Longitudinal Recovery Following Repetitive Traumatic Brain Injury
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Published:2023-09-26
Issue:9
Volume:6
Page:e2335804
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ISSN:2574-3805
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Container-title:JAMA Network Open
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language:en
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Short-container-title:JAMA Netw Open
Author:
Etemad Leila L.12, Yue John K.12, Barber Jason3, Nelson Lindsay D.45, Bodien Yelena G.67, Satris Gabriela G.12, Belton Patrick J.12, Madhok Debbie Y.8, Huie J. Russell12, Hamidi Sabah12, Tracey Joye X.12, Coskun Bukre C.12, Wong Justin C.12, Yuh Esther L.29, Mukherjee Pratik29, Markowitz Amy J.12, Huang Michael C.12, Tarapore Phiroz E.12, Robertson Claudia S.10, Diaz-Arrastia Ramon11, Stein Murray B.12, Ferguson Adam R.1213, Puccio Ava M.14, Okonkwo David O.14, Giacino Joseph T.67, McCrea Michael A.45, Manley Geoffrey T.12, Temkin Nancy R.3, DiGiorgio Anthony M.1215, Duhaime Ann-Christine16, Elguindy Mahmoud M.16, Fabian Brian16, Gopinath Shankar16, Grandhi Ramesh16, Halabi Cathra16, Jain Sonia16, Jha Ruchira M.16, Korley Frederick K.16, Madden Christopher16, Merchant Randall16, Ngwenya Laura B.16, Schnyer David M.16, Sun Xiaoying16, Taylor Sabrina R.16, Valadka Alex B.16, van Essen Thomas A.16, Vassar Mary J.16, Zafonte Ross D.16,
Affiliation:
1. Department of Neurological Surgery, University of California, San Francisco 2. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California 3. Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle 4. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee 5. Department of Neurology, Medical College of Wisconsin, Milwaukee 6. Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston 7. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts 8. Department of Emergency Medicine, University of California, San Francisco 9. Department of Radiology and Biomedical Imaging, University of California, San Francisco 10. Department of Neurological Surgery, Baylor College of Medicine, Houston, Texas 11. Department of Neurology, University of Pennsylvania, Philadelphia 12. Department of Psychiatry, University of California, San Diego 13. San Francisco Veterans Affairs Healthcare System, San Francisco, California 14. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15. Institute of Health Policy Studies, University of California, San Francisco 16. for the TRACK-TBI Investigators
Abstract
ImportanceOne traumatic brain injury (TBI) increases the risk of subsequent TBIs. Research on longitudinal outcomes of civilian repetitive TBIs is limited.ObjectiveTo investigate associations between sustaining 1 or more TBIs (ie, postindex TBIs) after study enrollment (ie, index TBIs) and multidimensional outcomes at 1 year and 3 to 7 years.Design, Setting, and ParticipantsThis cohort study included participants presenting to emergency departments enrolled within 24 hours of TBI in the prospective, 18-center Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study (enrollment years, February 2014 to July 2020). Participants who completed outcome assessments at 1 year and 3 to 7 years were included. Data were analyzed from September 2022 to August 2023.ExposuresPostindex TBI(s).Main Outcomes and MeasuresDemographic and clinical factors, prior TBI (ie, preindex TBI), and functional (Glasgow Outcome Scale–Extended [GOSE]), postconcussive (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]), psychological distress (Brief Symptom Inventory-18 [BSI-18]), depressive (Patient Health Questionnaire-9 [PHQ-9]), posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5 [PCL-5]), and health-related quality-of-life (Quality of Life After Brain Injury–Overall Scale [QOLIBRI-OS]) outcomes were assessed. Adjusted mean differences (aMDs) and adjusted relative risks are reported with 95% CIs.ResultsOf 2417 TRACK-TBI participants, 1572 completed the outcomes assessment at 1 year (1049 [66.7%] male; mean [SD] age, 41.6 [17.5] years) and 1084 completed the outcomes assessment at 3 to 7 years (714 [65.9%] male; mean [SD] age, 40.6 [17.0] years). At 1 year, a total of 60 participants (4%) were Asian, 255 (16%) were Black, 1213 (77%) were White, 39 (2%) were another race, and 5 (0.3%) had unknown race. At 3 to 7 years, 39 (4%) were Asian, 149 (14%) were Black, 868 (80%) were White, 26 (2%) had another race, and 2 (0.2%) had unknown race. A total of 50 (3.2%) and 132 (12.2%) reported 1 or more postindex TBIs at 1 year and 3 to 7 years, respectively. Risk factors for postindex TBI were psychiatric history, preindex TBI, and extracranial injury severity. At 1 year, compared with those without postindex TBI, participants with postindex TBI had worse functional recovery (GOSE score of 8: adjusted relative risk, 0.57; 95% CI, 0.34-0.96) and health-related quality of life (QOLIBRI-OS: aMD, −15.9; 95% CI, −22.6 to −9.1), and greater postconcussive symptoms (RPQ: aMD, 8.1; 95% CI, 4.2-11.9), psychological distress symptoms (BSI-18: aMD, 5.3; 95% CI, 2.1-8.6), depression symptoms (PHQ-9: aMD, 3.0; 95% CI, 1.5-4.4), and PTSD symptoms (PCL-5: aMD, 7.8; 95% CI, 3.2-12.4). At 3 to 7 years, these associations remained statistically significant. Multiple (2 or more) postindex TBIs were associated with poorer outcomes across all domains.Conclusions and RelevanceIn this cohort study of patients with acute TBI, postindex TBI was associated with worse symptomatology across outcome domains at 1 year and 3 to 7 years postinjury, and there was a dose-dependent response with multiple postindex TBIs. These results underscore the critical need to provide TBI prevention, education, counseling, and follow-up care to at-risk patients.
Publisher
American Medical Association (AMA)
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