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Abstract
Background and Objectives Traumatic brain injury (TBI) may be a chronic condition carrying risk of future sequelae; few prospective studies examine long-term postinjury outcomes. We examined the prevalence of functional, cognitive, and psychiatric change outcomes from 1 to 7 years postinjury.
Methods Transforming Research and Clinical Knowledge in TBI LONG (TRACK-TBI LONG) participants were prospectively enrolled within 24 hours of injury and followed up to 1 year postinjury; a subset participated in long-term follow-up from 2 to 7 years postinjury. Reliable change thresholds for the Brief Test of Adult Cognition by Telephone General Composite (cognition) and Brief Symptom Inventory (BSI)–18 (psychiatric) were derived from orthopedic trauma controls (OTCs). Multiple assessments were completed (postinjury baseline assessment and 2 or 3 visits 2–7 years postinjury) within a sample subset. Change was assessed for functional outcome (Glasgow Outcome Scale–Extended [GOSE]) and self-report/informant report of decline. Prevalence ratios for outcomes classified as stable, improved, and declined were reported individually and collectively. The Fisher exact test and log-binomial regression models examined factors associated with decline and improvement.
Results Of the sample (N = 1,264; mild TBI [mTBI], Glasgow Coma Scale [GCS] 13–15, n = 917; moderate-to-severe TBI [msTBI], GCS 3–12, n = 193; or OTC n = 154), “stable” was the most prevalent outcome. Functional outcome showed the highest rates of decline, regardless of TBI severity (mild = 29%; moderate/severe = 23%). When measures were collectively considered, rates of decline included mTBI (21%), msTBI (26%), and OTC (15%). Age and preinjury employment status were associated with functional decline (per 10 years; relative risk [RR] 1.16, 95% CI 1.07–1.25, p < 0.001; higher in retired/disabled/not working vs full-time/part-time; RR 1.81, 95% CI 1.33–2.45, respectively) in the mTBI group. Improvement in functional recovery 2–7 years postinjury was associated with higher BSI scores (per 5 points; RR 1.11, 95% CI 1.04–1.18, p = 0.002) and GOSE score of 5–7 (GOSE = 8 as reference; RR 2.64, 95% CI 1.75–3.97, p < 0.001). Higher BSI scores and identifying as Black (RR 2.28, 95% CI 1.59–3.25, p < 0.001) were associated with a greater likelihood of improved psychiatric symptoms in mTBI (RR 1.21, 95% CI 1.14–1.29, p < 0.001). A greater likelihood of cognitive improvement was observed among those with higher educational attainment in msTBI (per 4 years; RR 2.61, 95% CI 1.43–4.79, p = 0.002).
Discussion Function across domains at 1-year postinjury, a common recovery benchmark, undergoes change across the subsequent 6 years. Results support consideration of TBI as a chronic evolving condition and suggest continued monitoring, rehabilitation, and support is required to optimize long-term independence and quality of life.
Glossary
- BSI=
- Brief Symptom Inventory;
- BTACT=
- Brief Test of Adult Cognition by Telephone;
- GCS=
- Glasgow Coma Scale;
- GOSE=
- Glasgow Outcome Scale–Extended;
- GSI=
- Global Severity Index;
- mTBI=
- mild TBI;
- msTBI=
- moderate-to-severe TBI;
- OTC=
- orthopedic trauma control;
- RR=
- relative risk;
- TBI=
- traumatic brain injury;
- TBIMS=
- TBI-Model Systems;
- TRACK-TBI=
- Transforming Research and Clinical Knowledge in TBI
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Coinvestigators are listed in Appendix 2 at the end of the article.
Submitted and externally peer reviewed. The handling editor was Associate Editor Rebecca Burch, MD.
Editorial, page 287
- Received December 2, 2022.
- Accepted in final form April 21, 2023.
- © 2023 American Academy of Neurology
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