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Cited by 451Traumatic Brain Injury ResearchTraumatic Brain Injury and Neurovascular DisturbancesTrauma and Emergency Care Studies

Recovery After Mild Traumatic Brain Injury in Patients Presenting to US Level I Trauma Centers: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Study

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Nelson, Lindsay D., Temkin, Nancy R., Dikmen, Sureyya, Barber, Jason, Giacino, Joseph T., Yuh, Esther, Levin, Harvey S., McCrea, Michael A. +56 more·2019·JAMA Neurology
DOI 10.1001/jamaneurol.2019.1313PMC PMC6547159
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Abstract

IMPORTANCE: Most traumatic brain injuries (TBIs) are classified as mild (mTBI) based on admission Glasgow Coma Scale (GCS) scores of 13 to 15. The prevalence of persistent functional limitations for these patients is unclear. OBJECTIVES: To characterize the natural history of recovery of daily function following mTBI vs peripheral orthopedic traumatic injury in the first 12 months postinjury using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, and, using clinical computed tomographic (CT) scans, examine whether the presence (CT+) or absence (CT-) of acute intracranial findings in the mTBI group was associated with outcomes. DESIGN, SETTING, AND PARTICIPANTS: TRACK-TBI, a cohort study of patients with mTBI presenting to US level I trauma centers, enrolled patients from February 26, 2014, to August 8, 2018, and followed up for 12 months. A total of 1453 patients at 11 level I trauma center emergency departments or inpatient units met inclusion criteria (ie, mTBI [n = 1154] or peripheral orthopedic traumatic injury [n = 299]) and were enrolled within 24 hours of injury; mTBI participants had admission GCS scores of 13 to 15 and clinical head CT scans. Patients with peripheral orthopedic trauma injury served as the control (OTC) group. EXPOSURES: Participants with mTBI or OTC. MAIN OUTCOMES AND MEASURES: The Glasgow Outcome Scale Extended (GOSE) scale score, reflecting injury-related functional limitations across broad life domains at 2 weeks and 3, 6, and 12 months postinjury was the primary outcome. The possible score range of the GOSE score is 1 (dead) to 8 (upper good recovery), with a score less than 8 indicating some degree of functional impairment. RESULTS: Of the 1453 participants, 953 (65.6%) were men; mean (SD) age was 40.9 (17.1) years in the mTBI group and 40.9 (15.4) years in the OTC group. Most participants (mTBI, 87%; OTC, 93%) reported functional limitations (GOSE <8) at 2 weeks postinjury. At 12 months, the percentage of mTBI participants reporting functional limitations was 53% (95% CI, 49%-56%) vs 38% (95% CI, 30%-45%) for OTCs. A higher percentage of CT+ patients reported impairment (61%) compared with the mTBI CT- group (49%; relative risk [RR], 1.24; 95% CI, 1.08-1.43) and a higher percentage in the mTBI CT-group compared with the OTC group (RR, 1.28; 95% CI, 1.02-1.60). CONCLUSIONS AND RELEVANCE: Most patients with mTBI presenting to US level I trauma centers report persistent, injury-related life difficulties at 1 year postinjury, suggesting the need for more systematic follow-up of patients with mTBI to provide treatments and reduce the risk of chronic problems after mTBI.

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  • Psychological factors, alongside demographic variables and clinical indicators of brain injury severity, have consistently emerged as robust predictors of PPCS.

    “Psychological factors, when considered alongside demographic variables and clinical indicators of brain injury severity, have consistently emerged as robust predictors of PPCS.”

    From Acceptance and commitment therapy for mild traumatic brain injury (ACTion-mTBI): a quasiexperimental feasibility study (2025) · cites this paper as [13]

    The Discussion (page unavailable in our copy) says emotional distress, life stressors, and premorbid risk factors may affect recovery after traumatic injury. It does not establish that psychological factors consistently and robustly predict persistent post-concussion symptoms alongside demographic variables and injury-severity indicators; the Statistical Analysis describes group comparisons rather than that predictor analysis. (LLM, conf=0.83)

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Research works printed but not linked: 3

  1. Derogatis LR. Brief Symptom Inventory 18 (BSI-18): Administration, Scoring, and Procedures Manual. Bloomington, MN: Pearson; 2001.
  2. Rey A. L'examen psychologique dans les cas d'encephalopathie traumatique. Arch Psychol. 1941; 28:215-285.
  3. Wechsler D. Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Bloomington, MN: Pearson; 2008.

