Research Reports - Non-hospitalized patients with mild traumatic brain injury, the forgotten minority?

J Neurotrauma. 2016 Mar 30. [Epub ahead of print]

de Koning ME(1), Scheenen ME(2,)(3), van der Horn HJ(4), Hageman G(5), Roks G(6),
Spikman JM(7), van der Naalt J(8,)(9).

Non-hospitalized mild traumatic brain injury patients (mTBI) comprise a
substantial part of the trauma population. For these patients, guidelines
recommend specialized follow-up only in the case of persistent complaints or
problems returning to previous activities. This study describes injury and
outcome characteristics of non-hospitalized mTBI patients and the possibility of
predicting which of the non-hospitalized patients will return to the outpatient
neurology clinic. Data from all non-hospitalized mTBI patients (GCS 13-15, n=462)
from a prospective follow-up study on mTBI (UPFRONT-study) conducted in three
level-1 trauma centers were analyzed. At two weeks, three and six months after
injury, patients completed questionnaires on posttraumatic complaints,
depression, anxiety, outpatient follow-up, and resumption of activities. Most
patients were male (57%), with a mean age of 40 years (range 16-91). Injuries
were most often caused by traffic accidents (32%) or falls (39%). Six months
after injury 36% showed incomplete recovery as defined by the GOSE. Twenty-five
percent of the non-hospitalized patients returned to the outpatient neurology
clinic within six months after injury, of which one third had not completely
resumed pre-injury activities. Regression analyses showed an increased risk for
outpatient follow-up for patients scoring above the cut-off value for anxiety
(odds ratio [OR] =3.0), depression (OR 3.5), or both (OR 3.7) two weeks after
injury. Our findings underline that clinicians and researchers should be aware of
recovery for all mTBI patients, to prevent a forgotten minority. 

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