title: Prevalence of Incomplete Functional and Symptomatic Recovery among Patients with Head Injury but Brain Injury Debatable.
abstract: Head injury patients not meeting the American Congress of Rehabilitation Medicine (ACRM)'s criteria for mild traumatic brain injury (mTBI), referred to hereafter as HIBRID (Head Injury BRain Injury Debatable), are often excluded from studies. The prognostic importance of HIBRID is unclear. We investigated the differences in functional and symptomatic recovery at 1 month post-injury among TBI patients classified as: HIBRID, ACRM+ cranial computed tomography (CT)-, and cranial CT+; and trauma and healthy controls. Subjects were enrolled in an ongoing prospective cohort (Head Injury Serum Markers for Assessing Response to Trauma; HeadSMART). Outcomes measured at 1 month post-injury include: incomplete functional recovery (Glasgow Outcome Scale Extended <8); moderate/severe post-concussive symptoms (PCS), defined according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision definition; and moderate/severe depressive symptoms (Patient Health Questionnaire 9 ≥ 10). Between April 2014 and May 2016, 500 TBI and 100 control subjects were enrolled and 376 TBI and 78 control subjects completed outcome assessment. The HIBRID group, constituting 23.9% of study population, had a lower incidence of incomplete functional recovery (36.7% [33 of 90]) than ACRM+, CT- (60.7% [125 of 206]; p < 0.01) and CT+ (78.8% [63 of 80]; p < 0.01) groups. However, the incidence of delayed functional recovery within the HIBRID group was higher than in trauma (9.3% [5 of 54]; p < 0.01) and healthy controls (0% [0 of 24]; p < 0.01). Compared to trauma/healthy controls, the HIBRID group had a higher incidence of moderate/severe depressive symptoms and a similar incidence of moderate/severe PCS. Subjects in the HIBRID group are at high risk for adverse outcomes following head injury and warrant further investigation.
authors: 1 Department of Emergency Medicine, University of Michigan Medical School , Ann Arbor, Michigan.
authors: Frederick K
authors: FK
authors: Korley
authors: 2 Department of Neurology, University of Pennsylvania Perelman School of Medicine , Penn Presbyterian Medical Center, Philadelphia, Pennsylvania.
authors: Ramon
authors: R
authors: Diaz-Arrastia
authors: 3 Department of Emergency Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Hayley J
authors: HJ
authors: Falk
authors: 4 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Matthew E
authors: ME
authors: Peters
authors: 4 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Jeannie-Marie S
authors: JS
authors: Leoutsakos
authors: 4 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Durga
authors: D
authors: Roy
authors: 4 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Vani
authors: V
authors: Rao
authors: 5 Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Haris Iqbal
authors: HI
authors: Sair
authors: 3 Department of Emergency Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Uju
authors: U
authors: Ofoche
authors: 3 Department of Emergency Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Anna J
authors: AJ
authors: Hall
authors: 3 Department of Emergency Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Freshta
authors: F
authors: Akbari
authors: 6 Program for Neurological Diseases, ImmunArray, Inc. , Richmond, Virginia.
authors: Timothy E
authors: TE
authors: Van Meter
authors: 7 Department of Pediatrics, Johns Hopkins University School of Medicine, Bloomberg Children's Center , Baltimore, Maryland.
authors: Allen D
authors: AD
authors: Everett
authors: 8 Advanced Clinical Biosystems Research, Heart Institute, Department of Medicine, Cedar Sinai Medical Center , Los Angeles, California.
authors: Jennifer E
authors: JE
authors: Van Eyk
authors: 9 Department of Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors: Kathleen T
authors: KT
authors: Bechtold
mesh_terms: D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000150:complications / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D038223:Post-Concussion Syndrome / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence
keywords: head trauma; human studies; outcomes; prospective study; traumatic brain injury