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Authors
Nelson, L. D., Temkin, N. R., Dikmen, S., Barber, J., Giacino, J. T., Yuh, E., Levin, H. S., McCrea, M. A., Stein, M. B., Mukherjee, P., Okonkwo, D. O., Robertson, C. S., Diaz-Arrastia, R., Manley, G. T., and the TRACK-TBI Investigators, Adeoye, O., Badjatia, N., Boase, K., Bodien, Y., Bullock, M. R., Chesnut, R., Corrigan, J. D., Crawford, K., Duhaime, A.-C., Ellenbogen, R., Feeser, V. R., Ferguson, A., Foreman, B., Gardner, R., Gaudette, E., Gonzalez, L., Gopinath, S., Gullapalli, R., Hemphill, J. C., Hotz, G., Jain, S., Korley, F., Kramer, J., Kreitzer, N., Lindsell, C., Machamer, J., Madden, C., Martin, A., McAllister, T., Merchant, R., Noel, F., Palacios, E., Perl, D., Puccio, A., Rabinowitz, M., Rosand, J., Sander, A., Satris, G., Schnyer, D., Seabury, S., Sherer, M., Taylor, S., Toga, A., Valadka, A., Vassar, M. J., Vespa, P., Wang, K., Yue, J. K., & Zafonte, R.
Affiliations
  • Medical College of Wisconsin (US)
  • University of Washington (US)
  • Harvard University (US)
  • University of California, San Francisco (US)
  • Baylor College of Medicine (US)
  • University of California San Diego (US)
  • University of Pittsburgh (US)
  • University of Pennsylvania (US)
  • University of Cincinnati (US)
  • University of Miami (US)
  • University of Southern California (US)
  • Virginia Commonwealth University (US)
  • University of Southern California, Los Angeles
  • TIRR Memorial Hermann, Houston, Texas
  • University of Michigan (US)
  • Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
  • Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
  • Uniformed Services University of the Health Sciences (US)
  • University of Pittsburgh Medical Center (US)
  • Massachusetts General Hospital (US)
  • San Francisco General Hospital (US)
  • Memorial Hermann Institute for Rehabilitation and Research Foundation (US)
  • University of California, Los Angeles (US)
Corresponding author
Nelson, Lindsay D.
ORCID
Venue
JAMA Neurology
Publisher
American Medical Association (AMA)
Published
2019-09-01
Volume
76
Issue
9
Pages
1049
ISSN
2168-6149 (ISSN-L)
DOI
10.1001/jamaneurol.2019.1313
PMC
PMC6547159
OpenAlex
W2948832771
Cited by
451
References
71
Citations by year
2026: 58 · 2025: 70 · 2024: 85 · 2023: 74 · 2022: 61 · 2021: 59 · 2020: 33 · 2019: 9
FWCI
30.83
Type
journal article
Language
en
Open access
Locations
  • JAMA Neurology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion)
Funders
  • University of Southern California
  • Vanderbilt University
  • University of Miami
  • University of Pennsylvania
  • Ohio State University
  • University of Washington
  • University of Texas Southwestern Medical Center
  • University of Pittsburgh
  • University of Cincinnati
  • Virginia Commonwealth University
  • Vanderbilt University Medical Center
  • University of California, Los Angeles
  • Uniformed Services University of the Health Sciences
  • Medical Center, University of Pittsburgh
  • University of California, San Francisco
  • Medical School, University of Michigan
  • School of Medicine, Indiana University
  • National Institute of Neurological Disorders and Stroke (T32NS047996)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords
mild traumatic brain injury, functional recovery, Glasgow Outcome Scale-Extended, computed tomography, level I trauma center, long-term outcomes

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