Research Reports - Mild Traumatic Brain Injury: Longitudinal study of cognition, functional status, and post-traumatic symptoms

J Neurotrauma. 2016 Oct 27. [Epub ahead of print]

Dikmen S Ph D(1), Machamer J(2), Temkin NR Ph D(3).

Over 75% of traumatic brain injuries (TBIs) seeking medical attention are mild,
and outcome in that group is heterogeneous. Until sensitive and valid biomarkers
are identified, methods are needed to classify mild TBI into more homogeneous
subgroups. Four-hundred-twenty-one adults with mild TBI are divided into Glasgow
Coma Scale (GCS) 13-15 without CT abnormalities, GCS 15 with CT abnormalities,
and GCS 13-14 with CT abnormalities and compared with 120 trauma controls on
1-month and 1-year outcomes. At 1 month post-injury, almost all
neuropsychological variables differed significantly among the groups. Compared to
trauma controls, the GCS 13-15, CT normal group showed no significant differences
on any neuropsychological measure or Glasgow Outcome Scale (GOS). The GCS 15, CT
abnormal group performed significantly worse on only a measure of episodic memory
and learning (Selective Reminding Recall--SRCL) and GOS and the GCS 13-14, CT
abnormal group performed significantly worse on most neuropsychological measures
and GOS. At 1 year-post injury, except for an isolated difficulty on SRCL in the
GCS 13-14, CT abnormal group, no differences were observed on any
neuropsychological measures nor on GOS. Mean percent of total post-traumatic
symptoms endorsed as new or worse and percent endorsing 3 or more symptoms
differed significantly (p < .001) with each TBI subgroup reporting significantly
more symptoms than the trauma controls at both 1 month and 1 year. In conclusion,
this subgrouping improves granularity within mild TBI. While most
neuropsychological and functional differences abate by one year, reporting 3 or
more post traumatic symptoms remain for about half of individuals. 

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