Neuropsychologic and Functional Outcome After Complicated Mild Traumatic Brain Injury

doi:10.1016/j.apmr.2007.12.029

Archives of Physical Medicine and Rehabilitation

Volume 89, Issue 5, May 2008, Pages 904-911

https://doi.org/10.1016/j.apmr.2007.12.029 Get rights and content

Abstract

Kashluba S, Hanks RA, Casey JE, Millis SR. Neuropsychologic and functional outcome after complicated mild traumatic brain injury.

Objective

To investigate the extent to which neuropsychologic and functional outcome after complicated mild traumatic brain injury (TBI) parallels that of moderate TBI recovery.

Design

A longitudinal study comparing neuropsychologic and functional status of persons with complicated mild TBI and moderate TBI at discharge from inpatient rehabilitation and at 1 year postinjury.

Setting

Rehabilitation hospital with a Traumatic Brain Injury Model System.

Participants

Persons with complicated mild TBI (n=102), each with an intracranial brain lesion documented through neuroimaging and a highest Glasgow Coma Scale (GCS) score in the emergency department between 13 and 15, and 127 persons with moderate TBI.

Interventions

Not applicable.

Main Outcome Measures

FIM instrument, Disability Rating Scale, Community Integration Questionnaire, Wechsler Memory Scale logical memory I and II, Rey Auditory Verbal Learning Test, Trail-Making Test, Controlled Oral Word Association Test, Symbol Digit Modalities Test, Wisconsin Card Sorting Test, and block design.

Results

Few differences in neuropsychologic performance existed between the TBI groups. Less severely impaired information processing speed and verbal learning were seen in the complicated mild TBI group at rehabilitation discharge and 1 year postinjury. Despite overall improvement across cognitive domains within the complicated mild TBI group, some degree of impairment remained at 1 year postinjury on those measures that had identified participants as impaired soon after injury. No differences on functional ability measures were found between the TBI groups at either time period postinjury, with both groups exhibiting incomplete recovery of functional status at the 1-year follow-up.

Conclusions

When classifying severity of TBI based on GCS scores, consideration of a moderate injury designation should be given to persons with an intracranial bleed and a GCS score between 13 and 15.

Section snippets

Participants

Data were provided from 229 participants who were enrolled in the Southeastern Michigan Traumatic Brain Injury System (SEMTBIS), a participating center in the Traumatic Brain Injury Model Systems (TBIMS) project. Inclusion criteria for the TBIMS project require that participants (1) be at least 16 years of age at the time of injury, (2) arrived at a TBIMS level I trauma center within 24 hours of injury, (3) received both acute care and inpatient rehabilitation in hospitals designated as TBIMS

Results

Independent t tests and chi-square analyses of demographic factors showed no statistically significant differences (P>.05) between the complicated mild TBI and moderate TBI groups on level of education (Fisher exact test, P=.081), sex (Fisher exact test, P=.622), ethnicity (χ32_,N=229=2.56), or marital status (χ52_N=229=5.19). Conversely, the complicated mild TBI group was significantly older than the moderate TBI group (t₂₂₇=6.18, P<.001).

Comparison of injury severity characteristics, including

Discussion

Results of the current study support the hypothesis of similar levels of cognitive and functional outcome between complicated mild TBI and moderate TBI patients soon after injury. Unexpectedly, the finding of equivalent functional dependence and similar levels of cognitive impairment at 1 year postinjury did not support the hypothesis of better outcome after complicated mild TBI in the longer term. Overall, this study showed few differences in outcome between patients with mild TBI complicated

Conclusions

The current study extends findings of short-term cognitive and functional outcome after complicated mild TBI and provides a preliminary view of longer-term recovery. Sufficient parallels in outcome after complicated mild TBI and moderate TBI were found to indicate that when classifying severity of TBI based on GCS scores, consideration of a moderate injury designation should be given to persons with an intracranial bleed and a GCS score between 13 and 15.

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: Supported by the Social Sciences and Humanities Research Council of Canada and the National Institute on Disability and Rehabilitation Research (grant no. H133A020515).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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Special section: Original articleNeuropsychologic and Functional Outcome After Complicated Mild Traumatic Brain Injury

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Arch Phys Med Rehabil

Lancet

Arch Clin Neuropsychol

Neurosurg Clin N Am

Lancet

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Rehabilitation of persons with traumatic brain injury

JAMA

One year psychosocial outcome in head injury

J Int Neuropsychol Soc

A multicenter longitudinal investigation of return to work and community integration following traumatic brain injury

J Head Trauma Rehabil

Neuropsychologic and psychosocial consequences of minor head injury

J Neurol Neurosurg Psychiatry

Neurobehavioral outcome of minor head injury: a three center study

J Neurosurg

Factors influencing outcome following mild traumatic brain injury in adults

J Int Neuropsychol Soc

High-risk mild head injury

J Neurosurg

Mild head injury classification

Neurosurgery

Cognitive and neurobehavioral functioning after mild versus moderate traumatic brain injury in older adults

J Int Neuropsychol Soc

Cognitive and affective sequelae in complicated and uncomplicated mild traumatic brain injury

Brain Inj

A randomized trial of two treatments for mild traumatic brain injury

Brain Inj

Rehabilitation programs for patients with mild head injury: components, problems, and evaluation

J Head Trauma Rehabil

A review of mild head trauma: part IMeta-analytic review of neuropsychological studies

J Clin Exp Neuropsychol

Special section: Original article
Neuropsychologic and Functional Outcome After Complicated Mild Traumatic Brain Injury