Workplace and non-workplace mild traumatic brain injuries in an outpatient clinic sample: A case-control study

• Published in: PloS one 2018-06, Vol.13 (6), p.e0198128-e0198128
• Main Authors: Terry, Douglas P, Iverson, Grant L, Panenka, William, Colantonio, Angela, Silverberg, Noah D
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory Care Facilities - statistics & numerical data; Brain; Brain Concussion - epidemiology; Brain injuries; Brain research; Care and treatment; Case-Control Studies; Compensation; Concussion; Decision making; Female; Head injuries; Health care; Hospitals; Humans; Injuries; Injustice; Male; Medicine and Health Sciences; Middle Aged; Occupational health; Occupational Injuries - epidemiology; Patients; Post traumatic stress disorder; Post-Concussion Syndrome - epidemiology; Post-Concussion Syndrome - etiology; Posttraumatic stress disorder; Productivity; Quantitative psychology; Rehabilitation; Research and Analysis Methods; Return to Work - statistics & numerical data; Risk analysis; Risk Factors; Social Sciences; Socioeconomic Factors; Stress; Surveys and Questionnaires; Trauma; Trauma Severity Indices; Traumatic brain injury; Treatment Outcome; Work related injuries; Workers; Workers' Compensation; Workplace
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0198128

Individuals who are injured in the workplace typically have a greater risk of delayed return to work (RTW) and other poor health outcomes compared to those not injured at work. It is not known whether these differences hold true for mild traumatic brain injuries (MTBI). The present study examined differences associated with workplace and non-workplace MTBI upon intake to a specialty MTBI clinic, their outcomes, and risk factors that influence RTW. Slow-to-recover participants were recruited from consecutive referrals to four outpatient MTBI clinics from March 2015 to February 2017. Two clinics treat Worker's Compensation claimants and two clinics serve patients with non-work related injuries in the publically funded health care system. Of 273 eligible patients, 102 completed an initial study assessment (M age = 41.2 years, SD age = 11.7; 54% women) at an average of 2-3 months post injury. Participants were interviewed about their MTBI and completed a battery of standardized questionnaires and performance validity testing. Outcomes, including RTW, were assessed via telephone follow-up 4-5 months later. Workplace injuries comprised 45.1% of the sample. The workplace MTBI group had a greater proportion of men and lower education levels compared to the non-workplace MTBI group. The two groups had a comparable post-concussion symptom burden and performance validity test failure rate. Workplace MTBI was associated with greater post-traumatic stress symptoms. Fifteen patients (14.7%) were lost to follow-up. There were no workplace/non-workplace MTBI differences in RTW outcome at 6-7 months post injury. Of the entire sample, 42.5% of patients had full RTW, 18.4% had partial RTW, and 39.1% had no RTW. Greater post-concussion symptom burden was most predictive of no RTW at follow-up. There was no evidence that the workplace and non-workplace MTBI groups had different risk factors associated with prolonged work absence. Despite systemic differences in compensation and health care access, the workplace and non-workplace MTBI groups were similar at clinic intake and indistinguishable at follow-up, 6-7 months post injury.