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Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study.
Front Neurol. 2019; 10:343.FN

Abstract

Introduction: Over 70% of traumatic brain injuries (TBI) are classified as mild (mTBI), which present heterogeneously. Associations between pre-injury comorbidities and outcomes are not well-understood, and understanding their status as risk factors may improve mTBI management and prognostication.

Methods:

mTBI subjects (GCS 13-15) from TRACK-TBI Pilot completing 3- and 6-month functional [Glasgow Outcome Scale-Extended (GOSE)] and post-concussive outcomes [Acute Concussion Evaluation (ACE) physical/cognitive/sleep/emotional subdomains] were extracted. Pre-injury comorbidities >10% incidence were included in regressions for functional disability (GOSE ≤ 6) and post-concussive symptoms by subdomain. Odds ratios (OR) and mean differences (B) were reported. Significance was assessed at p < 0.0083 (Bonferroni correction).

Results:

In 260 subjects sustaining blunt mTBI, mean age was 44.0-years and 70.4% were male. Baseline comorbidities >10% incidence included psychiatric-30.0%, cardiac (hypertension)-23.8%, cardiac (structural/valvular/ischemic)-20.4%, gastrointestinal-15.8%, pulmonary-15.0%, and headache/migraine-11.5%. At 3- and 6-months separately, 30.8% had GOSE ≤ 6. At 3-months, psychiatric (GOSE ≤ 6: OR = 2.75, 95% CI [1.44-5.27]; ACE-physical: B = 1.06 [0.38-1.73]; ACE-cognitive: B = 0.72 [0.26-1.17]; ACE-sleep: B = 0.46 [0.17-0.75]; ACE-emotional: B = 0.64 [0.25-1.03]), headache/migraine (GOSE ≤ 6: OR = 4.10 [1.67-10.07]; ACE-sleep: B = 0.57 [0.15-1.00]; ACE-emotional: B = 0.92 [0.35-1.49]), and gastrointestinal history (ACE-physical: B = 1.25 [0.41-2.10]) were multivariable predictors of worse outcomes. At 6-months, psychiatric (GOSE ≤ 6: OR = 2.57 [1.38-4.77]; ACE-physical: B = 1.38 [0.68-2.09]; ACE-cognitive: B = 0.74 [0.28-1.20]; ACE-sleep: B = 0.51 [0.20-0.83]; ACE-emotional: B = 0.93 [0.53-1.33]), and headache/migraine history (ACE-physical: B = 1.81 [0.79-2.84]) predicted worse outcomes.

Conclusions:

Pre-injury psychiatric and pre-injury headache/migraine symptoms are risk factors for worse functional and post-concussive outcomes at 3- and 6-months post-mTBI. mTBI patients presenting to acute care should be evaluated for psychiatric and headache/migraine history, with lower thresholds for providing TBI education/resources, surveillance, and follow-up/referrals. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01565551.

Authors+Show Affiliations

Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States. Department of Neurology, University of Utah, Salt Lake City, UT, United States.Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.Department of Psychology, University of Texas in Austin, Austin, TX, United States.Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.Department of Neurology, University of California, San Francisco, San Francisco, CA, United States. Department of Neurology, Veterans Affairs Medical Center, San Francisco, CA, United States.Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States. Department of Radiology, University of California, San Francisco, San Francisco, CA, United States.Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States. Department of Radiology, University of California, San Francisco, San Francisco, CA, United States.Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, United States.Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States. Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31024436

