TY - JOUR PY - 2023// TI - Longitudinal recovery following repetitive traumatic brain injury JO - JAMA network open A1 - Etemad, Leila L. A1 - Yue, John K. A1 - Barber, Jason A1 - Nelson, Lindsay D. A1 - Bodien, Yelena G. A1 - Satris, Gabriela G. A1 - Belton, Patrick J. A1 - Madhok, Debbie Y. A1 - Huie, J. Russell A1 - Hamidi, Sabah A1 - Tracey, Joye X. A1 - Coskun, Bukre C. A1 - Wong, Justin C. A1 - Yuh, Esther L. A1 - Mukherjee, Pratik A1 - Markowitz, Amy J. A1 - Huang, Michael C. A1 - Tarapore, Phiroz E. A1 - Robertson, Claudia S. A1 - Diaz-Arrastia, Ramon A1 - Stein, Murray B. A1 - Ferguson, Adam R. A1 - Puccio, Ava M. A1 - Okonkwo, David O. A1 - Giacino, Joseph T. A1 - McCrea, Michael A. A1 - Manley, Geoffrey T. A1 - Temkin, Nancy R. A1 - DiGiorgio, Anthony M. SP - e2335804 EP - e2335804 VL - 6 IS - 9 N2 - 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.

Language: en

LA - en SN - 2574-3805 UR - http://dx.doi.org/10.1001/jamanetworkopen.2023.35804 ID - ref1 ER -