Introduction: Of the 1.7 million people in the US who experience a traumatic brain injury (TBI) annually, 75% are considered mild (mTBI). Classifying outcomes and recovery patterns following mTBI constitutes the majority of research, with little focus on predictors of outcome. Although an association between psychiatric disorders and TBI has been established, the directionality and precise relationship is unclear. Therefore, we sought to examine the relationship and predictive ability of pre-injury, self-reported psychiatric problems on outcomes following mTBI.
Methods: Participants were identified from the prospective multicenter Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Included were 329 mTBI (GCS score of 13-15) patients evaluated at a Level 1 Emergency Department, including patients with negative CT scans discharged the same day. Outcomes measures included the Glasgow Outcome Scale-Extended (GOS-E) score, Brief Symptom Inventory 18 Item (BSI-18), Post-Traumatic Stress Disorder Checklist (PCL) and the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), recorded at 6 and 12-month follow-up points. Logistic regression modeling, controlling for age, gender, race and admission GCS score was performed. A self reported history of psychiatric problems, history of neurologic disease and previous TBI were used as predictors.
Results: Patients were predominately male (70%) with a GCS of 15 (77%). History of any psychiatric problem yielded an odds ratio of 2.47(95% CI 1.38-4.41) for worse outcome at 6 months and 2.64 (95% CI 1.3-5.32) for worse outcome at 12 months on the GOSE (GOSE<8). Reported history of anxiety and depression most strongly predicted overall worse outcomes. Neurologic problems also predicted worse outcomes on the GOSE (GOSE<8) with odds ratios of 3.44 (95% CI 1.67-7.1) at 6 months and 3.14 (95% CI 1.3-7.62) at 12 months. Previous TBI was not a significant predictor of outcome at 6 or 12 months.
Conclusions: Pre-existing psychiatric or neurologic problems are predictive of poorer outcomes and prolonged recovery following mTBI.
Patient Care: Obtaining a psychiatric and neurologic history from patients who sustain mTBI will help better identify those patients likely to have overall worse outcomes from their injury. These patients can then be targeted for closer follow-up and more appropriate, specific care.
Learning Objectives: By the conclusion of this session participants should be able to: 1) Describe the association between psychiatric problems and traumatic brain injury (TBI) 2) Discuss the effect of history of psychiatric and neurologic problems as they relate to outcome following TBI 3) Recognize the potential importance of obtaining a thorough psychiatric and neurologic history from patients who sustain mild TBI.