Citation

Yue, John K., et al. "Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: a TRACK-TBI Study." Frontiers in Neurology, vol. 10, 2019, p. 343.
Yue JK, Cnossen MC, Winkler EA, et al. Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study. Front Neurol. 2019;10:343.
Yue, J. K., Cnossen, M. C., Winkler, E. A., Deng, H., Phelps, R. R. L., Coss, N. A., Sharma, S., Robinson, C. K., Suen, C. G., Vassar, M. J., Schnyer, D. M., Puccio, A. M., Gardner, R. C., Yuh, E. L., Mukherjee, P., Valadka, A. B., Okonkwo, D. O., Lingsma, H. F., & Manley, G. T. (2019). Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study. Frontiers in Neurology, 10, 343. https://doi.org/10.3389/fneur.2019.00343
Yue JK, et al. Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: a TRACK-TBI Study. Front Neurol. 2019;10:343. PubMed PMID: 31024436.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pre-injury Comorbidities Are Associated With Functional Impairment and Post-concussive Symptoms at 3- and 6-Months After Mild Traumatic Brain Injury: A TRACK-TBI Study. AU - Yue,John K, AU - Cnossen,Maryse C, AU - Winkler,Ethan A, AU - Deng,Hansen, AU - Phelps,Ryan R L, AU - Coss,Nathan A, AU - Sharma,Sourabh, AU - Robinson,Caitlin K, AU - Suen,Catherine G, AU - Vassar,Mary J, AU - Schnyer,David M, AU - Puccio,Ava M, AU - Gardner,Raquel C, AU - Yuh,Esther L, AU - Mukherjee,Pratik, AU - Valadka,Alex B, AU - Okonkwo,David O, AU - Lingsma,Hester F, AU - Manley,Geoffrey T, AU - ,, Y1 - 2019/04/09/ PY - 2019/01/23/received PY - 2019/03/20/accepted PY - 2019/4/27/entrez PY - 2019/4/27/pubmed PY - 2019/4/27/medline KW - functional impairment KW - mild traumatic brain injury KW - post-concussive symptoms KW - pre-injury comorbidities KW - prognosis SP - 343 EP - 343 JF - Frontiers in neurology JO - Front Neurol VL - 10 N2 - Introduction: Over 70% of traumatic brain injuries (TBI) are classified as mild (mTBI), which present heterogeneously. Associations between pre-injury comorbidities and outcomes are not well-understood, and understanding their status as risk factors may improve mTBI management and prognostication. Methods: mTBI subjects (GCS 13-15) from TRACK-TBI Pilot completing 3- and 6-month functional [Glasgow Outcome Scale-Extended (GOSE)] and post-concussive outcomes [Acute Concussion Evaluation (ACE) physical/cognitive/sleep/emotional subdomains] were extracted. Pre-injury comorbidities >10% incidence were included in regressions for functional disability (GOSE ≤ 6) and post-concussive symptoms by subdomain. Odds ratios (OR) and mean differences (B) were reported. Significance was assessed at p < 0.0083 (Bonferroni correction). Results: In 260 subjects sustaining blunt mTBI, mean age was 44.0-years and 70.4% were male. Baseline comorbidities >10% incidence included psychiatric-30.0%, cardiac (hypertension)-23.8%, cardiac (structural/valvular/ischemic)-20.4%, gastrointestinal-15.8%, pulmonary-15.0%, and headache/migraine-11.5%. At 3- and 6-months separately, 30.8% had GOSE ≤ 6. At 3-months, psychiatric (GOSE ≤ 6: OR = 2.75, 95% CI [1.44-5.27]; ACE-physical: B = 1.06 [0.38-1.73]; ACE-cognitive: B = 0.72 [0.26-1.17]; ACE-sleep: B = 0.46 [0.17-0.75]; ACE-emotional: B = 0.64 [0.25-1.03]), headache/migraine (GOSE ≤ 6: OR = 4.10 [1.67-10.07]; ACE-sleep: B = 0.57 [0.15-1.00]; ACE-emotional: B = 0.92 [0.35-1.49]), and gastrointestinal history (ACE-physical: B = 1.25 [0.41-2.10]) were multivariable predictors of worse outcomes. At 6-months, psychiatric (GOSE ≤ 6: OR = 2.57 [1.38-4.77]; ACE-physical: B = 1.38 [0.68-2.09]; ACE-cognitive: B = 0.74 [0.28-1.20]; ACE-sleep: B = 0.51 [0.20-0.83]; ACE-emotional: B = 0.93 [0.53-1.33]), and headache/migraine history (ACE-physical: B = 1.81 [0.79-2.84]) predicted worse outcomes. Conclusions: Pre-injury psychiatric and pre-injury headache/migraine symptoms are risk factors for worse functional and post-concussive outcomes at 3- and 6-months post-mTBI. mTBI patients presenting to acute care should be evaluated for psychiatric and headache/migraine history, with lower thresholds for providing TBI education/resources, surveillance, and follow-up/referrals. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01565551. SN - 1664-2295 UR - https://www.unboundmedicine.com/medline/citation/31024436/Pre_injury_Comorbidities_Are_Associated_With_Functional_Impairment_and_Post_concussive_Symptoms_at_3__and_6_Months_After_Mild_Traumatic_Brain_Injury:_A_TRACK_TBI_Study_ L2 - https://doi.org/10.3389/fneur.2019.00343 DB - PRIME DP - Unbound Medicine ER -
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