Outcomes after Complicated and Uncomplicated Mild Traumatic Brain Injury at Three-and Six-Months Post-Injury: Results from the CENTER-TBI Study
by
Daphne C. Voormolen 1,*,†
, Marina Zeldovich 2,*,†, Juanita A. Haagsma 1,3, Suzanne Polinder 1, Sarah Friedrich 4, Andrew I. R. Maas 5,6, Lindsay Wilson 7, Ewout W. Steyerberg 1,8, Amra Covic 2, Nada Andelic 9,10, Anne Marie Plass 2, Yi-Jhen Wu 2, Thomas Asendorf 4, Nicole von Steinbüechel 2 and CENTER-TBI Participants Investigators ‡
Daphne C. Voormolen 1,*,†, Marina Zeldovich 2,*,†, Juanita A. Haagsma 1,3, Suzanne Polinder 1, Sarah Friedrich 4, Andrew I. R. Maas 5,6, Lindsay Wilson 7, Ewout W. Steyerberg 1,8, Amra Covic 2, Nada Andelic 9,10, Anne Marie Plass 2, Yi-Jhen Wu 2, Thomas Asendorf 4, Nicole von Steinbüechel 2 and CENTER-TBI Participants Investigators ‡
1
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
2
Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
3
Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
4
Department of Medical Statistics, University Medical Center Göttingen, Göttingen 37073, Germany
5
Department of Neurosurgery, Antwerp University Hospital, Edegem 2650, Belgium
6
University of Antwerp, 2650 Edegem, Belgium
7
Department of Psychology, University of Stirling, Stirling FK9 4LJ, UK
8
Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
9
Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0450 Oslo, Norway
10
Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, 0373 Oslo, Norway
*
Authors to whom correspondence should be addressed.
†
Shared first authorship.
‡
The CENTER-TBI participants and investigator is provided in the Supplementary file.
J. Clin. Med. 2020, 9(5), 1525; https://doi.org/10.3390/jcm9051525
Received: 8 April 2020 / Revised: 11 May 2020 / Accepted: 15 May 2020 / Published: 18 May 2020
(This article belongs to the Section Clinical Neurology)
The objective of this study was to provide a comprehensive examination of the relation of complicated and uncomplicated mild traumatic brain injury (mTBI) with multidimensional outcomes at three- and six-months after TBI. We analyzed data from the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) research project. Patients after mTBI (Glasgow Coma scale (GCS) score of 13–15) enrolled in the study were differentiated into two groups based on computed tomography (CT) findings: complicated mTBI (presence of any traumatic intracranial injury on first CT) and uncomplicated mTBI (absence of any traumatic intracranial injury on first CT). Multidimensional outcomes were assessed using seven instruments measuring generic and disease-specific health-related quality of life (HRQoL) (SF-36 and QOLIBRI), functional outcome (GOSE), and psycho-social domains including symptoms of post-traumatic stress disorder (PTSD) (PCL-5), depression (PHQ-9), and anxiety (GAD-7). Data were analyzed using a multivariate repeated measures approach (MANOVA-RM), which inspected mTBI groups at three- and six-months post injury. Patients after complicated mTBI had significantly lower GOSE scores, reported lower physical and mental component summary scores based on the SF-36 version 2, and showed significantly lower HRQoL measured by QOLIBRI compared to those after uncomplicated mTBI. There was no difference between mTBI groups when looking at psychological outcomes, however, a slight improvement in PTSD symptoms and depression was observed for the entire sample from three to six months. Patients after complicated mTBI reported lower generic and disease specific HRQoL and worse functional outcome compared to individuals after uncomplicated mTBI at three and six months. Both groups showed a tendency to improve from three to six months after TBI. The complicated mTBI group included more patients with an impaired long-term outcome than the uncomplicated group. Nevertheless, patients, clinicians, researchers, and decisions-makers in health care should take account of the short and long-term impact on outcome for patients after both uncomplicated and complicated mTBI.
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Keywords:
Traumatic brain injury; outcome; generic and disease-specific health-related quality of life; complicated mild traumatic brain injury; functional outcome
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
- Supplementary File 1:
RAR-Document (RAR, 233 KB)
MDPI and ACS Style
Voormolen, D.C.; Zeldovich, M.; Haagsma, J.A.; Polinder, S.; Friedrich, S.; Maas, A.I.R.; Wilson, L.; Steyerberg, E.W.; Covic, A.; Andelic, N.; Plass, A.M.; Wu, Y.-J.; Asendorf, T.; von Steinbüechel, N.; Participants Investigators, C.-T. Outcomes after Complicated and Uncomplicated Mild Traumatic Brain Injury at Three-and Six-Months Post-Injury: Results from the CENTER-TBI Study. J. Clin. Med. 2020, 9, 1525.
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