Patients with mild TBI, negative CT scan should be evaluated 2 weeks after injury
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Most patients with mild traumatic brain injury and a negative CT scan experience incomplete recovery and should undergo a follow-up exam 2 weeks after injury to improve rehabilitation, according to a study published in JAMA Network Open.
“Although all-cause mortality for mild TBI is low, studies have found that patients are at a substantial risk for serious sequelae in the first 6 months after injury,” Debbie Y. Madhok, MD, of the department of emergency medicine at the University of California, San Francisco, and colleagues wrote.
Madhok and fellow researchers sought to describe 2-week and 6-month recovery outcomes in a cohort of patients with mild TBI, a Glasgow Coma Scale score of 15 and a negative CT head scan, as both short- and long-term functional outcomes in this population are unclear.
They included 991 participants (mean age, 38.5 years; 64% men) who were enrolled from January 2014 to December 2018 in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study, which was conducted in the EDs of 18 American level I trauma centers.
Outcomes of interest included Glasgow Outcome Scale-Extended (GOS-E) score, stratified by functional recovery (score = 8) and incomplete recovery (score <8) at 2 weeks and 6 months after the injury, and severity of mild TBI–related symptoms determined by the Rivermead Post Concussion Symptoms Questionnaire (RPQ) total score.
Of 751 enrollees who underwent a 2-week follow-up after injury, 204 (27%) had a GOS-E score of 8 and 547 (73%) had a GOS-E score of less than 8. Of 659 participants (66%) who were evaluated 6 months, 287 (44%) had functional recovery and 372 (56%) had incomplete recovery. Further, 88% of participants with incomplete recovery reported they had not returned to baseline or preinjury life (95% CI, 85%-90%).
In participants with a GOS-E score of 8, mean RPQ score was 16 (95% CI, 14-18) points lower at 2 weeks (7 vs. 23) and 18 (95% CI, 16-20) points lower at 6 months (4 vs. 22) compared with those with a GOS-E score less than 8.
“Given that most patients with TBI are managed solely by ED clinicians, understanding their outcomes is particularly relevant for ED care and disposition planning,” Madhok and colleagues concluded. “The findings of this study suggest that ED clinicians should recommend 2-week follow-up visits for these patients to identify those with incomplete recovery and to facilitate their rehabilitation.”