Return to work after mild traumatic brain injury: association with positive CT and MRI findings

• Published in: Acta neurochirurgica 2022-07, Vol.164 (7), p.1707-1717
• Main Authors: Huovinen, Antti, Marinkovic, Ivan, Isokuortti, Harri, Korvenoja, Antti, Mäki, Kaisa, Nybo, Taina, Raj, Rahul, Melkas, Susanna
• Format: Article
• Language: English
• Subjects: Adult; Brain Concussion - diagnostic imaging; Brain trauma; Computed tomography; Concussion; Humans; Interventional Radiology; Lesions; Magnetic resonance imaging; Magnetic Resonance Imaging - adverse effects; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neuroimaging; Neurology; Neuroradiology; Neurosurgery; Original - Brain trauma; Original Article - Brain trauma; Post-Concussion Syndrome - complications; Post-Concussion Syndrome - diagnostic imaging; Return to Work; Surgical Orthopedics; Tomography, X-Ray Computed - adverse effects; Traumatic brain injury
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-022-05244-4

Background Return to work (RTW) might be delayed in patients with complicated mild traumatic brain injury (MTBI), i.e., MTBI patients with associated traumatic intracranial lesions. However, the effect of different types of lesions on RTW has not studied before. We investigated whether traumatic intracranial lesions detected by CT and MRI are associated with return to work and post-concussion symptoms in patients with MTBI. Methods We prospectively followed up 113 adult patients with MTBI that underwent a brain MRI within 3–17 days after injury. Return to work was assessed with one-day accuracy up to one year after injury. Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and Glasgow Outcome Scale Extended (GOS-E) were conducted one month after injury. A Kaplan–Meier log-rank analysis was performed to analyze the differences in RTW. Results Full RTW-% one year after injury was 98%. There were 38 patients with complicated MTBI, who had delayed median RTW compared to uncomplicated MTBI group (17 vs. 6 days), and more post-concussion symptoms (median RPQ 12.0 vs. 6.5). Further, RTW was more delayed in patients with multiple types of traumatic intracranial lesions visible in MRI (31 days, n  = 19) and when lesions were detected in the primary CT (31 days, n  = 24). There were no significant differences in GOS-E. Conclusions The imaging results that were most clearly associated with delayed RTW were positive primary CT and multiple types of lesions in MRI. RTW-% of patients with MTBI was excellent and a single intracranial lesion does not seem to be a predictive factor of disability to work.