiatry Clin. Neurosci. 2019; ePub(ePub): ePub.

Affiliation

The Department of Psychiatry and Behavioral Sciences (Roy, Peters, Leoutsakos, Yan, Rao, Lyketsos), Department of Pediatrics (Everett), and Department of Physical Medicine and Rehabilitation (Bechtold), Johns Hopkins University School of Medicine, Baltimore; the Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore (Sair); the Program for Neurological Diseases, ImmunArray USA, Richmond, Va. (Van Meter); the Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Mich. (Falk, Korley); Theradex Systems, Princeton, N.J. (Vassila); the Department of Neurology, Johns Hopkins University, Baltimore (Hall); the Department of Forensic Science, Drexel University College of Medicine, Philadelphia (Ofoche); and the Department of Cardiac Surgery, University of Maryland, Baltimore (Akbari).

Copyright

(Copyright © 2019, American Neuropsychiatric Association, Publisher American Psychiatric Publishing)

DOI

10.1176/appi.neuropsych.18120379

PMID

31530119

Abstract

OBJECTIVE: The authors tested the hypothesis that a combination of loss of consciousness (LOC) and altered mental state (AMS) predicts the highest risk of incomplete functional recovery within 6 months after mild traumatic brain injury (mTBI), compared with either condition alone, and that LOC alone is more strongly associated with incomplete recovery, compared with AMS alone.

METHODS: Data were analyzed from 407 patients with mTBI from Head injury Serum Markers for Assessing Response to Trauma (HeadSMART), a prospective cohort study of TBI patients presenting to two urban emergency departments. Four patient subgroups were constructed based on information documented at the time of injury: neither LOC nor AMS, LOC only, AMS only, and both. Logistic regression models assessed LOC and AMS as predictors of functional recovery at 1, 3, and 6 months.

RESULTS: A gradient of risk of incomplete functional recovery at 1, 3, and 6 months postinjury was noted, moving from neither LOC nor AMS, to LOC or AMS alone, to both. LOC was associated with incomplete functional recovery at 1 and 3 months (odds ratio=2.17, SE=0.46, p<0.001; and odds ratio=1.80, SE=0.40, p=0.008, respectively). AMS was associated with incomplete functional recovery at 1 month only (odds ratio=1.77, SE=0.37 p=0.007). No association was found between AMS and functional recovery in patients with no LOC. Neither LOC nor AMS was predictive of functional recovery at later times.

CONCLUSIONS: These findings highlight the need to include symptom-focused clinical variables that pertain to the injury itself when assessing who might be at highest risk of incomplete functional recovery post-mTBI.

Language: en

Keywords

Diagnosis and Classification in Neuropsychiatry; Outcome Studies; Traumatic Brain Injury