Temporal profile of care following mild traumatic brain injury: predictors of hospital admission, follow-up referral and six-month outcome

• Published in: Brain injury 2017-12, Vol.31 (13-14), p.1820-1829
• Main Authors: Yue, John K., Winkler, Ethan A., Sharma, Sourabh, Vassar, Mary J., Ratcliff, Jonathan J., Korley, Frederick K., Seabury, Seth A., Ferguson, Adam R., Lingsma, Hester F., Deng, Hansen, Meeuws, Sacha, Adeoye, Opeolu M., Rick, Jonathan W., Robinson, Caitlin K., Duarte, Siena M., Yuh, Esther L., Mukherjee, Pratik, Dikmen, Sureyya S., McAllister, Thomas W., Diaz-Arrastia, Ramon, Valadka, Alex B., Gordon, Wayne A., Okonkwo, David O., Manley, Geoffrey T.
• Format: Article
• Language: English
• Subjects: Adult; Brain Injuries, Traumatic - therapy; Clinical evaluation; Disability Evaluation; Disabled Persons - psychology; Disabled Persons - rehabilitation; Emergency Service, Hospital; Female; follow-up care; Follow-Up Studies; Glasgow Outcome Scale; Hospital Administration; Humans; Male; Middle Aged; Multivariate Analysis; outcome assessment; Predictive Value of Tests; rehabilitation; traumatic brain injury; Treatment Outcome; Young Adult
• ISSN: 0269-9052; 1362-301X
• DOI: 10.1080/02699052.2017.1351000

Objective: To investigate the clinical management and medical follow-up of patients with mild traumatic brain injury (mTBI) presenting to emergency departments (EDs). Methods: Overall, 168 adult patients with mTBI from the prospective, multicentre Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) Pilot study with Glasgow Coma Scale (GCS) 13-15, no polytrauma and alive at six months were included. Predictors for hospital admission, three-month follow-up referral and six-month functional disability (Glasgow Outcome Scale-Extended (GOSE) ≤ 6) were analysed using multivariable regression. Results: Overall, 48% were admitted to hospital, 22% received three-month referral and 27% reported six-month functional disability. Intracranial pathology on ED head computed tomography (multivariable odds ratio (OR) = 81.08, 95% confidence interval (CI) [10.28-639.36]) and amnesia (>30-minutes: OR = 5.27 [1.75-15.87]; unknown duration: OR = 4.43 [1.26-15.62]) predicted hospital admission. Older age (per-year OR = 1.03 [1.01-1.05]) predicted three-month referral, while part-time/unemployment predicted lack of referral (OR = 0.17 [0.06-0.50]). GCS < 15 (OR = 2.46 [1.05-5.78]) and prior history of seizures (OR = 3.62 [1.21-10.89]) predicted six-month functional disability, while increased education (per-year OR = 0.86 [0.76-0.97]) was protective. Conclusions: Clinical factors modulate triage to admission, while demographic/socioeconomic elements modulate follow-up care acquisition; six-month functional disability associates with both clinical and demographic/socioeconomic variables. Improving triage to acute and outpatient care requires further investigation to optimize resource allocation and outcome after mTBI. ClinicalTrials.gov registration: NCT01565551