Long-term outcome in patients with mild traumatic brain injury: a prospective observational study.
BACKGROUND
Mild traumatic brain injury (MTBI) is common; up to 37% of adult men have a history of MTBI. Complaints after MTBI are persistent headaches, memory impairment, depressive mood disorders, and disability. The reported short- and long-term outcomes of patients with MTBI have been inconsistent. We have now investigated long-term clinical and neurocognitive outcomes in patients with MTBI (at admission, and after 1 and 10 years).


METHODS
Patients of a previous study investigating MTBI short-term outcome were prospectively reassessed after ±10 year using the same standardized data entry form and validated questionnaire (Beltztest with Beltz Score [BeSc]) for evaluation of Quality of life (QoL) and neurocognitive outcome (higher scores indicate lower QoL).


RESULTS
Eighty-six of 176 patients (49%) could be reassessed (n = 75 lost to follow-up; n = 8 second brain trauma; n = 7 death), 10.4 ± 2 years after initial evaluation. Over time, overall BeSc was significantly increased (5.92 ± 10.3 [admission] vs. 10.7 ± 12.8 [1 year] vs. 20.86 ± 17.1 [10 year]; p < 0.0001); only 54 of 86 patients (62.8%) presented with a normal BeSc. Long-term complaints were fatigue, insomnia, and exhaustion. Ten of eighty-six patients (11.6%) had intracranial injury (ICI) and initial BeSc was almost twofold higher in patients with ICI than in patients without ICI (10.0 ± 8.4 vs. 5.3 ± 9.6; p = 0.007). This difference was not seen after 1 year or after 10 years (10.3 ± 11.6 vs. 10.3 ± 10.1 and 21.4 ± 17.3 vs. 16.1 ± 16.4, respectively). Eight of eighty-six patients (9.3%) lost their jobs because of persistent complaints after MTBI.


CONCLUSIONS
BeSc deteriorates over time; our data suggest a decline in general health and QoL in a substantial proportion of patients (37.2%) 10 years after MTBI. Patients without ICI appear to have a better long-term outcome with regard to subjective complaints and QoL.
Department of Emergency Medicine, University Hospital, Bern, Switzerland.
Matthias A
MA
Zumstein
Mario
M
Moser
Matthias
M
Mottini
Sebastian R
SR
Ott
Charlotte
C
Sadowski-Cron
Bogdan P
BP
Radanov
Heinz
H
Zimmermann
Aristomenis
A
Exadaktylos
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D013997:Time Factors; D015599:Trauma Severity Indices; D055815:Young Adult