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

the TRACK-TBI Investigators, Hansen Deng Predictors of mTBI admission, referral and outcome

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1820-1829
Number of pages10
JournalBrain Injury
Volume31
Issue number13-14
DOIs
StatePublished - Dec 6 2017
Externally publishedYes

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Brain Concussion
Referral and Consultation
Odds Ratio
Glasgow Coma Scale
Triage
Hospital Emergency Service
Demography
Glasgow Outcome Scale
Aftercare
Amnesia
Unemployment
Resource Allocation
Predictors
Traumatic Brain Injury
Admission
Multiple Trauma
Ambulatory Care
Seizures
Head
Tomography

Keywords

  • Clinical evaluation
  • follow-up care
  • outcome assessment
  • rehabilitation
  • traumatic brain injury

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Developmental and Educational Psychology
  • Arts and Humanities (miscellaneous)
  • Clinical Neurology

Cite this

Temporal profile of care following mild traumatic brain injury : predictors of hospital admission, follow-up referral and six-month outcome. / the TRACK-TBI Investigators; Hansen Deng Predictors of mTBI admission, referral and outcome.

In: Brain Injury, Vol. 31, No. 13-14, 06.12.2017, p. 1820-1829.

Research output: Contribution to journalArticle

the TRACK-TBI Investigators & Hansen Deng Predictors of mTBI admission, referral and outcome 2017, 'Temporal profile of care following mild traumatic brain injury: predictors of hospital admission, follow-up referral and six-month outcome', Brain Injury, vol. 31, no. 13-14, pp. 1820-1829. https://doi.org/10.1080/02699052.2017.1351000
the TRACK-TBI Investigators ; Hansen Deng Predictors of mTBI admission, referral and outcome. / Temporal profile of care following mild traumatic brain injury : predictors of hospital admission, follow-up referral and six-month outcome. In: Brain Injury. 2017 ; Vol. 31, No. 13-14. pp. 1820-1829.
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TY - JOUR

T1 - Temporal profile of care following mild traumatic brain injury

T2 - predictors of hospital admission, follow-up referral and six-month outcome

AU - the TRACK-TBI Investigators

AU - Hansen Deng Predictors of mTBI admission, referral and outcome

AU - Yue, John K.

AU - Winkler, Ethan A.

AU - Sharma, Sourabh

AU - Vassar, Mary J.

AU - Ratcliff, Jonathan J.

AU - Korley, Frederick

AU - Seabury, Seth A.

AU - Ferguson, Adam R.

AU - Lingsma, Hester F.

AU - Meeuws, Sacha

AU - Adeoye, Opeolu M.

AU - Rick, Jonathan W.

AU - Robinson, Caitlin K.

AU - Duarte, Siena M.

AU - Yuh, Esther L.

AU - Mukherjee, Pratik

AU - Dikmen, Sureyya S.

AU - McAllister, Thomas W.

AU - Diaz-Arrastia, Ramon

AU - Valadka, Alex B.

AU - Gordon, Wayne A.

AU - Okonkwo, David O.

AU - Manley, Geoffrey T.

PY - 2017/12/6

Y1 - 2017/12/6

N2 - 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.

AB - 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.

KW - Clinical evaluation

KW - follow-up care

KW - outcome assessment

KW - rehabilitation

KW - traumatic brain injury

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U2 - 10.1080/02699052.2017.1351000

DO - 10.1080/02699052.2017.1351000

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