title: Lost productive work time after mild to moderate traumatic brain injury with and without hospitalization.
abstract: OBJECTIVE
  Lost productivity after mild traumatic brain injury (TBI) is a large component of the economic costs of brain trauma in the United States. This is the first prospective study of employment after mild TBI to include patients not admitted to a hospital.
  
  
  METHODS
  Concurrent inception cohorts of 210 working-age adults with mild to moderate TBI and 122 patients who sustained general trauma not involving the brain were recruited at a trauma center and followed up to 6 months later. Outcomes were time from injury until first day worked and problems reported after resuming work.
  
  
  RESULTS
  Most patients who worked after their injury remained employed 6 months later in a similar capacity as before the injury. No consistent differences were demonstrated between employment outcomes of patients with mild TBI and those with general trauma. The majority of nonhospitalized patients with mild TBI did not work for at least 1 month and did not begin working until 1 to 3 months after injury. Most patients with moderate TBI remained unemployed at 6 months postinjury. Patients with lower preinjury occupational status tended to have longer work absences.
  
  
  CONCLUSIONS
  Lost productive work time after nonhospitalized TBI may cause significant economic costs because these injuries are frequent. Contrary to the theory that brain injury is more disabling to patients in cognitively demanding occupations, patients with higher job status tended to begin work earlier. A technique is needed to screen patients with mild TBI for risk of employment problems. Rehabilitation after moderate TBI may help to minimize lost productivity.
authors.affiliation: Department of Physical Medicine, Baylor College of Medicine and University of Texas at Houston Medical School, Houston, Texas, USA. corwin.boake@uth.tmc.edu
authors.forename: Corwin
authors.initials: C
authors.lastname: Boake
authors.forename: Stephen R
authors.initials: SR
authors.lastname: McCauley
authors.forename: Claudia
authors.initials: C
authors.lastname: Pedroza
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Levin
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Brown
authors.forename: Susan I
authors.initials: SI
authors.lastname: Brundage
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D004522:Educational Status; D004526:Efficiency / Q000502:physiology; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D009790:Occupations; D016016:Proportional Hazards Models; D013997:Time Factors