Citation

Korley FK, Diaz-Arrastia R, Falk HJ, Peters ME, Leoutsakos JS, Roy D, Rao V, Sair HI, Ofoche U, Hall AJ, Akbari F, Van Meter TE, Everett AD, Van Eyk J, Bechtold KT. J. Neurotrauma 2016; 34(8): 1531-1538.

Affiliation

Johns Hopkins University School of Medicine, Department of Physical Medicine & Rehabilitation , Baltimore, United States ; kbechto1@jhmi.edu.

Copyright

(Copyright © 2016, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2016.4723

PMID

27784200

Abstract

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 one month after injury among TBI patients classified as: HIBRID, ACRM+ cranial 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 one month post-injury include: incomplete functional recovery (Glasgow Outcome Scale Extended<8); moderate/severe post-concussive symptoms (PCS), defined according to the ICD-10 definition; and moderate/severe depressive symptoms (Patient Health Questionnaire 9 (PHQ9)>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% [33/90]) than ACRM+,CT- (60.7% [125/206], p<0.01) and CT+ (78.8% [63/80], p<0.01) groups. However, the incidence of delayed functional recovery within the HIBRID group was higher than in trauma (9.3% [5/54], p<0.01) and healthy controls (0% [0/24], 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.

Language: en