Major study finds that a majority of patients seen in the ER with mild TBI do not fully recover within 6 months, highlighting the importance of follow-up care
As highlighted in prior posts in this blog, TBI research increasingly highlights the importance of providing follow-up care to patients discharged from the ER with a diagnosis of TBI. Put simply, patients with follow up care have better outcomes.
In August, 2022 JAMA Network Open (an American Medical Association journal) published the results of a large cohort study following patients discharged from emergency rooms with the mildest form of traumatic brain injury, patients with a Glasgow Coma score of 15 (the best possible score) and negative head CT scans. The study tracked 991 TBI patients meeting these criteria seen in 18 different level 1 trauma centers. (Participants met the American College of Rehabilitation Medicine definition for TBI.)
Patient outcomes were assessed using two measures, the Glasgow Outcome Scale Extended (GOS-E) score and the Rivermead Post Concussion Symptoms Questionnaire (RPQ) score. At six months after the injury, 44% of this cohort had functional recovery and 56% had incomplete recovery. Patients with incomplete recovery at 2 weeks were likely to have continued incomplete recovery at six months. Participants with incomplete recovery described difficulty returning to social activities outside the home, disruptions is family relationships and friendships, and an inability to return to baseline preinjury life. The study also attempted to characterize the patients more likely to have incomplete recovery. They found that patients with incomplete recovery were more likely to be female, have less education and have a premorbid psychiatric history including depression, anxiety and post-traumatic stress disorder.
The authors describe several other recent studies demonstrating the value of post-acute care – including providing accurate education and interventions such as cognitive behavioral therapy and cognitive rehabilitation – in minimizing persistent symptoms. “The findings suggest,” the authors conclude, “that emergency department clinicians should recommend 2-week follow-up visits for these patients to identify those with incomplete recovery and facilitate their rehabilitation.”