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Open AccessArticle

Clinical Predictors of 3- and 6-Month Outcome for Mild Traumatic Brain Injury Patients with a Negative Head CT Scan in the Emergency Department: A TRACK-TBI Pilot Study

1
Department of Emergency Medicine and Neurology, University of California San Francisco, Suite 6A, 1001 Potrero Ave, Building 5, Suite 6A, San Francisco, CA 94110, USA
2
Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA 94143, USA
3
Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, 1001 Potrero Ave, Bldg. 1, Rm 101, San Francisco, CA 94110, USA
4
Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, San Diego, CA 92093, USA
5
Department of Neurology, University of Utah School of Medicine, 175 North Medical Drive East, Salt Lake City, UT 84132, USA
*
Author to whom correspondence should be addressed.
The TRACK-TBI Investigators are listed at the end of the manuscript in alphabetical order by last name and are indexed on MEDLINE under “Collaborators”.
Brain Sci. 2020, 10(5), 269; https://doi.org/10.3390/brainsci10050269
Received: 21 March 2020 / Revised: 8 April 2020 / Accepted: 28 April 2020 / Published: 1 May 2020
(This article belongs to the Special Issue Health Disparities in Traumatic Brain Injury)
A considerable subset of mild traumatic brain injury (mTBI) patients fail to return to baseline functional status at or beyond 3 months postinjury. Identifying at-risk patients for poor outcome in the emergency department (ED) may improve surveillance strategies and referral to care. Subjects with mTBI (Glasgow Coma Scale 13–15) and negative ED initial head CT < 24 h of injury, completing 3- or 6-month functional outcome (Glasgow Outcome Scale-Extended; GOSE), were extracted from the prospective, multicenter Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot study. Outcomes were dichotomized to full recovery (GOSE = 8) vs. functional deficits (GOSE < 8). Univariate predictors with p < 0.10 were considered for multivariable regression. Adjusted odds ratios (AOR) were reported for outcome predictors. Significance was assessed at p < 0.05. Subjects who completed GOSE at 3- and 6-month were 211 (GOSE < 8: 60%) and 185 (GOSE < 8: 65%). Risk factors for 6-month GOSE < 8 included less education (AOR = 0.85 per-year increase, 95% CI: (0.74–0.98)), prior psychiatric history (AOR = 3.75 (1.73–8.12)), Asian/minority race (American Indian/Alaskan/Hawaiian/Pacific Islander) (AOR = 23.99 (2.93–196.84)), and Hispanic ethnicity (AOR = 3.48 (1.29–9.37)). Risk factors for 3-month GOSE < 8 were similar with the addition of injury by assault predicting poorer outcome (AOR = 3.53 (1.17–10.63)). In mTBI patients seen in urban trauma center EDs with negative CT, education, injury by assault, Asian/minority race, and prior psychiatric history emerged as risk factors for prolonged disability. View Full-Text
Keywords: mild traumatic brain injury; emergency department; clinical predictors; outcome mild traumatic brain injury; emergency department; clinical predictors; outcome
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MDPI and ACS Style

Madhok, D.Y.; Yue, J.K.; Sun, X.; Suen, C.G.; Coss, N.A.; Jain, S.; Manley, G.T.; the TRACK-TBI Investigators. Clinical Predictors of 3- and 6-Month Outcome for Mild Traumatic Brain Injury Patients with a Negative Head CT Scan in the Emergency Department: A TRACK-TBI Pilot Study. Brain Sci. 2020, 10, 269.

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